HomeMy WebLinkAbout04-18-06
COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG I PA 17128-0601
"*
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 OiP 0812.
ACN 05148381
DATE 10-19-2005
REV-151i5 EX AFP (09-00)
" '\
. .i.-.......
EST. OF HELEN T ESTOK
S.S. NO. 188-01-6605
DATE OF DEATH 07-29-2005
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
[X] CHECKING
D TRUST
D CERTIF.
MICHAEL C ESTOK
4440 MOTTER LN
CAMP HILL PA 17011
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLEJ PA 17013
SOVEREIGN BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedentl you were a joint owner/beneficiary of
this account. If you feel this information is incorrectl please obtain written correction from the financial institutionl attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. Questions may ba answared by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 2331047642 Date 02-16-1999
Established
PART
[!]
A.
[ CHECK ]
ONE
BLOCK B.
ONLY
c.
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
To insure proper credit to your accountl two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent...
x
NOTE: If tax payments are made within three
(3) months of the decedent's date of deathl
you may deduct a 57. discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
Tax
x
.;I~m~NIIIil~[~1~~
....................-.-.-........................
-...................................................
.......................................................................
...... .... ......
[] The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interestl or you may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
[] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
~ The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
If you indicate a different tax rat~~ please state your
relationship to decedent: r () !L
PART
~
TAX
LINE
RETURN - COMPUTATION
1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
S. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF TAX
1
2
3 X
4
5
6
7 X
8
ON JOINT/TRUST ACCOUNTS
~/t(;('l1
qq~J.r?
LO. DO
"'1~1 .,-q
'17 rt;: 3 ~
o
.Ol.lr
o
DEBTS AND DEDUCTIONS CLAIMED
PART
@]
DATE PAID
.,
PAYEE
TOTAL (Enter on Line 5 of Tax Computation)
$
Under penalties of perjurYJ I declare that the facts I have reported above are trueJ correct and
complete to the best of m~ knowledge and belief. HOME (., (7 ) ) ?:;o . f-r<? ()
WORK ( )
TELEPHONE NUMBER
If ff'({06
DAT
TA
Thomas R. Drew, Jr.
:Drew)4.emorilll eOmpllHII
16 INMAN AVENUE
COLONIA, NEW JERSEY 07067
Tel. (732) 388-4396
Fax (732) 382-9370
February 6, 2006
The lettering has been completed on the
ESTOK monument. Enclosed is the deed to the plot.
We thank you for your valued business!
.::,-)
(~J
~
"
\ I:'
Parrott Funeral Home
8355 Sanoia Road
Fairburn. GA 30213
PHONE: (770)964.4800
No. 05-204
DECEASED Helen Theresa Estok
DATE OF DEATH July 29, 2005
PLACE OF DEATH Decedent's Residence Fairburn, GA
DATE OF STATEMENT July 29, 2005
A. CHARGE FOR SERVICES SELECTED
1. Professional Services:
Basic Services of Funeral Director & StafL _ _
Embalming _ _ _ _ _ _ _ _ _ _ _' _ _
Other preparation of body_ _ _ _ _ _ _ _ _
o
575.00
200.00
o
2. Facilities, Equipment & Staff:
Use of Facilities & Staff for ViewlngNisitation_
Use of Facilities & Staff for Funeral Ceremony_
Use of Facilities & Staff for Memorial Service_
Use of Equipment & Staff for Graveside Service _ _
Use of Equipment & Staff for Church Service _ _ _
Extra Night's Visitation _ _ _ _ _ _ _ _ _ _
3. Transportation
Transfer of Remains to Funeral Home _ _ _ _ _
Hearse_ _ _ _ _ _ _ _ _ _ _
Limousine_ _ _ _ _ _ _ _ _ _
Sedan_ _ _ _ _ _ _ _ _ _ _
Service / Utility Vehicle_ _ _ _ _ _ _
225.00
o
o
o
150 00
4. Other
TOTAL OF SERVICES SELECTED
B. CHARGE FOR MERCHANDISE SELECTED
Casket (or other receptacle) _ _ _ _ _ _ _
Name/No. EMERALDTONE .. 20 GAUGE
Material
Color GREEN
Outer Burial Container _ _ _ _ _
Name/No. WILBERT MONARCH
Material
Acknowledgement Cards _ _ _ _ _ _ _ _ _ _ _ _ _ _
Register Book. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Memory Folders/Prayer Cards. _ _' _ _ _ _ _ _ _ _ __
Clothing _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
.Panel_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ .
Cremation Urn _ _ _ _ _ _ _ _ _ _ _. _ _ _ _ _ _
~~~------------------_.
TOTAL OF MERCHANDISE SELECTED
C. SPECIAL CHARGES
@$
35.00 each
Clerav
OraanlstlPlanist
Soloist
Paid Newsoaoer Notice
Cemetery .. OoeninQ & Closina
Motor Escort
Flowers
Air Transoortation
TOTAL CASH ADVANCES $
$
35.00
o
o
o
o
o
o
o
o
350.00
o
o
385.00
We charge you for our services in obtalning:(specify cash advances Items).
775.00
o
o
o
o
o
o
SUMMARY
Total Funeral Home Charges_ _ _ _ _ _ _ $
Local Sales Tax (if applicable) _ _ _ _ _ _ $
State Sales Tax (if applicable) _ _ _ _ _ _ $
Total Cash Advances _ _ _ _ _ _ _ _ _ $
GRAND TOTAL $
o Less Credits and Prepayments
375.00
$
$
Total Credits_ _ _ _ _ '- _ _ _ $
BALANCE DUE ~ I $
Billing ToJane Estok
390 Greenvlew Circle
o
o
o
- $
Fairburn, GA 30213-
DISCLOSURES
1,150.00
Reason for embalming Family viewing/visitation
1.595.00
If any law, cemetery or crematory requirements have required the
purchase of any items listed, the law or reqUirement is explained below.
3.940.00
o
195.30
385.00
4,520.30
ACKNOWLEDGEMENT AND AGREEMENT
I hereby acknowledge that I have the legal right to arrange the final
services for the deceased, and I authorize this funeral establishment
to perform services. furnish goods, and incur outside charges
specified on this Statement. I acknowledge that I have received the
General Price List and the Casket Price List and the Outer Burial
Container Price List.
995.00
$
o
o
o
o
75.00
o
125.00
o
2,790.00
Terms of Payment:
Full payment is due no later than September 12. 2005
If any payment Is not paid when due,an unanticipated LATE CHARGE
of % Der month (ANNUAL PERCENTAGE RATE o/.2L-
on the unpaid balance will be due. I agree to pay the Balance Due
listed on this Statement, plus any Late Charge. In the event I default i
__...___"._ a.a...:_ &....._~I _.......,.......u......................... I ""',...,ft..ft. +^ """"'..., ..a"'!l~^r\.t!!Ihla
'"C'{"';'?-ct""2-'C"'T'-7~C''';T?~<r;>~~'-----'---~-~~~;; ;;;;~ ,",- C"=~~=c"~~-"'~"0')~0JfJ7)0;C<?<"""""-
/
. } vtlA~":st:~.'^D.!! .-'.
'. .'.. .' .... "~S' '''I'IIW
'.1....1.3 '6' 2'3(1ltttl?nltr (lJ~ju.'.,.'....', tttrt~~"
SG. .... '. . ',' . c, ~. --"." . .;...,.(;) j"';, .'
'. . .. . J\tt~~intt!it Qf Ntlllark
lU
'" 1.;L{.
i;~....
AddreSs
.q~met~ry ('\ \~ ,-
GRAVE NO.
4.: ;
Dote
8~OCI<'
.~e c,.rtfflcate to be r~i"'red in ~. na,..e of:
~'.'" . ....
..~Clme
.ab~ve name Clnd Its correCtness u'nd
cate has ....n issued'.
.1
~i~nQt'~re
(NOT T9~~ SlG~'~'.FU~~.~IRECTOR)
. - '" . " - - . .. -:.-'~~ ..
. . - . .' - .," '. .-' ':.' ',. . ,'. : -' -.:_~~";,# "-.
RETURN, Up;p'~lc PORrlO.NTa: O'fAl" ClmFICATE
. .'. . '" :..,0 -
f.teceived From
f!~~1~~
CAsH ,CHECK M.O,
ODD"
'Acldtess .
-. ~.:.,_<t
", .~-:.;~
Interment of
pk,."~
BLO:C;K . r1 /)
SEC. TIER'"
GRAVE No':!33B
New GraVe
Permanent, Annual Care.
D.~ficote Deeds
Re~vaI5'
New Plo,
Opening
t.rif
V~~Renf
Fo'undations
Received For
~.. .
By
Dote
.1'_ 'J
0' ~......
-'-
-: ()5
. . - ~ .
-. ...
Allor.,. accepted sublectto the rUles
and regulations 01 the ~metery.
SG 113623
I
MJAMJ SYSJiMS(973) n3-8800 189176-BR
FORM A
-L-
-='k~'. .... ....~~ 2219
...../i"~~.--~{bf .
"t~~~:::;:~D4
StjBovereignBaIlk .... . . .,.... ..
-:~'~~m~:l~~- nHO~~~' .
. 2331035504 # 2219 08/04/05 $1;525.00
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 0 (p () 3/2-
ACN 05149229
DATE 10-26-2005
REV-1543 EX AFP (09-00)
EST. OF HELEN T ESTOK
S.S. NO. 188-01-6605
DATE OF DEATH 07-29-2005
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
[X] CHECKING
D TRUST
D CERTIF .
t- '~
J \ ~-?
MICHAEL C ESTOK
4440 MOTTES IN
CAMP HIll PA 17011
REMIT PAYMENT AND FORMS TO:
REGISTER OF WIllS
CUMBERLAND CO COURT HOUSE
CARlISlE~ PA 17013
SOVEREIGN BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, yoU were a joint owner/beneficiary of
this account. If yOU feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of PennsYlvania. Questions may be answered by cf'llJing (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 2331035504 Date 06-22-1998
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
3~705.39
16.667
617.58
.15
92.64 ·
TAXPAYER RESPONSE
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
x
NOTE: If tax payments are made within three
(3) months of the decedent's date of death,
you may deduct a 5Z discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
Tax
A. D The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or YOU may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
[CHECK ]
ONE
BLOCK
ONLY
B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
C. ~The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
If you indicate a different ta~ r,~~~ please state your
relationship to decedent: ...\ ~-IH
PART
~
TAX
LINE
RETURN - COMPUTATION
I. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF
I
2
3
4
5
6
7
8
x
TAX ON JOINT/TRUST ACCOUNTS
~/~~~ f
(~~'197
, I ) . ),f
J ro> ,.00
::;
D
DEBTS AND DEDUCTIONS CLAIMED
x
PART
~
DATE PAID
o
PAYEE
DESCRIPTION
AMOUNT PAID
.f:
TOTAL (Enter on Line 5 of Tax Computation)
$ /
Under penalties of perjury~ I declare that the facts I have reported above are truel correct and
complete to the best of my knowledge and belief. HOME (1/)) ') 30 . 't r? d
fJrJA~C ~ WORK ( )
TAXPA~R SIGNATURE . TELEPHONE NUMBER
if! fir tl6
DATE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG I PA 17128-0601
*'
INFORMATION NOTICE
AND
TA_XPAYER RESPONSE
FILE NO. 21 D& 63/.2
ACN 05149230
DATE 10-26-2005
REY-1543 EX AFP (09-00)
: EST. OF HELEN T ESTOK
S.S. NO. 188-01-6605
DATE OF DEATH 07-29-2005
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
[i] CHECKING
D TRUST
D CERTIF .
JANE M ESTOK
390 GREENVIEW CIR
FAIRBURN GA 30213
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
SOVEREIGN BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedentl you were a joint owner/beneficiary of
this account. If you feel this information is incorrectl please obtain written correction from the financial institutionl attach a COpy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 2331035504 Date 06-22-1998
Established
x
3,705.39
16.667
617.58
.15
92.64
TAXPAYER RESPONSE
To insure proper credit to your accountl two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Willsl Agent...
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
NOTE: If tax payments are made within three
(3) months of the decedent"s date of deathl
you may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
Tax
PART
[!]
A.
[ CHECK ]
ONE
BLOCK B.
ONLY
c.
[] The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interestl or you may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
[] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent"s representative.
~The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
LINE
1. Date Establ~shBd
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8.
x
() t/ r
o
DEBTS AND DEDUCTIONS CLAIMED
PART
~
TAX RETURN - COMPUTATION OF TAX
If you indicate a different tax r~, rlease state your
relationship to decedent: /) A {~J t:
Tax DUB
1
2
3
4
5
6
7
8
x
ON JOINT/TRUST ACCOUNTS
(~. ~>I q 1
':l 71JC:. :) 'i
I to. (g" 'I
GII.~
C. r r-. 00
PART
~
DATE PAID
7/J'~{ DC
t~Y/J
PAYEE DESCRIPTION
FII AI G <t.l-: .t E RtI I CE I HI ~ I:-f 4~ r IE If 11 ( t-€:f'
TOTAL (Enter on Line 5 of Tax Computation)
AMOUNT PAID
I cy:~
$ " .0;)
perjury, I declare that the facts I have reported above are true, correct and
knowledge and belief. HOME (/({ ) 730 - I{rC(O
WORK () ~~1/i"
TELEPHONE NUMBER
TAX