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Home My WebLink About04-26-06 LUIVIIVIUI\JVVtALI H Ur t-'tl\JI\J~YLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT =lECEIVED FROM: SEIFERT ANNE M 75 MANADA CREEK CIR CARLISLE, PA 17013 n__n_ fold ESTATE INFORMATION: SSN: 169-14-5032 FILE NUMBER: 2106-0364 DECEDENT NAME: BOJARCHECK JOHN F DATE OF PAYMENT: 04/26/2006 POSTMARK DATE: 04/25/2006 COUNTY: CUMBERLAND DATE OF DEATH: 01/26/2006 NO. CD 006609 ACN ASSESSMENT CONTROL NUMBER AMOUNT 06116981 I $76.82 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK#189 SEAL INITIALS: MG RECEIVED BY: REGISTER OF WILLS $76.82 GLENDA FARNER STRASBAUGH REGISTER OF WillS Cl-i'iHONWEAL "H OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 ACN 06116981 DATE 04-11-2006 "}l\~( ~ Lj-.>-J . 25 ?i'l \: 0'/ EST. OF JOHN F BOJARCHECK S.S. NO. 169-14-5032 DATE OF DEATH 01-26-2006 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS [X] CHECKING o TRUST o CERTIF . REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ** ANNE M SEIFERT 75 MAN ADA CREEK CIR CARLISLE PA 17013 PNC 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 8ddress. 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. 5004496333 Date 02-01-2005 Established x 2,286.12 100.00 2,286.12 .12 274.33 TAXPAYER RESPONSE To insure proper credit to your account I two (2) copies of this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of WillS, 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 death, 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 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 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. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ~ 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. PART If you indicate a differen~ tax rate, please state your ~ relationship to decedent: cta...U:)", t e.r- TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1. ~ -01 <;(005 2. Account Balance 2 1, /... 'is b I 'J-. 3. Percent Taxable 3 X I () n . 00 4, Amount Subject to Tax 4 a) iJ (;" 1 ;).... 5. Debts and Deductions 5 ~ Jq. J~ 6. Amount Taxable 67 D (. . (j ~ 7. Tax Rate 7 X .OY,:) 8, Tax Due 8 lln. <6).. DEBTS AND DEDUCTIONS CLAIMED PART ~ DATE PAID PAYEE teo/ I TOTAL (Enter on Line 5 of Tax Computation) DESCRIPTION AMOUNT PAID CG=lli1(~oL {~VYr I $ perjury, I declare that the my knowledge and belief. - ') J,.~ facts I have reported above are true, correct and HOME (( Il ) ,~4 C . 031'-1- WORK ( ) ~ IA- TELEPHONE NUMBER DATE Date paid Payee Description Amount paid 2/09/06 ROBC Bal of care (rent) $ 37.83 2/09/06 Alert Pharmacy Meds $150.95 02/09/06 Moffitt Heart & Doctor care $ 25.11 Vascular Group 02/09/06 Kreamer Funeral Funeral expenses $255.71 Home 03/11/06 Urology Of Cen Medical expense $ 24.78 Pa 03/14/06 Pinnacle Health Emergency Room $ 38.45 Emergency 03/14/06 Mobile X-Ray Medical Expense $ 14.35 ImaQinQ 03/14/06 Hospital Phone Hospital Expense $ 32.00 Telcom Service Total $579.18 '7'- ,- ~.) ~~ ,- c:~ ~ r- 6' ~ o r- r- ~~, c \~ !..t. t ....1 C) f..t. (sJ .... l...l 1:"1 I.L\ ,..) ~ ""'~...I ';p C~ <r <:--- C ~.; ~.c, ~...;;;.. c';: ;r C. v'J ~ I -..J C) ~ (- 'i" (' t ....." C" $.:. (,~ "'-fl ,.... (, .. I" [.,) ~ ;'!>. '"",,, ~ I ::> > "'" v ~ ?..f. iJ ::0 1--1 G"l tN '[- r- .,., r~ G) 1',; :~ :~ '-' (h 1l "f'j .J ?"~ ,p- r>,J i-l- ';,J ;...J.