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Home My WebLink About04-26-06 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT LINE HARRY E 100 FLlNTSTONE DRIVE NEWVILLE, PA 17241 n__n__ fold ESTATE INFORMATION: SSN: 204-03-5222 FILE NUMBER: 2106-0014 DECEDENT NAME: LINE FLORENCE E DATE OF PAYMENT: 04/26/2006 POSTMARK DATE: 04/26/2006 COUNTY: CUMBERLAND DATE OF DEATH: 12/21/2005 NO. CD 006612 ACN ASSESSMENT CONTROL NUMBER AMOUNT 06118884 I $15.41 06118889 I $8.52 I I I I I I I TOTAL AMOUNT PAID: $23.93 REMARKS: LINE HARRY E CHECK# 1291 SEAL INITIALS: CM RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 '* INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 06-0014 ACN 06118889 DATE 04-24-2006 REV-1S43 EX AFP 109-DD) EST. OF FLORENCE ELINE 5.5. NO. 204-03-5222 DATE OF DEATH 12-21-2005 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST 00 CERTIF. HARRY ELINE 100 FLINSTONE DR NEWVILLE PA 17241 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has providlld the Departllent 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 fro. 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 PllnnsYlvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 75049-40 Data 03-12-1990 Established Account Balanca Parcent Taxable Amount Subject to Tax Rate Potential Tax Due x 5,682.07 3.333 189.38 .045 8.52 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice must accompany your payment to thll Register of Wills. Make chllck payable to: "Register of Wills, Agent". x NOTE: If tax paYllents are made within three (3) months of the decedent's date of death, you may dllduct a SY. discount of the tax due. Any inheritanclI tax due will becolle delinqullnt nine (9) months after the date of death. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. c=J The above information and tax due is correct. ~ ~ 1. You may choose to remit paYllent to the Register of Wills with two copies ot~h~ notice~. obtail'l..;I::J a discount or av,:,i~ interest, or y,:,u lIay ~heck box "A" and return this noti!l'li! ~ the Regwer ot-:." ~_Cj Wills and an offICIal assesSlllent WIll be Issued by the PA DepartJIllnt of RevemHl"j _ -'0 .... "' (') -: ( ) '-0 .....'; -;::J [] The above asset has been or will be reported and tax paid with the Pennsylvania i~~~nce ~ ret~n; C:J to be fil9d by the decedent's representative. ' ... G', >,) ~=:j [] The above information is incorrect and/or debts and deductions were paid by you. You lIust complete PART 0 and/or PART ~ below. " PART [!J DATE PAID DEBTS AND DEDUCTIONS CLAIMED If you indicate a different tax rata, please state your relationship to decedent: PART ~ TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME ( ) WORK ( ) TELEPHONE NUMBER DATE TAXPAYER SIGNATURE COMMONWEALTH OF PENNSVLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 06-0014 ACN 06118884 DATE 04-24-2006 REV-15~5 EX AFP (09-00) EST. OF FLORENCE ELINE S.S. NO. 204-03-5222 DATE OF DEATH 12-21-2005 COUNTY CUMBERLAND TYPE OF ACCOUNT [i] SAVINGS o CHECKIN( o TRUST o CERTIF. HARRY ELINE 100 FLINSTONE DR NEWVILLE PA 17241 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE3 PA 17013 MEMBERS 1ST FCU has provided the Departllent with the inforllation 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 ioint owner/beneficiary of this account. If you feel this inforllation is incorrect, please obtain written correction frail the financial institution, attach a copy to this forll and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the COllllonweelth of Pennsylvania. Questions.ay be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 75049-00 Date 05-26-1961 Established x 103272.31 3.333 342.38 .045 15.41 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice IIUSt aCCOllpany your paYllent to the Register of Wills. Make check payable to: "Register of Wills, Agent". Account Balance Percent Taxable A.ount Subject to Tax Rate Potential Tax Due x NOTE: If tax pay.ents are lIade within three (3) lIonths of the decedent's date of death, you .ay deduct a Sie discount of the talC due. Any inheritance tax due will beCOlle delinquent nine (9) lIonths after the date of death. Tax PART L!1 A. [ CHECK ] ONE BLOCK B. ONLY c. O The above inforllation and tax due is correct. r"~O ~'" _ ,:;"::J 1. You lIay choose to re.it paYllent to the Register of Wills with two copies of-tr~ notice ~obtaill_d (.l..l a discount or avoid interest, or you .ay check box "A" and return this notice'. ~ ~e Reg~r of,,:j -:":) Wills and an official assesSllent will be issued by the PA Departlllent of RevenUji":: ;<2 ::7.) ,; 5j ''7 ,T1 N . . " ~...) o The above asset has been or will be reported and tax paid with the Pennsylvania rnp!ir~ce bl\ retur.,l ;:g to be filed by the decedent' s representative. ,,',' /', -.' - .' < (,J, _ ~ . ~ - ~";"i ':0 ~.=~:. rT1 o The above inforllation is incorrect and/or debts and deductions were paid by you. You lIust co~lete PART ~ and/or PART ~ below. PART [!1 TAX RETURN - COMPUTATION OF TAX ON LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 X ~. ABount Subject to Tax ~ S. Debts and Deductions 5 6. A.ount Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 JOINT/TRUST ACCOUNTS If you indicate a different tax rate3 please state your relationship to decedent: PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ Under penalties of perjurY3 I declare that the facts I have reported above are true3 correct and complete to the best of BY knowledge and belief. HOME ( ) WORK ( ) TELEPHONE NUMBER DATE TAXPAYER SIGNATURE