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COMMONWEALTH 'IF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT 280601
HARRISBURG. PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLV ANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
GEIGER BEVERLY
940 STERLING CT
ENOlA, PA 17025
-~------ fold
ESTATE INFORMATION: SSN: 204-03-5222
FILE NUMBER: 2106-0014
DECEDENT NAME: LINE FLORENCE E
DA TE OF PAYMENT: 05/30/2006
POSTMARK DATE: 05/16/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 12/21/2005
NO. CD 006748
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
06118887 I $8.52
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$8.52
REMARKS:
CHECK#1293
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
BUREAU OF INOIVIOUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 06-0014
06118887
04-24-2006
REY-1543 EX AFP [09-00)
-,
TYPE OF ACCOUNT
o SAVINGS
D CHECKING
o TRUST
~ CERTIF.
EST. OF FLORENCE ELINE
5.5. NO. 204-03-5222
DATE OF DEATH 12-21-2005
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
BEVERLY J GEIGER
3502 \IUlA DR
MECH~ICSBURG PA 17055
qL{U S-U./JH1Q Cf
e= tJ UL II\- Y p, It c)! C;
MEMBERS 1ST FCU 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 calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 75049-40 Date 03-12-1990
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
Tax
PART
[!]
[CHECK ]
ONE
BLOCK
ONLY
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
5,682.07
3.333
189.38
.045
8.52
TAXPAYER RESPONSE
NOTE: If tax payments are made within three
(3) months of the decedent's date of death,
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.
x
above information and tax due is correct.
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 "An and return this notice to the Register of
Wills and an official assessment will be issued by the PA Oepartment of Revenue.
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.
OF TAX ON JOINT/TRUST ACCOUNTS
PART
@]
TAX RETURN - COMPUTATION
If you indicate a different tax rate, please state your
relationship to decedent:
LINE 1. 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
PART
@]
DATE PAID
PAYEE
1
2
3 X
4
5
6
7 X
8
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
I
$
TOTAL (Enter on Line 5 of Tax Computation)
declare that the facts I have reported above are true, correct and
and belief. HOME (1/7 ) j:S L - Uf / /
WORK ( )
TELEPHONE NUMBER
5 -Iv -()&;;
DATE
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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
HOCI<ENBERRY FLORENCE VIRGINIA
2313 LINDSAY lOT ROAD
SHIPPENSBURG, PA 17257
____u_ [old
ESTATE INFORMATION: SSN: 204-03-5222
FILE NUMBER: 2106-0014
DECEDENT NAME: LINE FLORENCE E
DATE OF PAYMENT: 05/30/2006
POSTMARK DATE: 05/30/2006
COUNTY: CUMBERLAND
DA TE OF DEATH: 12/21/2005
NO. CD 006761
ACN
ASSESSM ENT
CONTROL
NUMBER
AMOUNT
101 I $3,818.07
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$3,818.07
REMARI<S:
CHECI<# 112
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WillS