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Home My WebLink About06-21-06 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVEI,UE BUREAU OF INDIVIDUAL TAXES DEFT 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLV ANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT HOUDESHELL EMILY DAISY 12 SHARON RD ENOLA, PA 17025 -----~~- fold ESTATE INFORMATION: SSN: 164-36-2795 FILE NUMBER: 2106-0446 DECEDENT NAME: LENI<ER DAISY ALMA DATE OF PAYMENT: 06/21/2006 POSTMARK DATE: 06/20/2006 COUNTY: CUMBERLAND DA TE OF DEATH: 04/16/2006 NO. CD 006869 ACN ASSESSMENT CONTROL NUMBER AMOUNT 06500274 I $3,894.70 I I I I I I I I TOTAL AMOUNT PAID: REMARI<S: EMILY 0 HOUDESHELL CHECI<# 2042 SEAL INITIALS: CM RECEIVED BY: REGISTER OF WILLS $3,894.70 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 ACN DATE NO. 21 () ~ Lf L( Ct7 06500274 06-06-2006 REV-154lA AFP [7-00) 1,C) EST. OF DAISY A LENKER S.S. NO. 164-36-2795 DATE OF DEATH 04-16-2006 COUNTY CU ERLAND TYPE OF ACCOUNT [X] SECURITY D SEC ACCT D STOCK BONDS EMILY D HOUDESHELL 12 SHARON ROAD ENOLA PA 17025 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 EDWARD JONES 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 beneficiary of this asset. If you feel this information is incorrect, please obtain written correction from the transfer agent, attach a COpy to this form and return it to the above address.. This account is taxable in accordance with the Inheritance Tex '-aw~ 04= 1-hQ r('1mmon~~~lth of P~~!"'Ic;:~h.'a~i=. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 85112410 DOD Valuation Percent Taxable Amount Subject to Tax Rate Potential Tax Due 194,929.00 50.000 97,464.50 .045 4,385.90 TAXPAYER RESPONSE x Tax x PART [!] 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". NOTE: If tax payments are made within three (3) months of the decedent's date of death, you may deduct a 5% discount of Any inherItance ax due will become delinquent nine (9) months after the date of death. A. [] 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 "An 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 tax rate, please state your relationship to decedent: PART ~ TAX RETURN - COMPUTATION LINE 1. DOD Valuation 2. Percent Taxable 3. Amount Subject to Tax 4. Debts and Deductions 5. Amount Taxable 6. Tax Rate 7. Tax Due OF TAX ON ABOVE ASSETCS) .C\ q . cU.Jt. 0 0 {;t) ~ 1 a..t ~L.f. S'C <'~€lo.<O\ q J.'C~.ecr .O~S'" 'II Dfq · '- :\ .CJ8 3 ~ct&(, 70 DEBTS AND DEDUCTIONS 1 2 3 4 5 6 7 x x -SO PART @] DATE PAID CLAIMED TOTAL (Enter on Line 5 of Tax Computation) $ PAYEE DESCRIPTION facts I have reported above are true, correct and HOME (7/7 ) 11>1.-01$/ WORK ( ) -~..__..._... Tl:"ll:"pl-lntdl:" tdllMRI=R nATF ~I=-;MI\RI< r\" "',....-- May 24, 2006 Emily D. Houdeshell 12 Sharon Rd Enola PA 17025. Re: D. Lenker ~ Veba Payment Reminder Dear Ms. Houdeshell: On behalf of Highmark, please accept our condolences on the death of your mother, Daisy. Higllmark offers its retirees the opportunity to participate in medical, dental, and vision plans. To participate in the plans, retirees are required to pay part of the monthly premium. During a recent audit of accounts, I found we have not received Daisy's portion of the premium payments for Feb, Mar and April. Premiums are $297.87 per month. Please bring her account to current status by sending a check, payable to "Highmark VEBA," in the amount of $893.61. Payment is due June 7. A postage-paid return envelope is enclosed for your convenience. If you are unable to remit the amount in full, please contact me to make payment arrangements. Please be advised that we are permitted to cancel coverage after 90 days of non- payment. Please send your payment today to avoid coverage cancellation effective February 1, 2006. This could also adversely affect any previously paid claims. I may be reaclled directly at 717 302 4565 or via 1-800-341-1524 (options 3 and then 4) should YOLl need to contact me. Regards, Linda K Ward, Benefits Specialist Corporate Employee Benefits Enclosure(s) Oal011'I43 ~ ~ · l\J \j Corporate Offices: e11llp Hill Pc'. I lOW) Firth !\venue PI~lC(' 0 12n Fiith i\Vl'lllll' 0 Pitl~hurgh Pi\ I S22~-,~{)l)q \\'\\,\ \.111 ~hm'lrk.lO!ll !]tichardson guneral rJ{ome, c!Jnc. 29 SOUTH ENOLA DRIVE ENOLA, PA 17025 (717) 732-0587 MICHAEL G. MURRAY SUPERVISOR STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED Charges are only for those items that you selected or that are required. If we are required by law or by a cemetery or crematory to use any items, we will explain in writing below. If you selected a funeral that may require embalming, such as a funeral with viewing, you may have to pay for embalming. You do not have to pay for embalming you did not approve if you selected arrangements such as a direct cremation or immediate burial. If we charged for embalming, we will explain why below. For the Service of LJ0< ,5", ,{- / ... ,,/- t"' -' Dek'~ p.- ~ . <.:' s' --- ~. - , /) , . . "t,-' ']<; {',C('. ":..1 ,r-;,'{/cJ, j-'yJ' 17<;",~?" Address City State Other clothing .nr/' Charge to: A. CHARGE FOR SERVICES SELECTED: I. PROFESSIONAL SERVICES Services of Funeral Director/Staff . Embalming . . Oth~r preparation of body ( (;, P} /1',/, ) I r'j'~-r ~, .....'"l . (_ / . . Ii.L!.L .~-, .- .- .- Cremation urn . . . (Description) OTHER '- .- .- .~. SUB-TOTAL OF PROFESSIONAL SERVICES. 2. FACILITIES AND SERVICES Use of facilities and services for viewing (Visitation/Wake). Use of facilities and services for funeral ceremony Use of facilities and services for Memorial Service Use of equipment and services for graveside service. Other use of facilities .....Al._ ..- TOTAL MERCHANDISE SELECTED. C. SPECIAL CHARGES: Forwarding of remairu; to (Funeral Home) Receiving of remains from ....8._ ..- .- .- ......- ..- $- (Funeral Home) Immediate Burial . Direct Cremation. . ..- ..... .- .........- SUB.TOTAl OF FACllITIES/EQUlPMENT . . 3. AUTOMOTIVE EQUIPMENT ~:~lle to tra~fer re~ai~to Funeral H~j/2; L Hearse (Casket Coach) Local . ...A2'_ SUB-TOTAL OF SPECIAL CHARGES D. CASH ADVANCED Opening Grave .. .~ (, \'" Cemetery Equipment. . . ._ LotandDeed......... ..........._" { Newspaper Notices-Local. . . . . . . .. .~... f -=.. f..,,' .J- - ' Newspaper Notices-Out-of-town.... ._ Telephone & Telegrams ...... '_ Airfare . . Clergy/Mass Offering. ./00 . (> 1.1 Pallbearers. .. ._ Certified Copies of the Death Certificate .. .. . .. .. .. . Police Escort Flowers Vault Service Charge. . . . . . . . . . . ...C._ " .fl../~ Limousine Local. ._ Family car Local. ......._ Flower car or floral disposition Local. ._ Lead car/clergy car Local. . . .. .. . . fl.' ~ Car for pallbearers Local. ._ Out of town tnnsportation . . $_ .- .- SUB-TOTAL OF AUTOMOTIVE EQUIPMENT. . . .. A3 ._ TOTAL OF PROFESSIONAL SERVICES, FACILITIES AND AUTOMOTIVE EQUIPMENT A s.2:~5.:!" f,," 7 v .,1 . .., -f $- ..~ ..~"... ....- .- .'},'. .... .... .- .- $- .- o . 75':) r ,. SUB-TOTAL OF ADVANCES....... We charge you for our services in obtaining: (specify casb advances tbat are marked-up) B. CHARGE FOR MERCftANDlSE SELECTED: Casket.. /)'-1,."'.........,............... . lis!; r/. (Description) ,J ,.. .' r-" ,., .-- .) c" l,-. , ,J:' / ......' I r "" i '<' Other Receptacr'e . .- (Description) 0"- SUMMARY OF CHARGES A. Professional Services, Facilities and Equipmenr, and Automotive Equipm~nt . . .. s ,,;J X''l ( ,'" -' 8. Merchandise... ..... S~ ,<e:.-'-' C. Special Charges . .. D. Cash Advances. . . . . , . . s 7 f,~) . tJ 0 TOTAL OF ALL SECTIONS. . . . . . . . $- PAID AT TIME OF OR PRIOR TO ARRANGEMENTS. . BALANCE DUE. . ..~ . '~70~, .~/v Outer burial container ,,:,.:...:,, .<'f.. . . . . 7 )c, . (Description) le;- ,... A.. 0~, .~'I V1 .? / " .'/~- // Acknowledgement cards .. .- Register book(s) . . . . . . . . . . .- Memory folders . . .y-- Prayer cards . . .. '.r:7- Temporary gravr marker. . . . ..s~ Burial clothing . .. l~ HE N FOR EMBALMING . /_ j .0' ~ , ~.U If any law, cern ery, or cr atory requirements have required the purchase of.~ny of the items listed above the law or requirement is explained below. (>;: . ';:: :';;':r; /("/7''' " , 0 ~ /' .. ,/ ~ ,. / I agree that I have examined the items of goods and services selected above and found them to be correct and according to the arrangements I have requestrd. lacknowlrdgt receipt of a copy of this Statement of Funeral Goods and Services Selected. I represent that I have sufficient funds availahlr for payment of the cash price for the goods and services selected. ( also agree to make payment of' -' within ..-/ days. I agree to be jointly and severally liablrwith.anyone else who signs below. A late charge of ,/ per month amounting to.. ...... per.yearwiU be aJlP~ied to the unJlaid balance beginning days 8< ') <> i -:t. l ~gl'!] _: -: '-.) 0 3or- <.J ~-<>~ ~~ '"' ~ .> ~ ---' q} \f\ ~ - ,- ~ ~ r'E~ ~~U ".;;;-,\ "..' :c ."">' ,J .., i;;.. . l'l::;; l~ ~ ~~ ~ ....-I... Q.J~~ ~~~ "S \t) cO ~~~ (o.! i:n (t:i f':i !",) -r"l () l.... , ,:..J