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Home My WebLink About08-04-06 COr'v'll\'lUr'J\NtllL,""-H I=:F F'Ef"JNSYLVANIA CEPART~.,lEi'JT:::-,r= ,8E\/EN''....IE BUREAU :JF T.AYES CEPT HARRiSEL/FiC" i=,.1 1-;" 1 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT AMIGH JENNIFER K 8 MEADOW RIDGE DRIVE SHIPPENSBURG, PA 17257 --. ----- f,)ld ESTATE INFORMATION: SSN: 000-00-0000 FILE NUMBER: 2106-0697 DECEDENT NAME: COFFEY JOYCE l DA TE OF PA YMENT: 08/04/2006 POSTMARK DATE: 08/04/2006 COUNTY: CUMBERLAND DA TE OF DEATH: 00/00/0000 NO. CD 007054 ACN ASSESSMENT CONTROL NUMBER AMOUNT 06137399 I $47.98 I I I I I I I I TOTAL AMOUNT PAID: REMARI<S: JENNIFER AMEIGH CH ECI<# 1892 SEAL INITIALS: AJW RECEIVED BY: REGISTER OF WILLS $47.98 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 06137399 07-26-2006 REV-1543 EX 4FP [09-00) Est, OF JOYCE L COFFEY S.S. NO. 206-32-1264 DATE OF DEATH 05-08-2006 COUNTY CUMBERLAND TYPE OF ACCOUNT [Xl SAVINGS o CHECKING o TRUST o CERTIF . JENNIFER K AMIGH 8 MEADOW RIDGE DR SHIPPENSBURG PA 17257 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ORRSTOWN BANK has pl'ovided the Depal'tment with the infor-mation listed below which has been used in calculating the potential tax due. Theil' 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. 786802 Date 03-14-2003 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 6,734.17 16.667 1,122.38 .15 168.36 TAXPAYER RESPONSE To insure propel' 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 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. [J 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 Oepartment of Revenue. [J The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax retul'n to be filed by the decedent's representative. ~he above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. PART [!] DATE PAID PART If yo~ ind~cate a differen~~r~~~~~r-state your ~ relat10nsh1p to decedent:~~ ~:.~ n~~~~~:~~:T:.~N I :~~~1~%~ :COUNTS 5. Debts and Deductions 5 6. Amount 7. Tax R 8. Tax Du PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ Under penalties to the best facts I have reported above are true, correct and HOME (717) 530-8895 WORK (7 J 7) 30- 2S I .8::.l..=.Qio TELEPHONE NUMBER DATE ..... .J o ,.... .:..1 ..f- i..' ~..I ~il ,-:. I u) ~il (.,.... 0...1 q'" I~ (..1 - - - - - - - - - - - - - d \:.. CAt) ~. rf' (r 0~ L 'v: i.:. . nn~ ~ ~ ro r-l E:I ()Q t-' 0' 1-'- 1-'- ro en en r-l rt t-'t-'ro ro ~ r-l ::l 'i:jp..a ~ t-h n a ::E:: ...... 1-'- .......nt-' oat-' ...... ~ en \.J.lr-l rt ~ a ~ en ro v . \ ---t) ----- ....) () ~ :J (j' (t- ~ -< ~ :5 ,.) ';:J o CS: tJr- \ L_~\ ~ v ~ o l:ll o X ~ ... -.J N III -.J PRESORTED FIRST CLASS :s: C) ;:.::) ~ ~~': fTI 0J :t~ O({J .." ~ ::U({J o J> S (n N 'U)> -(;R Oc OGlO 000 ~ N. " ~J I\J ,., oeD ':~ ~ w UNITeD "r~l, ..)j.. Jk':.:'.~ ~ -( ~ 11 & ,';;- "})