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Home My WebLink About08-08-06 COMMor"NE~c-h CF PENNSYLVANIA CEF'ART:\,1ENT :;~ FE\/E[\JUE i:-:L,RE,L':.l) Ir'~r TAXE3 DEFT 230601 ~',"'::" 1 1 REVc1162 EX(11c96) RECEIVED FROM: PENNSYLV ANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BETZ DOUGLAS J 308 EF~FORD ROAD CAMP HILL, PA 17011 I I ESTATE INFORMATION: SSN: 169-28-7475 I FILE NUMBER: 2106-0705 DECEDENT NAME: BETZ JANE M DA TE OF PA YMENT: 08/08/2006 POSTMARK DATE: 08/07/2006 COUNTY: CUMBERLAND DATE OF DEATH: 12/06/2005 I NO. CD 007072 .. - .. ACN ASSESSMENT CONTROL NUMBER AMOUNT 06118874 I $171.28 I I I I I I I I TOTAL AMOUNT PAID: $171.28 REMARKS: DOUGLAS J BETZ CHECI<# 2838 INITIALS: AJW RECEIVED BY: SEAL 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 REVISED NOTICE * * * FILE ACN DATE NO. 21 Q\.Q l(J~ 06118874 07-10-2006 * REV-1543 EX AFP (09-00l * EST. OF JANE M BETl 5.5. NO. 169-28-7475 DATE OF DEATH 12-06-2005 COUNTY CUMBERLAND TYPE OF ACCOUNT [i] SAVINGS D CHECKING o TRUST o CERTIF . DOUGLAS J BETl 1342 SCONSETT WAY NEW CUMBERLAND PA 17070 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 COMMERCE 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 address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Penns~lvania. Questions may be answp.rqd hy calling (717) 787-8327_ COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 410115542 Date 12-28-1988 Established x 22,837.41 16.667 3,806.31 .045 171. 28 TAXPAYER RESPONSE 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". 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 5% discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. Tax PART ill A. ~ The above information and tax due is correct. ~l. 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. [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. 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. x If you indicate a different tax rate, please state your relationship to decedent: PART [3J TAX RETURN - COMPUTATION LINE 1. Date Established TAX ON JOINT/TRUST ACCOUNTS Tax Due OF 1 2 3 4 5 6 7 8 x PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I $ TOTAL (Enter on Line 5 of Tax Computation) of perjury, I declare that the facts I of my knowledge and belief. have reported above are true, correct and HOME ( '1'1 ) "11tl 1/,;~."'( WORK (111 ) C; 1(, , q 11Y 111,1 Oi. TELEPHONE NUMBER ~ 1r'~ c. \-' ..../. , '-.\ (::, ,',.:. ~:,.i ~ .r: c' ~ J. - -:"t~ '. t. , ,t,.' 1:\.1 1.1:1 ,,",:, --::::=:. ~ ........" ... .. .c....... '.:::-; ... ::;:: :::.::: , .. . ;;:: ..... ,.-.... :.7'" "-... -~. .~ :-:-" ~.;:: .-. -.. ," .. .. ".;:: .......... C__F ~ ,IlI!~ --- S' ::> ~ ~ --' ~ C/ -- ~;;; -z:. c-:::" ~ ~- ~ 1-_t:r ~- 'e ...1' ?- ...I' ~ .- -- (' ~ ifC~ E: .... nIVo ~\\,g ge'% ",,'(00 tt:I li"::l g,~~ >> to! tIol. ..,-<. > .... <=> -I o ~ \J1 IV t..] ;1~ :..,.;,;