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Home My WebLink About10-11-06 COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 R~~_E INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21~- ~ ( 06500459 09-15-2006 REV-l541A IF' 17-1" 2006 OCT eLF.:- OP," ) I~. ('\: -,QURT ',C(\ p:\ ) ..',.)" .' TYPE OF ACCOUNT EST. OF LOUISE JOHNSTON D SECURITY S. S. NO. 180-28-5741 Ii] SEC ACCT DATE OF DEATH 07-03-2006 D STOCK COUNTY CUMBERLAND D BONDS REHIT PAYHENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLEI PA 17013 TIMOTHY L BOCK 1351 MCCORMICK ROAD MECHANICSBURG PA 17050 AHERICAN FUNDS has provided the llepa..tHnt lIith the infanlation listed b.lol1 IIhich has b..n us.d in calculating the pot.ntial tax du.. Thai.. ...co..ds indic.t. that at the d..th of the .bov. d.cedent. YOU II.... . b.nefici...y of this .ss.t. If you f..l this info...ation is inco....ect. pl..s. obtain lI..itten co.....ction f..o. the t.-ansfe.. agent. .ttach . copy to this fo... and ...tu..n it to the above .dd...ss. This account is taxable in accordanc. lIith the Inh.ritanc. T.x L.lls of the Co_.lth of P.nnsylvani.. Questions ..y be anSll8...d by c.lling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS AccOW'lt No. 73995315 DOD ValuaHon Percent T.xBble AIIount Subject to T.x T.x Rate Potentiel T.x Due x 221375.21 33.333 71458.33 .045 335.62 TAXPAYER RESPONSE To insu... P"OP." c.-.dit to you.. .ccount. two (2) copi.s of this no tic. ....st acco.pany you.. paya.nt to the Registe.. of lUlls. Mak. chack p.yabl. to: "Registe.. of lUlls. Agent". x HOTE: If tax payaents .... .ad. lIithin th.... (3) aonths of the dec.dent's d.t. of d..th. yOU ..y d.duct a S;C discount of the tax du.. Any inh...itanc. tax due 11111 b.coa. delinquent nine (9) IIOnthS aft... the date of death. PART [!] The above info....tion and tax due is co....ect. . You .ay chao.. to .._it pay_nt to the R.gist... of lIills lIith tIIo copi.s of this notic. to obtain · discount 0.. avoid int....st. 0" you aay check box "A" and ...tu..n this notic. to the Regist... of lIills and an official ass.s...nt lIill b. issued by the PA Dapa..ta.nt of R.v.nue. B. DTh. above asset h.s b..n 0.. lIill be ..epo..t.d and tax paid lIith the Pennsylvania Inh...itanc. T.x ...turn to b. fil.d by the d.c.dent's ...p.....ntativ.. C. DTha above info...ation is inco....ect and/o.. debts and deductions II.... p.id by you. You .ust co.pl.t. PART 0 and/o.. PART III b.loll. [CHECK ] ONE BLOCK ONLY PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED If you indicate a different tax ratel please state your relationship to decedent: PART ~ TAX RETURN - COMPUTATION LINE 1. DOD VeluaHon 2. Percent T.xllble 3. AlIOunt Subject to T.x 4. Debts end Deductions S. AIIOunt Taxable 6. Tax Rate 7. Tax Due OF TAX I 2 X 3 4 S 6 X 7 ON ABOVE ASSETCS) PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line S of Tax Computation) I $ of perjury I I declare that the facts I have reported &bove are trUBI correct and of. knowledge and belief. HOME C '1'~ ) t, q t - OLl 610 WORK C 1 \1) (P'H -<5';;l6 DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 * . INFORMATION NOTICE .r (,.: AND ccr \ t....\-.....~ .~.._"..;.... _.:. ~\ TAXPAYER RESPONSE n. ,) .I '. ". .J \ ~'J ~. =-sa 'U, ('~"l ,1 .\.: \ 1'- FILE NO. 21 ACN 06500459 DATE 09-15-2006 1n~t OC\ \ \ CG\/ at: JU::J\l:~ A-.' )\-i~,~\~) r~)' r-~r""':"""" \ 1 ' ~\'\ \0' C U TYPE OF ACCOUNT D SECURITY [Xl SEC ACCT D STOCK D BONDS EST. OF LOUISE JOHNSTON S.S. NO. 180-28-5741 DATE OF DEATH 07-03-2006 COUNTY CUMBERLAND TIMOTHY L BOCK 1351 MCCORMICK ROAD MECHANICSBURG PA 17050 ,i":_r REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLEI PA 17013 AMERICAN FUNDS has provided the o.partunt with the Infol"llat1on list8CI belaw which has b..n used in calculating the patentlal tax due. ThlIir racords indicate that. at the death of the above decedent, you were a beneficiary of this asset. If yOU feel this Infor..tion Is Incorrect, please obtain written correction fro. the transfer agent. attach a copy to this for. and return it to the above address. This IICcount is taxable In IICcordance with the Inheritance TalC Laws of the Co_onNBalth of Pennsylvania. Questions ay till an_,-.d by calling (717) 187-83t7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS AccOW\t No. 73995315 x 221375.21 33.333 7,458.33 .045 335.62 TAXPAYER RESPONSE To insure proper credit to your acCOW'lt, two (2) caples of this notica BUst acco.pany your pay.ent to the R8lIIster of Wills. Meke check payable to: "R8lIister of Wills, Agant". DaD V.lu.Uon P.rc....t Tmc_le AIIount Subject to Tax T.x R.te Potential Tmc au. x NOTE: If tax paYlHlllts are .ade within thrae (3) aanths of the decedent's date of death, you ay deduct a SX discount of the tax due. Any Inheritance talC due will becD8a delinquent nine (9) .onths after the date of death. PART [!] The above Inforaation and tax dUB is corract. 1. You aay choose to raait pay.ent to the Ragister of Wills with two copies of this notice to obtain a discount or avoid Interest, or you .ay check box "Aft and return this notice to the Registar of Wills and an official assesSllent will be issued by the PA DepartJlant of Revenue. B. DThe above asset has been or will be reported and talC paid with the PeMsylvenia Inheritance Tex return to be filed by the decadent"s representative. C. DThe above inforaation is incorrect and/or debts and deductions were paid by you. You BUst cOlIPlete PART [!] and/or PART 0 below. [CHECK ] ONE BLOCK ONLY PART (!] TAX RETURN - COMPUTATION LINE 1. DaD Valuation 2. Percent Tax8ble 3. AIIount Subjeet to Tax 4. Debts and Dac:luctions S. AIIount Taxable 6. Tax Rete 7. Tax Due ON ABOVE ASSETCS) If you indicete a different tax ratel pleese state your relationship to decedent: OF TAX 1 2 X 3 4 S 6 X 7 PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I $ I TOTAL (Enter on Line S of Tex COMPUtation) declare that the feets I have reported IIbove ara true I correct and and belief. HOME (I)'" ) ~C(l-OL.\bb WORK ("l \1) ) "'ten -66a 6 DATE vV orl \- ~ 't tt t ~ S. 'J N C') ~ b .ct 0 ~ :,fn ::t ",.?,Q . "-'1' i , ~\ , \t.'t' ~ 1 ~ ._-----~-----"- ~ " :. '. : l \11(1) :)\11 %~% .... \11;::0 $ ru.Jen ~ ~c(> C'll u..:)- .... 090 ~ ...'2:~ c( %~........o. ~_\I1$C) __u..(.)O~ t;O%co:) ..... c(C'llCD ~~t:><(I) '8~ffigi c(:)iO$ 0.10-0.... Q) '0 ~ It; o ~ ~ (') -:! UJ ~ 2 ... g ~ ! 4 lO lO o C- ..;' - - - -' - - - - - - - - - - - - - -= - . - - " - - - - -