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HomeMy WebLinkAbout11-29-06 (2) COMMONWEALTH OF PENNSVLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 171Z8-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 -OitJ/Cfj)- 06157533 11-22-2006 REV-15~5 EX AFP [09-00) STEVEN L GOUSE 23RD STREET EXT ENOLA PA 17025 TYPE OF ACCOUNT EST. OF WALTER E GOUSE 0 SAVINGS S.S. NO. 714-18-2611 0 CHECKING DATE OF DEATH 10-01-2006 0 TRUST COUNTY CUMBERLAND [X] CERTIF. REMIT PAYMENT AND F~MS TO: REGISTER OIf~I,LLS ....' CUMBERLAND CO'<COURT. HOUSE CARLISLE, PA-l1"'()13 PNC BANK has provided the Department with the information listed below which hasjjeen used-in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were aiolrlt owner/beneficiary Qf 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 t~JCommonwealth of Pennsylvania. Questions may be answerad by calling (717) 767-63Z7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 21001030348 Date 02-15-2001 Established Account Balance Percent Taxable AMount Subject to Tax Rate Potential Tax Due x 18,413.04 16.667 3,068.90 .045 138.10 TAXPAYER RESPONSE To insure proper credit to your account, two (Z) 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 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. [ CHECK ] ONE BLOCK B. ONLY c. [] 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, Dr 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. [] The above asset has been Dr will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. [] The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. PART ~ DATE PAID il/7/()(; DEBTS AND DEDUCTIONS CLAIMED If you indicate a different tax rate, please state your relationship to decedent: PART @] TAX RETURN - COMPUTATION 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 OF 1 2 3 4 5 6 7 8 x TAX ON JOINT/TRUST ACCOUNTS x r$1i:t.1#7? PAYEE ~t' u!J DUA~~ DESCRIPTION ~-'~_I, -:J at' AMOUNT PAID 1.11 / ~.p./O $ I TOTAL CEnter on Line 5 of Tax COMputation) Under penalties of perjury, I declare that the facts I COMplete to the best of MY knowledge and belief. have reported above are true, correct and HOME (7/7) 7 j)-/~1J3 WORK ( . ) 71'-1 7;;' 3.J TELEPHONE NUMBER DATE ~ TAXPAYER SIGNATURE COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 - 04:> - '0C50 06157531 11-22-2006 REY-1545 EX AFP (09-00> TYPE OF EST. OF WALTER E GOUSE S.S. NO. 714-18-26110 DATE OF DEATH 10-01-2006~ COUNTY CUMBERLAND ;',-,;. ACCOUNT [X] SAVINGS D C~ECj:KING D TRU~T D CER~IF . STEVEN L GOUSE 23RD STREET EXT ENOLA PA 17025 RE"IT PAY"ENT AND FOR~$ TO: REGISTER OF WIllS '..- CUMBERLAND CO COURT HQySE CARLISLE, PA 11~13 ;--, -~ c:; PNC 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 Pennsylvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 5130189166 Date 02-15-2001 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 10,435.84 16.667 1,739.34 .045 78.27 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". 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 IT] A. [ CHECK ] ONE BLOCK B. ONLY c. [] 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 Department of Revenue. [] 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. [] The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. PART ~ DATE PAID O/J111Jt DEBTS AND DEDUCTIONS CLAIMED If you indicate a different tax rate, please state your relationship to decedent: PART [3J TAX RETURN - COMPUTATION 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 OF 1 2 3 4 5 6 7 8 x TAX ON JOINT/TRUST ACCOUNTS x PAYEE c!J ~1bYJ j" IJ m.l~o", DESCRIPTION .~l) 'l1.1u-4~ ~ 41f AMOUNT PAID 1/7t':J--"} $ I TOTAL CEnter on Line 5 of Tax Computation) Under penalties of perjury, I declare that the facts I complete to the best of my knowledge and belief. have reported above are true, correct and HOME C; I 7 ) _rit-fMlrf, lJ ,~1jJ-.-lt(j~~ WORK ( ) -77 If-I Y j ..J . TELEPHONE NUMBER DATE TAXPAYER SIGNATURE 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- d.o - 1050 06157531 11-22-2006 REV-1545 EX iFP (09-001 EST. OF WALTER E GaUSE S.S. NO. 714-18-2611 DATE OF DEATH 10-01-2006 COUNTY CUMBERLAND TYPE OF ACCOUNT IX] SAVINGS D CHECKING D TRUST D CERTIF . STEVEN L GaUSE 23RD STREET EXT ENOLA PA 17025 REMIT PAYMENT AND FORMS TO: REGISTER OF WttLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 11013 PNC BANK has provided the Department with the information listed below which has b"'fn used fri calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a join~,owner/b.nQficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial insJitution, 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 th~~~ommonwealth of Pennsylvania. Questions may be answered by cailing (7i7> 787-8327. .',"' COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 5130189166 Date 02-15-2001 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 10,435.84 16.667 1,739.34 .045 78.27 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". 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 [!] A. [ CHECK ] ONE BLOCK B. ONLY c. [] 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 Department of Revenue. [] 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. [] The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. PART [!J DATE PAID /t/)..1/(I(, DEBTS AND DEDUCTIONS CLAIMED If you indicate a different tax rate, please state your relationship to decedent: PART [3J TAX RETURN - COMPUTATION 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 OF 1 2 3 4 5 6 7 8 x TAX ON JOINT/TRUST ACCOUNTS x PAYEE ~) .r;,v4rt ;1,..fj O(,(Afl> DESCRIPTION 3.-.-.J1In~.,G. d ~ AMOUNT PAID , 7?' ).. 7 I TOTAL (Enter on Line 5 of Tax Computation) I $ Under penalties of perjury, I declare that the facts I complete to the best of my knowledge and belief. have reported above are true, correct HOME (1/7 ) -J ~).. ..., {.IJ.~ WORK ( ) 774-:' (13:) TELEPHONE NUMBER and TAXPAYER SIGNATURE DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2B060 1 HARRISBURG, PA 17128-0601 REV-1162 EX( 11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT GOUSE STEVEN l 23RD STREET EXT ENOlA1 PA 17025 nh____ fold ESTATE INFORMATION: SSN: 714-18-2611 FILE NUMBER: 2106-1050 DECEDENT NAME: GOUSE WALTER E DATE OF PAYMENT: 11/29/2006 POSTMARK DATE: 11/27/2006 COUNTY: CUMBERLAND DA TE OF DEATH: 10/01/2006 NO. CD 007491 ACN ASSESSMENT CONTROL NUMBER AMOUNT 06157531 I $78.27 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: STEVEN GOUSE CHECK# 036409239 SEAL INITIALS: WZ RECEIVED BY: REGISTER OF WILLS $78.27 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 ~ 0(0 - \()5D 06157533 11-22-2006 REV-1545 EX AFP 109-00) TYPE OF ACCOUNT o SAVINGS D CHECKING o TRUST 00 CERTIF. EST. OF WALTER E GOUSE S.S. NO. 714-18-2611 DATE OF DEATH 10-01-2006 COUNTY CUMBERLAND C~) STEVEN L GOUSE 23RD STREET EXT ENOLA PA 17025 REMIT PAYMENT AND FORMS; TO: REGISTER OF WILLS- CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 :.. ~ PNC BANK has provided the Departllent with the information listed below which has been used il:!u 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 froll the financial institution, attach a copy to this forll and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of PBnns~l~snia. Questions may be an5wsred by ~alling (717) 787-~3Z7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 21001030348 Date 02-15-2001 E stabli. shed Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 18,413.04 16.667 3,068.90 .045 138.10 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". x NOTE: If tax payments are lIade 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 ill A. [ CHECK ] ONE BLOCK B. ONLY c. [] The above information and tax due is correct. 1. You may choose to rellit 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 assessllent will be issued by the PA Departllent of Revenue. [] 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. [] The above inforllation 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 [!] DATE PAID flll/IL . DEBTS AND DEDUCTIONS CLAIMED PART [!J TAX RETURN - COMPUTATION 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 OF 1 2 3 4 5 6 7 8 x TAX ON JOINT/TRUST ACCOUNTS x PAYEE .J:.'f;,,..e-u t. .A/1U4"" DESCRIPTION .;:,. tu~ .1~ AMOUNT PAID 8/:7'1',,/0 I TOTAL (Enter on Line 5 of Tax Computation) I $ Under penalties of perjury, I declare that the facts I complete to the best of my knowledge and belief. have reported above are true, correct HOME (117) ?~;'-f(,03 WORK ( ) '1"1'!-7?3Y TELEPHONE NUMBER and TAXPAYER SIGNATURE DATE 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 GOUSE STEVEN L 23RD STREET EXT ENOLA, PA 17025 _n__n_ fold ESTA TE INFORMATION: SSN: 714-18-2611 FILE NUMBER: 2106-1050 DECEDENT NAME: GOUSE WALTER E DATE OF PAYMENT: 11/29/2006 POSTMARK DATE: 11/27/2006 COUNTY: CUMBERLAND DATE OF DEATH: 10/01/2006 NO. CD 007492 ACN ASSESSMENT CONTROL NUMBER AMOUNT 06157533 I $138.10 I I I I I I I I TOTAL AMOUNT PAID: $138.10 REMARKS: STEVEN GOUSE CHECK# 036940924 SEAL INITIALS: WZ RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS r- .q:' rl ~ .. 0; f U 1A-. :X ;i;; i< ~ co. f~ V) . ~. Cl' ci '4: 'J:, ~: l;-...... 4: r" ('~J , ' I ! .' ;',' J~" \ i )11_ j! ,f J ~ ~ J ~ ~ 0 " ~ ~ ~ ~ ~~~ - - - - - - - ... ... o LJ ~ o .... .,.. ,,, .... o /'" ...