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Home My WebLink About12-14-06 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 STONE DAVID HEAN STONE LAFAVER & SHEKLETSKI 414 BRIDGE ST PO BOX E NEW CUMBERLAND, PA 17070 nh_n_ fold ESTATE INFORMATION: SSN: 128-20-6360 FILE NUMBER: 2106-0968 DECEDENT NAME: BURKE JOSEPHINE A DA TE OF PAYMENT: 12/14/2006 POSTMARK DATE: 12/13/2006 COUNTY: CUMBERLAND DA TE OF DEATH: 10/18/2006 NO. CD 007560 ACN ASSESSMENT CONTROL NUMBER AMOUNT 06161284 I $ 48.46 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK#1275 SEAL INITIALS: CJ RECEIVED BY: REGISTER OF WILLS $48.46 GLENDA FARNER STRASBAUGH REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 171Z8-0601 R.r-*, .--1 E "',;!-, NFORMATION NOTICE 'i- h, \f AND ':, ' ,"" ',' (~TAXPAYER RESPONSE r~:,_~\J-.J : l. :--'i '~,/: ~' .._. REV-1545 EX AFP 109-001 FILE ACN DATE NO. 21 06-0968 06161284 12-07-2006 2006 DEe I 4 AM II: 42 CLERK OF ORPHNTS COURT CLl" 1r,'--' ," 1'"\ (','1 P,\ ,v i' :. -~ i '.'.,,-, :,", EST. OF JOSEPHINE BURKE S.S. NO. 128-20-6360 DATE OF DEATH 10-18-2006 COUNTY CUMBERLAND TYPE OF ACCOUNT [i] SAVINGS o CHECKING o TRUST o CERTIF. KATHLEEN GALLACHER 719 BARBARA ST NEW CUMBERLAND PA 17070 REHIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 HEHBERS 1ST FCU has provided the Department with the infor.ation 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 ioint 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. QUQsticns ~ay be answBrB~ by ~411in9 (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 263033-00 Date 04-12-2005 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 2.153.97 50.000 1.076.99 .045 48.46 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 SiC discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. Tax PART [!] 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. [CHECK ] ONE BLOCK ONLY B. D The abo~e asset has been or will :,,, r<'''~~t'oj and tax paid with the PennsYlvania Inheritance Tax return to be flied by the decedent's representatlva. C. [] The above information is incorrect and/or debts and deductions were paid by y~u. 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. 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 PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED OF 1 2 3 4 5 6 7 8 x TAX ON JOINT/TRUST ACCOUNTS x PAYEE DESCRIPTION AMOUNT PAID 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. ~~ URE have reported above are true. correct and HOME (..., 17) ;7 C{ - 1?3 ( WORK (, ( ) 7 )4 - S2 I?' ({/r.:L/O(:. TELEPHON N MBER DATE f COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 171Z8-0601 _ ~_~rN~~R~TION NOTICE " !, t ih lTiif:: ,1=", .I- AND ~~;~':I' ..'~ tA~lfAVER RESPONSE iY~,l.}. ; 1,,_,;;- <,i:: L. ~ REY-1543 EX AFP CD'-.., FILE NO. 21 06-0968 ACN 06161285 DATE 12-07-2006 ~~ KATHLEE GALLACHER 719 BARBARA ST NEW CUMBERLAND PA 17070 2006 DEe I 4 AM": 4 3 EST. OF JOSEPHINE BURKE CLEfii< OF S.S. NO. 128-20-6360 a...R. p. H. i.Ar\!'S COt IM.T T.E OF DEATH 10-18-2006 CU\/[':!-":"::'1~~TY CUMBERLAND REMIT PAYMENT AND REGISTER OF WILLS CUMBERLAND CO COURT CARLISLE, PA 17013 TYPE OF ACCOUNT o SAVINGS IXJ CHECKING o TRUST o CERTIF. FORMS TO: HOUSE MEMBERS 1ST FCU has provided the Depart.ent with the infor.ation 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 inforBation is incorrect, please obtain written correction fro. 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 COB.onwealth of PennsYlvania. Questions Bay be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 263033-11 Date 10-26-2005 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x .00 100.00 .00 .045 .00 TAXPAYER RESPONSE To insure proper credit to your account, two [Z) copies of this notice BUSt aCCoBpany your pay.ent to the Register of Wills. Make check payable to: "Register of Wills, Agent". Tax x NOTE: If tax paYllants are Bade within three (3) Bonths of the decedent's date of death, you bY deduct a 5;( discount of the tax due. Any inheritance tax due will becoae delinquent nine (9) Bonths after the date of death. PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. [J The above inforBation and tax due is correct. 1. You say choose to reBit pay.ent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you Bay check box "A" and return this notice to the Register of Wills and an official assessBent will be issued by the PA DepartBent of Revenue. [J 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. [J The 2bove inforBation is incorrect and/or debts and deductions were paid by You. You BUSt coaplete PART ~ and/or PART ~ below. If you indicate a different tax rate, please state your relationship to decedent: PART (!J TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 X 4. A.ount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 PART f!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME ( WORK ( TElEPHONE ) ) NUMBER DATE TAXPAYER SIGNATURE r ...-1 .... r-..., t'l 'i"'l ({ it Ci. 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