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HomeMy WebLinkAbout12-12-06 en W ~ .... <( :;) o :> is ~ ... o :;) <( W Ill: :;) ... ~ :;) o >- c o ..; e ... . .5 Q) :;) c Q) ~ '0 ~ o Q) Q. Q. o 1;j :;) E "'t1 S o u c Q) ~ u Q) ..c u - c Q) E t o Q. Q) o Q) -= >- ..a 11 > .~ >- c. o. o - "'t1 ! Q) Q) ..c ~ <Ii ~ ..c! = .!:!:;) 0 ..c "i Q) ~ u Q. 3:e ~ l!Q.> c- c Q) 0 . ~ E c u 0 0 o C III D~~ -~Q <( .!!.,;:..= Z iS~~~ <( Q)u ~w ~i ~~ ~~ ~.~ Ii; . i Will: = "'t1 ~ 0 A. .- C" A. "'0 ~ ~ ~ o ... Q) :Z:Z -0 = Q. ..c !:; W ~ .... .~ ~~ ~ :;) ~ ... ~<( .i ~>- Ii.! ZA. 0) "'t1 0 Q" i~ ~ !t E Z '0 ~ ~ol$.u 8 2~.! iDe o w.....~O ;;; 0,- 2- a o ::) o >- ~ c o ..c .... >. .. ~ 8 c Cii c o .iii .:~ :co u)(- ..00 >-.... N ..c Q)-q e-uto... :;)CClO ~.2to... c.iF::" ..c..c- ..g.!:~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *,..., "''':-! ''''-r: I'...'i, " f!j. 'L_.....-:..._ " ,',' ,:,_..,. ,'__ , i\E~"'~~AfI;'(~OOl ~-'" "'" XNFORMATXON NOTXCE I I' AND X. ::TAXPAYER RESPONSE FILE NO. 21 ACN 06153200 DATE 10-13-2006 KAREN J MARCH 3755 MOUNTAIN VIEW RD MECHANICSBURG PA 17050 P" (" ClLif, f , l ~,' lOT Onn! ;,\~y~ rl\\ \; ,I oj,r:\~'~\ ",,"',;:::::,(\ 0,\ EST. OF RICHARD N PETERSON S.S. NO. 086-20-0896 DATE OF DEATH 07-17-2006 COUNTY CUMBERLAND TYPE OF ACCOUNT iii SAVINGS o CHECKING o TRUST o CERTIF. lGUn GEe \ 2 p~ 2: \ 6 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has provided the Depart.ent 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 infor.ation is incorrect, please obtain written correction fro. the financial institution, attach a copy to this for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co.monwealth of PennsYlvania. Questions .ay be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 118029-00 Date 01-29-1993 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 6,452.29 16.667 1,075.40 .045 48.39 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) .onths after the date of death. Tax PART [II 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 Depart.ent 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. 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 TAX ON JOINT/TRUST ACCOUNTS OF 1 2 3 4 5 6 7 8 x x PART [!J DATE PAID PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ perjury, I declare that the facts I have reported above are true, correct and knowledge and belief. HOME (7/ 7 7.. -3,;;... ~ (j & 6.-/ WORK ( TElEPHON //c4().LlG::; DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 . INFORMATION NOTICE , ","I, ....irv. ,. AND f',. ,. _.) 'j ~\,.[ TAXPAYER RESPONSE FILE NO. 21 ACN 06153198 DATE 10-13-2006 REVl$c!~J~' .FP_ (UHE~ TYPE OF ACCOUNT o SAVINGS iii CHECKING o TRUST o CERTIF. KAREN J MARCH 3755 MOUNTAIN VIEW RD MECHANICSBURG PA 17050 CI q:w (v:: !'.-L.j \l \ I.~i\ ORDi-'t.',I'C'",' ('(!I IQT i 1 i ,{....,l -~ \} \..' ',j'..,..,' ; I CII',',' '. "-', "', '\ rv., ......: '," , ~ /...., P~1 2: I 6 EST. OF RICHARD N PETERSON S.S. NO. 086-20-0896 DATE OF DEATH 07-17-2006 COUNTY CUMBERLAND ZOG6 DEe I 2 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU 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. 118029-11 Date 01-29-1993 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 21,416.51 16.667 3,569.49 .045 160.63 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) .onths after the date of death. Tax PART [II A.'i;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 asseSSBent will be issued by the PA Depart.ent 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. [J The above information 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 @] TAX RETURN - COMPUTATION OF LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 8. Tax Due 8 PART [!J DATE PAID DEBTS AND DEDUCTIONS CLAIMED TAX ON JOINT/TRUST ACCOUNTS x x PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ perjury, I declare that the facts I have reported above are true, correct and my knowledge and belief. HOME 73~ . <If/!~':::;;- //-.3.tJ .6& DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 171Z8-0601 *~ , : - I _~\ .: ',: .' '''n! I '..' REV:'15q~X i6i'P. q'-O~j INFORMATION NOTICE AND FI(I 'f~XPAYER RESPONSE ~ ': I FILE NO. 21 ACN 06153194 DATE 10-13-2006 TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST IX] CERTIF. KAREN J MARCH 3755 MOUNTAIN VIEW RD MECHANICSBURG PA 17050 CLEfiK OF OQPf_l. \ \ H:; (-"nl.!RT I ' :1....,: ~ 'j \ /1 ),), , CLi'.'-' '-;; Fp., '" PH 2: 16 EST. OF RICHARD N PETERSON S.S. NO. 086-20-0896 DATE OF DEATH 07-17-2006 COUNTY CUMBERLAND 2006 DEe I 2 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU 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 for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Com.onwealth of Pennsylvania. Questions .ay be ~"s~~red by celling '7!7) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 118029-44 Date 01-06-2005 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 53,279.43 16.667 8,880.08 .045 399.60 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice must acco.pany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax pay.ents 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 beco.e delinquent nine (9) .onths after tha date of death. Tax PART [II A~ The above infor.ation and tax due is correct. I. You .ay choose to remit pay.ent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you .ay check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Oepart.ent of Ravenue. [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. [J The above information 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 @] 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 [!J DATE PAID DEBTS AND DEDUCTIONS CLAIMED OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) declare that the facts I and belief. I $ have reported above are true, correct and HOME (7/7) 73~. <I<I(;;S WORK ( ) TElEPHONE NUMB R ) l.3o (j~ DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 iF'.f! ;: '".. ,. .~- -:~ ," ,-- ~~~5~5,Ek~F~ t!'"DOI' INFORMATION NOTICE ," AND :::TAXPAYER RESPONSE FILE ACN DATE NO. 21 06153192 10-13-2006 KAREN J MARCH 3755 MOUNTAIN VIEW RD MECHANICSBURG PA 17050 ("\ '-PK r,[" I....iLti 'i \ \')1- ORPlP,\"C (\')I'QT 1, I \1 \~ \ ',"; \,.._.'l__ \..J; II CL . EST. OF RICHARD N PETERSON S.S. NO. 086-20-0896 DATE OF DEATH 07-17-2006 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST IX! CERTIF . 2005 DEe I 2 P~l 2: I 6 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has provided the Departllent with the information listed below which has been used in calculating the potential tax dua. 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 ceiling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 118029-45 Date 01-06-2005 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 53,514.93 16.667 8,919.33 .045 401. 37 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) .onths 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 [II 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. [] 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. [J The above information 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 @] 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 [!J 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 $ perjury, I declare that the facts I have reported above are true, correct and my knowledge and belief. HOME 7 ~ . t./ (j(f)6~ WORK T L I ;'.,30 '<l0 DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 ~r"r",C' ,_tM. S,_. I. i'~I\._~ ',L..\)\.'''' .,' -- "', '_",:" i., ", ~ " -1lE'-lst~ E~ AfIl :109-011 INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 ACN 06153190 DATE 10-13-2006 e \ 2 P~'\ 2: \ 5 ltiOfJ DE EST. OF RICHARD N PETERSON S.S. NO. 086-20-0896 DATE OF DEATH 07-17-2006 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST IX] CERTIF. Clef'. ,.'1 C';': Li'\t\. J, ,f" (' ..~\ lOT OPOlrJi~\\\.1.~). .,_J) -;:! \ I \ U i .f -, '"'d \ KAREN J MARCH CUI' - 3755 MOUNTAIN VIEW RD MECHANICSBURG PA 17050 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU 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 for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions say be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 118029-46 Date 02-04-2005 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 21,094.91 16.667 3,515.89 .045 158.22 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 becoBe delinquent nine (9) months after the date of death. Tax PART [II 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 .ay 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. [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. C. [] The above information 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 [!J DATE PAID DEBTS AND DEDUCTIONS CLAIMED PART @] TAX RETURN - COMPUTATION OF LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 8. Tax Due 8 TAX ON JOINT/TRUST ACCOUNTS x x PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ perjury, I declare that the facts I have reported above are true, correct and my knowledge and belief. HOME 7.3,;2 - '-14(/;/)'- DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIOUAl TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 .,/1 ." ,'-.. . '.....' -',.,-, '.- INFORMATION NOTICE ~{.rll'.- ~.. AND :-)iAXP~YER RESPONSE (- -. 'j ii' .-, FILE NO. 21 ACN 06153188 DATE 10-13-2006 2005 DEe I 2 Pr1 2i:~i. OF RICHARD N PETERSON S.S. NO. 086-20-0896 CLERi< OF DATE OF DEATH 07-17-2006 ORPr.I/\i'!'S COURTCOUNTY CUMBERLAND C~L,lf r"''""'1 F/I. TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST IX] CERTIF. KAREN J MARCH 3755 MOUNTAIN VIEW RD MECHANICSBURG PA 17050 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has provided the Departllent 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 infor.ation is incorrect, please obtain written correction from 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 Com.onwealth 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. 118029-49 Date 09-28-2004 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 5,342.82 16.667 890.49 .045 40.07 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice must accompany your pay.ent to the Register of Wills. Make check payable to: "Register of Wills, Agent". Tax x NOTE: If tax pay.ents are made within three (3) lIonths of the decedent's date of death, you .ay deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. PART [II 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 .ay check box "A" and return this notice to the Register of Wills and an official assesseent will be issued by the PA Depart.ent of Revenue. [CHECK ] ONE BLOCK ONLY B. [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. C. [J The above information is incorrect and/or debts and deductions were peid by you. You must co.plete PART ~ and/or PART ~ below. If you indicate a different tax rate, please state your relationship to decedent: PART @] TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 X 8, Tax Due 8 PART [!J DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ perjury, I declare that the facts I have reported above are true, correct and knowledge and belief. HOME ) 73;;. (/(/(1' ~ ) MBER 1/.:3JJ6~ DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128~0601 *5 INFORMATION NOTICE JF!Cf.iiipA YE:N~ESPONS E FILE NO. 21 ACN 06153186 DATE 10-13-2006 r",j" i ",;' i J REV-154J~X.~~P:,' If': Qdl ' . KAREN J MARCH 3755 MOUNTAIN VIEW RD MECHANICSBURG PA 17050 2006 DEe 12 PH 2: 1 iST. OF RICHARD N PETERSON S.S. NO. 086-20-0896 CLERK OF DATE OF DEATH 07-17-2006 ORPHAi\j'S COUFiT COUNTY CUMBERLAND ('ll' d' ,,,(', f'1.\. QA .V<' ' - ...." \1\1., ,...." TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST [X] CERTIF. FORMS TO: REMIT PAYMENT AND REGISTER OF WILLS CUMBERLAND CO COURT CARLISLE, PA 17013 HOUSE MEMBERS 1ST FCU has provided the Department with the inforllation 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 infor.ation is incorrect, please obtain written correction fro. the financial institution, attach a copy to this for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co.monwealth 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. 118029-56 Date 08-03-2004 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 10,714.93 16.667 1,785.86 .045 80.36 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice must acco.pany 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 .ay deduct a 5% discount of the tax due. Any inheritance tax due will beco.e delinquent nine (9) months after the date of death. Tax PART [II A~ The above information and tax due is correct. 1. You may choose to re.it 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. r=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. C. r=J The above infor.ation 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 @] 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 [!J 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 $ perjury, I declare that the facts I have reported above are true, correct and knowledge and belief. ~~~. ~~~~_ /J.~{) 'eX, DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 R*JFICE ~:XOp:~AEYN~:SNp:::CEE "'-"--";'"'.":- ,',. ,-,.,,'- REVJis4.s.:EX ~FP,?9',.!OI i. '_ FILE NO. 21 ACN 06153184 DATE 10-13-2006 KAREN J MARCH 3755 MOUNTAIN VIEW RD MECHANICSBURG PA 17050 CLERI< OF ORPH. !' \ I 'C:. ("JIIRT i-!l',,!., 1,.1 V 1 f"lll ." ._:' " ",~', r, pr, lJ )'.' . , ' ',.'f\ PM 2: 17 EST. OF RICHARD N PETERSON S.S. NO. 086-20-0896 DATE OF DEATH 07-17-2006 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST !Xl CERTIF. 2006 DEe 12 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU 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 infor.ation 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 Com.onwealth 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. 118029-57 Date 09-01-2004 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 10,714.85 16.667 1,785.84 .045 80.36 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice must acco.pany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". Tax 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 beco.e delinquent nine (9) .onths after the date of death. PART [II A.~ The above information and tax due is correct. 1. You .ay choose to remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or yoU .ay check box "A" and return this notice to the Register of Wills and an official asses~ent will be issued by the PA Depart.ent of Revenue. [CHECK ] ONE BLOCK ONLY If yoU indicate a different tax rate, please state your relationship to decedent: B. c=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. C. c=J The above information is incorrect and/or debts and deductions were paid by you. You must cOMplete PART ~ and/or PART ~ below. 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 [!J DATE PAID DEBTS AND DEDUCTIONS CLAIMED OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 PAYEE I TOTAL (Enter on Line 5 of Tax Computation) declare that the facts I and belief. DESCRIPTION AMOUNT PAID I $ /1,30 .()& DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 n...--:,.r [::I,C. 'I" .j . 1. ~_.'_., '. . ...... ....', I 1,. ~,~. INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 ACN 06153182 DATE 10-13-2006 ~W:.~5~~ i6!"fP(~"-D~ KAREN J MARCH 3755 MOUNTAIN VIEW RD MECHANICSBURG PA 17050 CLEF1K OF ORnl~!";'I'C: r'iJURT ! ~ t'''\, \, ',-,' \~,t I, CUi ,.c, PlI EST. OF RICHARD N PETERSON S.S. NO. 086-20-0896 DATE OF DEATH 07-17-2006 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST 00 CERTIF. 2006 DEe I 2 PM 2: I 7 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU 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. 118029-59 Date 01-29-1993 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 10,579.59 16.667 1,763.30 .045 79.35 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice must acco.pany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". Tax 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. PART [II The above information and tax due is correct. 1. You .ay choose to remit pay.ent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you .ay check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Depart.ent 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. [J The above information 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 @] TAX RETURN - COMPUTATION OF LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 8. Tax Due 8 PART [!J DATE PAID DEBTS AND DEDUCTIONS CLAIMED TAX ON JOINT/TRUST ACCOUNTS x x PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter 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. I $ have reported above are true, correct and -- ) 7. ,~~ . <I c/ (j; ,") ) NUMBER HOME ( 71 7 WORK ( TELEPHONE //.3/).(J0 DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *Ci I OF;;;:A~AEY.:'fESNpOO:ISCEE REV-154! E~'~'~~~D'; FILE NO. 21 ACN 06153196 DATE 10-13-2006 KAREN J MARCH 3755 MOUNTAIN VIEW RD MECHANICSBURG PA 17050 TYPE OF ACCOUNT 2006 DEe 12 Pt~ 2: ds7r. OF RICHARD N PETERSON 0 SAVINGS S. S. NO. 086-20-0896 0 CHECKING CLERK OF DATE OF DEATH 07-17-2006 0 TRUST ORPH,to.t-';'~J COURT COUNTY CUMBERLAND 00 CERTIF. CU'I C'-',', 0.\ REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 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 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 Co.monweslth of Pennsylvania. Questions mey be enswered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 118029-40 Date 01-29-1993 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 16,089.93 16.667 2,681.71 .045 120.68 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice .ust accompany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax pay.ents 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 [II A. ~ 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 .ay check box "A" and return this notice to the Register of Wills and an official assesSBent will be issued by the PA Depart.ent of Revenue. [CHECK ] ONE BLOCK ONLY B. [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. C. [] The above infor.ation is incorrect and/or debts and deductions were paid by you. You must co.plete 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 [!J 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 declare that the facts I knowledge and belief. I $ have reported above are true, correct and ) 73;).,. '-I </uS- ) M HOME WORK L //..jja O~ DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 _or. INFORMATION NOTICE ... AND ~~AtER RESPONSE FILE NO. 21 ACN 06153176 DATE 10-13-2006 REV-15~5 EX AFP ,to,"'!,. KAREN J MARCH 3755 MOUNTAIN VIEW RD MECHANICSBURG PA 17050 TYPE OF ACCOUNT 200& DEe' 2 pr1 f2;rlloF RICHARD N PETERSON 0 SAVINGS S.S. NO. 086-20-0896 0 CHECKING "'L""'IK 01-- DATE OF DEATH 07-17-2006 0 TRUST V tl'~ ' rvl ORPH,~l'!'S,~,C,)9\~, \ ~~..,TY CUMBERLAND lXJ CERTIF. CI.l.,~"" , !, \ REMIT PAYMENT AND FORMS TO: ~ REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU 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 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 Com.onwealth 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. 118029-63 Date 02-06-2006 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 25,555.30 16.667 4,259.30 .045 191.67 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". Tax x NOTE: If tax paYments are .ade within three (3) months of the decedent's date of death, you .ay deduct a 5% discount of the tax due. Any inheritance tax due will beco.e delinquent nine (9) months after the date of death. PART [II A. ~ The above infor.ation and tax due is correct. 1. You .ay choose to remit pay.ent 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 assess.ent will be issued by the PA Department of Revenue. [CHECK ] ONE BLOCK ONLY B. c=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. C. [] The above infor.ation 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 @] TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 PART [!J DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) perjury, I declare that the facts I my knowledge and belief. I $ have reported above are true, correct and (/7/'1 ) ?3~. yt/(j;6~ ( ) PH UM HOME WORK T L // ~()cJ(~ DA E COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 . INFORMATION NOTICE r!("c r '. AND ':" .,--' C r"A TAXPAYER RESPONSE REV-~.;i~{AFP =' o~ ~i: ' FILE NO. 21 ACN 06153180 DATE 10-13-2006 KAREN J MARCH 3755 MOUNTAIN VIEW RD MECHANICSBURG PA 17050 ,..., E'-;" Or vL -rif\ r ORPl.'f.'J\!'S,.~Q9RT rl i' ' , , V< PH 2: 11EST. OF RICHARD N PETERSON S.S. NO. 086-20-0896 DATE OF DEATH 07-17-2006 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST IX] CERTIF. 2005 DEe I 2 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has provided the Departllent with the inforllation 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 COllmonwealth of PennsYlvania. Questions .ay be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 118029-60 Date 01-29-1993 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 20,885.21 16.667 3,480.94 .045 156.64 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". Tax x NOTE: If tax payments are made within three (3) lIonths 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. PART [II A. ~ 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 If yoU indicate a different tax rate, please state your relationship to decedent: B. c=J The above asset has been or will be reported and tax paid with the PennSYlvania Inheritence Tax return to be filed by the decedent's representative. C. [J The above information is incorrect and/or debts and deductions were paid by you. You IIUSt complete PART ~ and/or PART ~ below. 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 [!J 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 $ perjury, I declare that the facts I my knowledge and belief. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *v '" '" - : -' C' " REV-i5U',6l!';~p -,O~~Ob.I' INFORMATION NOTICE r'r.(: r' AND :'\..II::''t~XPAYER RESPONSE ", FILE NO. 21 ACN 06153178 DATE 10-13-2006 zonG DEe 12 PM 2: \ lEST. OF RICHARD N PETERSON S.S. NO. 086-20-0896 DATE OF DEATH 07-17-2006 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST 00 CERTIF. KAREN J MARCH 3755 MOUNTAIN VIEW RD MECHANICSBURG PA 17050 CLEr-:"f 01= nf\ 'I .,.. t. ,,'" rr,! \'R" I ORP\.J '."\, ',", v..Jvl .~,\ ,) '.. .:" \r~-\ ,,-".f"\ Pt\ 0\ IL! ' ' \.J..... ; REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has provided the Departllent 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 inforllation is incorrect, please obtain written correction fro. the financial institution, attach a copy to this for. and return it to 'the above address. This account is taxable in accordance with the Inheritance Tax laws of the Co.monwealth 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. 118029-61 Date 01-29-1993 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 10,342.20 16.667 1,723.73 .045 77.57 TAXPAYER RESPONSE To insure proper credit to your acco~t, two (2) copies of this notice must accompany your paY.ent to the Register of Wills. Make check payable to: "Register of Wills, Agent". Tax x NOTE: If tax payments are made within three (3) .onths 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) .onths after the date of death. PART [II A.'1sJ The above infor.ation and tax due is correct. 1. You may choose to re.it pay.ent to the Register of Wills with two copies of this notice to obtain a disco~t or avoid interest, or you may check box "A" and return this notice to the Register of Wills and an official assess.ent will be issued by the PA Department of Revenue. [CHECK ] ONE BLOCK ONLY B. [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. C. [] The above infor.ation 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 @] 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 [!J DATE PAID DEBTS AND DEDUCTIONS CLAIMED OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 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 7 ~~.;;l . W w -"}- jb~~.{)& COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 .or ,.-v, 1__, REV-1545 iE~P: 109-8'1 ' INFORMATION NOTICE ~. ,-, AND n:::C!uiM~PAYER RESPONSE ....-'" ,_..~ - FILE NO. 21 ACN 06153174 DATE 10-13-2006 .~ KAREN J MARCH 3755 MOUNTAIN VIEW RD MECHANICSBURG PA 17050 TYPE OF ACCOUNT 2006 DEe 12 PM 2: EfST. OF RICHARD N PETERSON 0 SAVINGS S. S. NO. 086-20-0896 0 CHECKING CLEf-iK OF DATE OF DEATH 07-17-2006 0 TRUST ORPHt\N'S COURT COUNTY CUMBERLAND IX) CERTIF. CU\/'" I" i:/\ REGIS~;~T ;~Y~E:~L~ND FORMS TO: CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU 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 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 Co.monwealth of PennsYlvania. Questions .ay be answElrDd by clilling (717) 787"1I3Z7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 118029-62 Date 12-20-2005 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x .00 50.000 .00 .045 .00 TAXPAYER RESPONSE To insure proper credit to Your account, two (2) copies of this notice must acco.pany your payment to the Register of Wills. Make check peyable to: "Register of Wills, Agent". Tax x NOTE: If tax pay.ents are .ade within three (3) .onths of the decedent's date of death, yoU .ay deduct a 5% discount of the tax due. Any inheritance tax due will beco.e delinquent nine (9) .onths after the dete of death. PART [II A. ~ The above information and tax due is correct. 1. You .ay choose to remit pay.ent 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 assess_ent will be issued by the PA Department of Revenue. [CHECK ] ONE BLOCK ONLY If yOU indicate a different tax rate, please state your relationship to decedent: B. r=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. C. r=J The above infor~tion is incorrect and/or debts and deductions were paid by you. You .ust complete PART ~ and/or PART ~ below. PART @] TAX RETURN - COMPUTATION OF LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 8. Tax Due 8 PART [!J DATE PAID DEBTS AND DEDUCTIONS CLAIMED TAX ON JOINT/TRUST ACCOUNTS x x PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) $ facts I have reported above are true, correct and HOME 73.;;>. .<,/c.j&~ //.3o,CJ0 DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 :~ '4MM _, ._,......, ,",,~" I REV-l~ r:: '~'I~'" 1,!,~pJt,- ' INFORMATION NOTICE FFlCEYAXPA VE:N~ESPONS E I, L. .~. FILE NO. 21 ACN 06153175 DATE 10-13-2006 ETHEL J PETERSON 1520 SELTZER CT MECHANICSBURG CLERK OF ORPHP\I\l'S COURT cu\r-:,':'" P!\ PM 2: IltST. OF RICHARD N PETERSON S.S. NO. 086-20-0896 DATE OF DEATH 07-17-2006 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST OCI CERTIF. 200& DEe I 2 PA 17050 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU 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 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 Com.onwealth of PennsYlvania. Questions may be answered by ceiling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 118029-63 Date 02-06-2006 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 25,555.30 16.667 4,259.30 .00 .00 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice must accompany your pay.ent to the Register of Wills. Make check payable to: "Register of Wills, Agent". Tax x NOTE: If tax payments are .ade within three (3) .onths 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. PART [II 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 .ay check box "A" and return this notica to the Register of Wills and an official asseSSBent will be issued by the PA Depart.ent 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. [J The above information is incorrect and/or debts and deductions were paid by you. You .ust 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 [!J 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 TOTAL (Enter on Line 5 of Tax Computation) I $ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 _t, 0C(\f " .\<, :''', "'-'.i..-\r._i' .. ".'~ :~,~ \;'('1 '-". I:: ;Rt~~~ ':Ex ':A:p...i';'-brl) ',,' ,\ L ;'".1 INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 ACN 06153177 DATE 10-13-2006 ETHEL J PETERSON 1520 SELTZER CT MECHANICSBURG '[nun GEe \ 2 p~" 2: \ 4 Cll:FK O~, \r:'T ORPH~N:S C\:~:." 1 ?~ ('\ \~..r-:' . , " V\.....". EST. OF RICHARD N PETERSON S.S. NO. 086-20-0896 DATE OF DEATH 07-17-2006 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST [Xl CERTIF. PA 17050 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has provided the Depart.ent 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 infor.etion 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 Commonwealth of Pennsylvania. Questions .ay be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 118029-61 Date 01-29-1993 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 10,342.20 16.667 1,723.73 .00 .00 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 .ade within three (3) months of the decedent's date of death, you .ay deduct a 5% discount of the tex due. Any inheritance tax due will beco.e delinquent nine (9) months after the date of death. Tax PART [II The above infor.ation and tax due is correct. 1. You may choose to re.it payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you .ay check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Depart.ent 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. [J The above information is incorrect and/or debts and deductions were paid by you. You .ust complate PART ~ and/or PART ~ below. If you indicate a different tax rate, please state your relationship to decedent: PART [!J DATE PAID DEBTS AND DEDUCTIONS CLAIMED 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 TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ I have reported above are true, correct and '7~ . 4-%~")'- (7/7 ) ( ) HONE NUMBER / ;.~{) 'd~ DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 '* INFORMATION NOTICE ~""J'\r j-:: AND .., ,CX) C'r:\i:TAXPAYER RESPONSE ",.J1,..' ,'" ,: ',-,,' \ '~,.. - ':: i ~,11! " :"~ REv-lm~x.lfP(09H'1 . . , FILE NO. 21 ACN 06153179 DATE 10-13-2006 ETHEL J PETERSON 1520 SELTZER CT MECHANICSBURG PA 17050 TYPE OF ACCOUNT or DEe \ Z ?I~ 2: J~. OF RICHARD N PETERSON 0 SAVINGS 2auo S.S. NO. 086-20-0896 0 CHECKING OP.?~~~ g9~~ql~~~F DEAT~UM:~;~~~~006 ~ ;~;.. Cljl;'!- . . . REGISR:~~T ;;Y~e:~L~ND FORMS TO: CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU 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 infor.ation is incorrect, please obtain written correction fro. the financial institution, attach a copy to this for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Co.monwealth of Pennsylvania. Questions may be answered by calli..g (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 118029-60 Date 01-29-1993 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 20,885.21 16.667 3,480.94 .00 .00 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) .onths 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) .onths after the date of death. Tax PART [II A.~ The above information and tax due is correct. 1. You .ay choose to remit pay.ent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or yoU .ay check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Oepart.ent of Revenue. [CHECK ] ONE BLOCK ONLY B. [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. C. [J The above infor.ation is incorrect and/or debts and deductions were paid by you. You must co.plete PART ~ and/or PART ~ below. If you indicate a different tax rate, please state your relationship to decedent: PART @] TAX RETURN - COMPUTATION OF LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 8. Tax Due 8 PART [!J DATE PAID DEBTS AND DEDUCTIONS CLAIMED TAX ON JOINT/TRUST ACCOUNTS x x PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ I have reported above are true, correct and HOME ~.~~&~- 1/..30.0& DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 _INFORMATION NOTICE '.n.. l~n. .'" --'("\r ......-. AND f 1,-' ... ,I , ., . J", ;.,"-LJ dfIDAYER RESPONSE r\ FILE ACN DATE NO. 21 06153195 10-13-2006 o'" ~ ~~' t.", , r REV-I545 EX AFP !~U~'l. ETHEL J PETERSON 1520 SELTZER CT MECHANICSBURG PA 17050 Z006 DEe I 2 PM as~.4 OF RICHARD N PETERSON S.S. NO. 086-20-0896 CLERf< OF DATE OF DEATH 07-17-2006 ORFH4N'S COUfWUNTY CUMBERLAND cur H"-', ' ".. ."" pI 11',/- ," "':.: '...,::, 1 :~/-i TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST !Xl CERTIF. REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU 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 Co.monwealth of Pennsylvania. Questions .ay be an~wered by. calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 118029-40 Date 01-29-1993 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 16,089.93 16.667 2,681. 71 .00 .00 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice .ust accompany your pay.ent to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax pay.ents 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) .onths after the date of death. Tax PART [II 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 Depart.ent of Revenue. [CHECK ] ONE BLOCK ONLY B. [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. C. [] The above infor.ation 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 @] 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 [!J 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 $ are true, correct and 1/ '..:2(} .06 DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 Dr::~.r'IC i_,~li'__ ir".(",';."'"~:-~! {- ~~:"! j ;{y.;~4~ ~HFP tl9Luoi' ,~'.j INFORMATION NOTICE (-I~ AND 'iTAXPAYER RESPONSE FILE NO. 21 ACN 06153197 DATE 10-13-2006 CLERf< OF ORPH" "r" "nl 'RT , . ,F,,\J ,) :'..!'v'.1 i ('l i ~'J"~; ,., , , o~, V JI.: 1"'/. EST. OF RICHARD N PETERSON S.S. NO. 086-20-0896 DATE OF DEATH 07-17-2006 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS iii CHECKING o TRUST o CERTIF. Z006 DEe I 2 PM 2: I 4 ETHEL J PETERSON 1520 SELTZER CT MECHANICSBURG PA 17050 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU 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 fro. the financial institution, attach a copy to this fo~ and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Co.monwealth of PennsYlvania. Questions .ay be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 118029-11 Date 01-29-1993 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 21,416.51 16.667 3,569.49 .00 .00 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice must acco.pany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax pay.ents 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 [II A;~ The above information and tax due is correct. 1. You may choose to re.it 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. r=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. C. r=J The above information is incorrect and/or debts and deductions were paid by you. You .ust complete PART ~ and/or PART ~ below. If you indicate a different tax rate, please state your relationship to decedent: PART @] TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date EstablIshed 1 2. Account Balance 2 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 PART [!J DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ facts I have reported above are true, correct and HOME 7.302 ' ~ ~fL, 6 /~.aG,()i? ATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE - AND , : "':1'-0 OFCI(!A)<PAYER RESPONSE . -" '-~, -- . '...- > REV-15d~ IAf;'iol4iDi , FILE NO. 21 ACN 06153199 DATE 10-13-2006 TYPE OF ACCOUNT iii SAVINGS o CHECKING o TRUST o CERTIF. ETHEL J PETERSON 1520 SELTZER CT MECHANICSBURG CLERK OF OnDi.J",\!'S ::(11 IRT rll . J d 'I ''''" v,~~,~1 CUI'! . , /\:, Pr'l 2: liisT. OF RICHARD N PETERSON S.S. NO. 086-20-0896 DATE OF DEATH 07-17-2006 COUNTY CUMBERLAND 2006 DEe I 2 PA 17050 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU 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 for. 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. 118029-00 Date 01-29-1993 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 6,452.29 16.667 1,075.40 .00 .00 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". Tax x NOTE: If tax payments are made within three (3) months of the decedent's date of death, yoU .ay deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. PART [II 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. r=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. C. c=J The above information 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 @] 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 [!J 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 $ facts I have reported above are true, correct and HOME (;;/1) ?~d2. c/~u5- WORK () /1- Jj{J ,od-J TELEPHONE NUMB R DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 .~ .eli '\= f'lNFORMA~INODN NOTICE Qr::~i i ':'" ,: TAXPAYER RESPONSE 1 \ __\j,.....' ...... .,__'"",\ (" _ ,r '''' 'H~~ '~~;4F~ ['''~'~Dl: FILE NO. 21 ACN 06153181 DATE 10-13-2006 1GGn DEe \ 2. pf\ 2.~ \ 4 EST. OF RICHARD N PETERSON S.S. NO. 086-20-0896 DATE OF DEATH 07-17-2006 COUNTY CUMBERLAND TVPE OF ACCOUNT o SAVINGS o CHECKING o TRUST [i] CERTIF. ETHEL J PETERSON 1520 SELTZER CT MECHANICS BURG Clcev n~ L,-\;k\ ((,\ lOT OOr.UII'\i'c' ,,)',,;,\1 ~C ,r.~:\ ,,\.. ,~ P\ CUi" REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PA 17050 MEMBERS 1ST FCU has provided the Department with the inforllation 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/beneficiery 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. 118029-59 Date 01-29-1993 Established Account Balance Percent Taxable A.ount Subject to Tax Rate Potential Tax Due x 10,579.59 16.667 1,763.30 .00 .00 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice .ust accompany your paYllent to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax pay.ents are lIade 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 [II A. ~ 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 assessment will be issued by the PA Department of Revenue. [CHECK ] ONE BLOCK ONLY B. r=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. C. [] The above information 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 @] 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 [!J DATE PAID DEBTS AND DEDUCTIONS CLAIMED OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) facts I I $ R /1-.dJ .(J!.tJ DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 Q..[I \~[~t::p::AE:~~:sN:O:ZSCEE RE!,~(!'tX..~ '~9~OO) , . FILE NO. 21 ACN 06153183 DATE 10-13-2006 ETHEL J PETERSON 1520 SELTZER CT MECHANICSBURG C\ \=pv nr- \-.,-Ill"\ v ,~..... ,,.... ,'"".(.....\ d J! 00n1 J I,",\"~' : " I:, ;ill r"\('Cli-": i lJ '-, '-:., - C\" ,;"",, . ,-} ~ . -.' EST. OF RICHARD N PETERSON S.S. NO. 086-20-0896 DATE OF DEATH 07-17-2006 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST IX] CERTIF. LGOb DEe \ 2 Pi" 2: \ 4 PA 17050 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU 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 ebove 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 Co.monwealth of Pennsylvania. Questions .ay be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 118029-57 Date 09-01-2004 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 10,714.85 16.667 1,785.84 .00 .00 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice .ust accompany your pay.ent 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) .onths after the date of death. Tax PART [II The above infor.ation and tax due is correct. 1. You .ay choose to remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you .ay 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. If you indicate a different tax rate, please state your relationship to decedent: PART @] TAX RETURN - COMPUTATION OF LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 8. Tax Due 8 PART [!J DATE PAID DEBTS AND DEDUCTIONS CLAIMED TAX ON JOINT/TRUST ACCOUNTS x x PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ perjury, I my knowledge and facts I have reported above are true, correct and 13d- ' LIe; &~~- HOME (7/7) WORK ( ) ELEPHONE NUMBER / /. So 'o~ DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 laM"", " ,,"'D'\'.' . . ': 'J,.I).} \'-:'_:~_"_'" '~'f.' C'-~t"'i~4h~ Aip 109-001 INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 ACN 06153185 DATE 10-13-2006 \ '2. ?:f\?~ \ l~un Dr.\:' EST. OF RICHARD N PETERSON S.S. NO. 086-20-0896 DATE OF DEATH 07-17-2006 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST !Xl CERTIF. ......,,/ (-\c. C' \-\-'\" '" ~ \ 'D1' ,__o--lp("> C'I\\,.J\ \ \ D' It,h'" ,.".J " OQr'.\.-."'....I.~....... ,..... r'i \ \ \,\ J ~ \ '" "', ' "'\ ii,''''' ETHEL J PETERSON v~\ 1520 SELTZER CT MECHANICSBURG PA 17050 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU 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. 118029-56 Date 08-03-2004 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 10,714.93 16.667 1,785.86 .00 .00 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 [II A.~ 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 assesSBent 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. [J The above information 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 @] TAX RETURN - COMPUTATION LINE 1. Date Esiablished 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 [!J 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 $ facts I have reported above are true, correct and 73,). c..; <I C?~ HOME ('7/7) WORK ( ) T LEPHONE N MBER J;' .30. ottJ DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 o-,~.b "\r-\, .\ )"Y\,-)c...'..J ......1.._ . I'"~ -':j~.-I5~,EN'1"'m"'~I,. __ INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 06153173 10-13-2006 i '..._,..." .~ ETHEL J PETERSON 1520 SELTZER CT MECHANICS BURG 7.n~'o DEe \ 2 PM 2~ \ 5 C\ r. ~,\1 o~ ~hf'\ 1 opp:!7~r\'S,S~9\~~1 C):\ 0\ \\::' , v""" ..' EST. OF RICHARD N PETERSON S.S. NO. 086-20-0896 DATE OF DEATH 07-17-2006 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST IX] CERTIF. PA 17050 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has provided the Department with the inforllation listed below which has been used in calculating the potential tax due. Their records indicate that at the deeth 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 Co.monwealth 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. 118029-62 Date 12-20-2005 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x .00 50.000 .00 .00 .00 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice must accompany your pay.ent to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax payments are made within three (3) .onths of the decedent's date of deeth, you lIay deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent nine (9) .onths after the date of death. Tax PART [II A.~ 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. [] 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. If you indicate a different tax rate, please state your relationship to decedent: PART @] TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date EstablIshed 1 2. Account Balance 2 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 PART [!J DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) facts I I $ J/ ~ ()J) DA COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 - ~::~,~(: C"\, 'I"~ ,-: REV-154J gtt"'lo!l~aal -r.,~PRMATION NOTICE ,;''''','", '. AND 1:'iT~PAYER RESPONSE FILE NO. 21 ACN 06153193 DATE 10-13-2006 Er. \ 2 Pt'1 2: \ 5 2M~, D ..v - uuu-- EST. OF RICHARD N PETERSON S.S. NO. 086-20-0896 C~~~,~ ~'Rl :R"f DATE OF DEATH 07-17-2006 OPPhr' , ,~ '~' J ~ p,~OUNTY CUMBERLAND CL TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST 00 CERTIF. ETHEL J PETERSON 1520 SELTZER CT MECHANICSBURG PA 17050 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU 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 infor.ation is incorrect, please obtain written correction fro. the financial institution, attach a COpy to this for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co..onwealth of Pennsylvania. QUBstion:; may be answe,iid blr calling ~717) 787"63,7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 118029-44 Date 01-06-2005 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 53,279.43 16.667 8,880.08 .00 .00 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice must accompany your pay.ent to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax pay.ents are made within three (3) .onths 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 [II The above information and tax due is correct. 1. You may choose to re.it pay.ent 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. 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 [!J 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 $ facts I have reported above are true, correct and ? 3.2 c../ V>~'J ").-- R / /..,3o.och DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 . INFORMATION NOTICE --\'-'C r,c,' AND " -\ i .,\~i\j'~TAXPAYER RESPONSE r""1""" 0\ ":~.. )'. ',' REVIi~4!~~Y:~:'-:t~fq.,( FILE NO. 21 ACN 06153191 DATE 10-13-2006 ; I'~. TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST [X] CERTIF. FORMS TO: ETHEL J PETERSON 1520 SELTZER CT MECHANICSBURG M 2' \ S l. \ 2. ?n ' EST. OF RICHARD N PETERSON 1~~~Dt. S.S. NO. 086-20-0896 Q~ nr DATE OF DEATH 07-17-2006 y\~,\ii~' to\.\8\ ~pUNTY CUMBERLAND OnlJ;- L.I.\ \ ,J ,- ..~. \, ',-. \\\,;"', '. ,- '....., . , ' REMIT PAYMENT AND r,\ \,;' ".' REGISTER OF WILLS ~~ CUMBERLAND CO COURT CARLISLE, PA 17013 HOUSE PA 17050 MEMBERS 1ST FCU has provided the Depart.ent 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. Question$ .ay be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 118029-45 Date 01-06-2005 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 53,514.93 16.667 8,919.33 .00 .00 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice must eccompany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax payments are .ade 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) .onths after the date of death. Tax PART [II A~ The above infor.ation and tax due is correct. 1. You .ay choose to re.it pay.ent 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 Depart.ent 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. [J The above information is incorrect and/or debts and deductions were paid by you. You must co.plete PART ~ and/or PART ~ below. If you indicate a different tax rate, please state your relationship to decedent: PART [!J DATE PAID DEBTS AND DEDUCTIONS CLAIMED 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 PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ facts I have reported above are true, correct and ?,gc~' ~<;.tft,S ) ) UMBER /1- .30'0& DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 * INFORMATION NOTICE AND DC( ('\pnCfM:'f~:'E~ RESPONSE t.__, \j. ",._,-_,_ -' REV-1545 EX AFP 109-0.0\ 1'" FILE NO. 21 ACN 06153189 DATE 10-13-2006 TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST [X] CERTIF. FORMS TO: ETHEL J PETERSON 1520 SELTZER CT MECHANICSBURG PA 17050 2006 DEe 12 ~~: ~~. RICH::~_:o~~~~:SON ,DS~~;g\ (~~;r~F DEAT~UM~~;~~~~006 QRI}:~: ,', ". ::, REMIT PAYMENT AND CU\ · . REGISTER OF WILLS CUMBERLAND CO COURT CARLISLE, PA 17013 HOUSE MEMBERS 1ST FCU 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 Co.monwealth of PennsYlvania. Questions may be answered by calling (717) 787-83Z7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 118029-46 Date 02-04-2005 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 21,094.91 16.667 3,515.89 .00 .00 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) .onths 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) .onths after the date of death. Tax PART [II A.~ 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 assess.ent 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. [J The above information 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 [!J DATE PAID DEBTS AND DEDUCTIONS CLAIMED PART @] TAX RETURN - COMPUTATION OF LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 8. Tax Due 8 TAX ON JOINT/TRUST ACCOUNTS x x PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation> I $ of perjury, I declare that the facts I y knowledge and belief. have reported above are true, correct HOME (7/')) ?c9.;2 -i,k{,/&_",> WORK ( ) ELEPHONE MBER and 11.3tJ oz, DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 ,)c'I'n~n*'} ; j. , ,\,; \...,.; ..~.'........- .." -::,~~, ('i!~-<!S~r~ AfPf09-0QI I '., .<\_; , '- INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 06153187 10-13-2006 ZUO& DEe \ 2 PN 2: t 5 EST. OF RICHARD N PETERSON S.S. NO. 086-20-0896 DATE OF DEATH 07-17-2006 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST 00 CERTIF. Cl EFi\ Of n- -: ~ l!i...... f-'i,l \~_,.J \ OPP\.L\;\I.; V'..."." \ I !1 '--.\~_. ',' " "~":"'I ,''''' ,F_", P,t.'. ETHEL J PETERSIOl:' 1520 SELTZER CT MECHANICSBURG PA 17050 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU 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 for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of PennsYlvania. Questions .ay be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 118029-49 Date 09-28-2004 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 5,342.82 16.667 890.49 .00 .00 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 [II A.~ 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. [] 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. c=J The above information 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 @] TAX RETURN - COMPUTATION OF LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 8. Tax Due 8 PART [!J DATE PAID DEBTS AND DEDUCTIONS CLAIMED TAX ON JOINT/TRUST ACCOUNTS x x PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter 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. I $ have reported above are true, correct and HOME (7/7) 73.;l.<.../V~~- WORK ( ) TELEPHON NUMBER JI.~tloot, 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 NO, CD 007558 DUPLICA TE MARCH KAREN J 3755 MOUNTAIN VIEW ROAD MECHANICSBURG, PA 17050 __n_h_ fold ESTATE INFORMATION: SSN: 086.20.0896 FILE NUMBER: 2106-1101 DECEDENT NAME: PETERSON RICHARD N DA TE OF PAYMENT: 12/13/2006 POSTMARK DATE: 11 /30/2006 COUNTY: CUMBERLAND DATE OF DEATH: 07/17/2006 ACN ASSESSMENT CONTROL NUMBER AMOUNT 06153200 06153198 06153194 06153192 06153190 06153188 06153186 06153184 06153182 $48.39 $160.63 $399.60 $401.37 $158.22 $ 40.07 $80.36 $80.36 $79.35 TOTAL AMOUNT PAID: REMARKS: KAREN J MARCH CHECK# 1041 SEAL INITIALS: WZ RECEIVED BY: REGISTER OF WILLS $1,448.35 GLENDA FARNER STRASBAUGH REGISTER OF WILLS 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 NO, CD 007559 MARCH KAREN J 3755 MOUNTAIN VIEW ROAD MECHANICSBURG, PA 17050 __h_h_ fold ACN ASSESSMENT CONTROL NUMBER AMOUNT ESTATE INFORMATION: SSN: 086-20-0896 FILE NUMBER: 2106-1101 DECEDENT NAME: PETERSON RICHARD N DA TE OF PA YMENT: 12/13/2006 POSTMARK DATE: 11/30/2006 COUNTY: CUMBERLAND DATE OF DEATH: 07/17/2006 06153196 06153176 06153180 06153178 $120.68 $191.67 $156.64 $77.57 TOTAL AMOUNT PAID: $546.56 REMARKS: KAREN J MARCH CHECK# 1041 SEAL INITIALS: WZ RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS \ \ \ "- " ;- (J (' :t\J- l>OZlII\J JJ :tCl> JJOJmJJo (j)~~~m ~I\):;c;g JJggZOJJ G>0'l(")"~ Om-::::' )>"tJ .... ~ Z m )>OZ ..... ><<-1 ""-I -0 .... 00 I\) -C" C/O :Sl>JJ o ~r-m O'l 0 < ~ Z:;m ><Z mC CJ)m q; co co co co :z ~~ S ow:;:j~ ~:=>~:J --; .c.n; ~ ::z