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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 171Z8-0601
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"",,
IIEV-1545 EX if' ( ..~
INFORMATION NOTICE
--crY~i;~~~:N~ESPONSE
,"..- ;r\ r \ "t',J! ; ': (~
FILE NO. 21 ~ (0\.03
ACN 06159506
DATE 12-05-2006
~
2006 DE I) Ai'~dt .0 ~F JANE F BURKETT
S.S. NO. 194-24-2208
J../ ~... (.-;lFRK O..F.. D.ATE OF DEATH 09-16-2006
/r'. OAPr COldifurry CUMBERLAND
. WBr ...-' . PA REHIT PAYHENT AND
SUE E HAHN REGISTER OF WILLS
612 LYMAN AVE CUMBERLAND CO COURT
WOMELSDORF PA 19567 CARLISLE, PA 17013
TYPE OF ACCOUNT
D SAVINGS
o CHECKING
D TRUST
!Xl CERTIF .
FORHS TO:
HOUSE
HEHBERS 1ST FCU has provided the Departaent Nith the info~ation listed belON Nhich has bllen used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, YOU Nere a joint owner/beneficiary of
this account. If you feel this infor_tion is incorrect, pleasa obtain Nritten correction froa the financial institution, attach a copy
to this fo~ and return it to the above address. This account is taxable in accordance Nith the Inheritance Tax L_s of the C~eelth
of Pllnnsylvllnia. ~esti~s _y be answered by calling (717) 787-83Z7.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
ACCO\mt No. 203464-40 Date 08-31-2005
EstBbl1shed
Account BelllnCe
Percent Taxable
AIIount Subject to
Tax Rate
Potential Tax Due
x
33,578.89
16.667
5,596.59
.045
251.85
TAXPAYER RESPONSE
To insure proper credit to your acc:aunt, two
(Z) copies of this notice -.1st acco.peny your
payaent to the Register of lIills. lIBke check
payable to: -Register of lIills, Agent".
x
NOTE: If tax paYll8l1ts are IIade Nithin three
(3) IIOf1ths of the decedent"s date of death,
you _y deduct a 5% discount of the tax due.
Any inhari tance tax due Nill ~ delinqwnt
nine (9) IIOf1ths after the date of death.
Tax
PART
[!]
he above infor.-tlon and tax due is correct.
1. You aay choose to r_it payaent to the Register of Wills Nith two copies of this notice to obtain
a discount or avoid interest, or you aay check box "A" and return this notice to the Register of
Wills and an official assesS8ent Nill be issued by the PA Departeent of Revenue.
[CHECK ]
ONE
BLOCK
ONLY
B. c=l The above asset has been or Nil I be reported and tax paid Nith the Pennsylvania Inheritance Tax return
to be filed by the decedent.s representative.
C. 0 The above infor_tion is incorrect and/or debts and deductions ...re paid by YOU.
You Bust coeplete PART 0 and/or PART @] belON.
If you indicete 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 Texable 3 X
4. AiIount Subject to Tax 4
5. Debts and Deductions 5
6. A.ount Taxable 6
7. Tax Rate 7 X
8. Tex Due 8
PART
[!]
DATE PAID
J~/I~~i
PAYEE
I
TOTAL (Enter on Line 5 of Tax C~tetion)
DESCRIPTION
be/" djAe,~
AMOUNT PAID
<< ? '1. "2.G,
I
$
Under ~lties of perjury, I declare that the
ete to the pOf. knowledge and belief.
A
fects I heve reported above ere true, correct and
:~=: t<1.2 ~ ,~ - 0I0SS'"
TELEPHONrNURmr /?;~3/~
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
HAHN SUELLEN
612 LYMAN AVE
WOMELSDORF, PA 19567
___uu_ fold
ESTATE INFORMATION: SSN: 194-24-2208
FILE NUMBER: 2106-1063
DECEDENT NAME: BURKETT JANE F
DA TE OF PAYMENT: 12/15/2006
POSTMARK DATE: 12/14/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 09/16/2006
NO. CD 007571
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
06159506 I $239.26
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$239.26
REMARKS:
CHECK#1004
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS