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Home My WebLink About09-06-07 (2) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 '* INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 07 C)~ 22... 07125551 06-08-2007 REV"lS4'3 EX /lFp (09~DO) I Z~:r}7 S'.- .~, ,. " {). i.. J TYPE OF -J ";.~:~ \.-' ,-" ACCOUNT o SAVINGS [X] CHECK ING o TRUST o CERTIF. EST. OF DORA J SHUMATE S.S. NO. 226-10-1432 DATE OF DEATH 04-20-2007 COUNTY CUMBERLAND ,"'...., (lr'). u ('.: J ** THOMAS K SHUMATE 406 SPRING HOUSE RD CAMP HILL PA 17011 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CITIZENS BANK OF PA 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 P2nnsYlvanio:. Questions may be answe~ed b,. cal1in~ C7l7) 787..8327. Account No. 6218189094 COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Date 04-04-2007 Establ1shed To insure proper credit to your account, two (2) copies of this notice must accompany YOUI' payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART ill 8,204.04 X 50.000 4,102.02 X .045 184.59 TAXPAYER RESPONSE NOTE: If tax payments are made within three (3) months of the decedent's date of death, yoU may deduct a 57, discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. [CHECK] ONE BLOCK ONLY A. [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 assessment will be issued by the PA Department of Revenue. 8. [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. .K1 T.he above information is incorrect lln<t.._~.~:; :,,<1 <I.II11.h!." lJtr. ~_~d h~ ~-. """ ""', --"PAt. PlI.Rl @J ,,,..1.',- PAPT ~ ___n_ DGC E1?6'NT OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 PART ~ TAX RETURN - COMPUTATION If YOU indicate a different tax rate, please state your relationship to decedent: NOI,r--f(ESi tJE'tVT LINE l. 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 f!1 DATE PAID PAYEE DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID 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. have reported above are true, correct and HOME (""r 7) '"7"t;" ~- $6 .,.~ WORK ( ) TI=I I=p/.ln"lI= IIII1MRi:=D nATr- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1712870601 '* INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO.21 01 08'27... 07125552 06-08-2007 S'~--~ll - b .:._i...,.... (' \~f L,__ , rlo~';--' \.ji I REV.1543 EX AFP (09-00) (!. 1 ~ u" vV TYPE OF ACCOUNT o SAVINGS [iJ CHECK I NG o TRUST o CERTIF. J ~ \ j EST. OF DORA J SHUMATE S.S. NO. 226-10-1432 DATE OF DEATH 04-20-2007 COUNTY CUMBERLAND r-' ** SUSANNE M SHUMATE 406 SPRING HOUSE RD CAMP HILL PA 17011 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CITIZENS BANK OF PA 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 Pennsslvania. Questions may be answered by ~al1ing (717) 787~83Z7. Account No. 6218189094 COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Date 04-04-2007 Establ1shed 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". Account Balance Percent Taxable Amount SUbject to Tax Tax Rate Potential Tax Due PART [!] 8,204.04 X 50.000 4,102.02 X .045 184.59 TAXPAYER RESPONSE 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. [CHECK ] ONE BLOCK ONLY A. c=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, Of" YOU may check box "AU and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. 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. , ~ ;:: ::::0,:::::::';::, 'M":::::~' ;::; -t:J'~:<" O~ ~-V~=r" 1$ "'A- NOM - Ross I P~T PART [3J TAX If yoU indicate a different tax rate, please state your relationship to decedent: RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due PART @] DATE PAID PAYEE I DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) $ Under penalties of perjury, I declare that the facts complete to the best of my knowledge and belief. ~ I JTl~, _ ,-'A -::1:-; TAXPAYER SIGNATURE V' have reported above are true, correct and HOME (717) ?~/--G'76:x:t WORK ( ) TELEPHONE NUMBER DATE