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HomeMy WebLinkAbout06-10-09 (2), • ._ -, BUREAU OF INDIVIDUAL TAXES PO BOX 280601 NARRISBURG PA 17128-0601 REV-1543 IX PENNSYLVANIA INHERITANCE INFORMATION NOTICE AND ~w (~~~: ~~A~PAYE R RE S P O N S E T Z~9 JUa i 0 PM 2~ I ~/~~~Q~~~ ~p~~pC~~A~~Ap~~ ~'y ' 4rlAYlRLflt.tvV4I W , DONALD H MOWERY 166 UNION HALL RD CARLISLE PA 17013 FILE N0. 21 09-0219 ACN 09131074 DATE 05-27-2009 EST. OF MARY J MOWERY SSN 196-14-3126 DATE OF DEATH 02-28-2009 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. CITIZENS BANK OF PA provided the Department with the information below, which has been used in calculating the votential tax due. Records indicate that at the death of the above-named decedent, you were a ioint owner/beneficiary of this account. If you feel the infonation 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. Please call C717) 787-8327 with westions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 6100735478 Date 09-06-1989 To ensure proper credit to the account, two Established copies of this notice ^ust accompaw payment to the Register of Wills. Make check Account Balance $ 2, 690 .71 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are ^ade within three Amount Subject to Tax $ 1,345.36 months of the decedent's date of death, X .045 deduct a 5 percent discount on the tax due. Tax Rate Any Inheritance Tax due will become delinquent Potential Tax Due $ 60 • 54 nine months after the date of death. PART TAXPAYER RESPONSE ~. A. ~ Tha above information and tax due is correct. Remit payment to the Register of Wills with two co pies of this notice to obtain a discount or avoid interest, or check box "A" and return this notice to the Register of CHECK Wills and an official assessment will be issued by the PA Department of Revenue. ONE C B L 0 C K 8. ~ The above asset has been or will be reported and tax D aid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART a below. PART If indicating a different tax rate, Please state ~ " relationship to decedent: ~ TAX RE TURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 rid ~ ~ ~!~'~~ ; (~ ~ d ~ ~ ~ 2. Account Balance 2 $ i ~ ~ ~~~~k r ~ a+. d ' ~ r~ i~(4!yx/ ~ ~~ i } ~ull~i~a~ y!li ~. ~ ~~ , 3. Percent Taxable 3 X 3'e ~ ~ ~Nr.wrw iwwW~ ~~~¢~~ ~ re ~ `p~' ~ 4. Amount Subject to Tax 4 ~ ~,4. ~ 5. Debts and Deductions 5 ~ ~` ~~ ~~w `E 6. Amount Taxable 6 $ ~ , ~,~~. 7. Tax Rate 7 X ~. 8. Tax Due 8 PART a DEBTS AND DEDUCTIONS CLAIMED da penalties of perjury, I declare that the facts I have reported above are true, correct and i mp to to the best of my knowledge and belief. HOME C~ ) S7 ~~~~~ WORK ( /'j ) .S7 ~/v~G SAYER SIGNATURE TELEPHONE NUMBER AT HATE PAiD PAYEE DESCRIPTION AMOUNT PAID BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 ml1-1563 E1( PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE AND FILE N0. 21 09-0219 i (~ ~~T.~ICPAYER RESPONSE ACN 09131072 `~~ ~`` DATE 05-27-2009 1 ~~ n y~h .~ ~.. .. S Z0~! JUN I p P~ ~: ~ 7 1JF11'(~'' (~ ~j' DONALD H MOWERY 166 UNION HALL RD CARLISLE PA 17013 EST. OF MARY J MOWERY SSN 196-14-3126 DATE OF DEATH 02-28-2009 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. CITIZENS BANK OF PA provided the Department with the information below, which has been used in calculating the Dotential tax due. Records indicate that at the death of the above-named decedent, you were a ioint owner/beneficiary of this account. If you feel the 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. Please call (717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 6247351017 Date 07-13-2005 To ensure proper credit to the account, twa Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance ~ 125, 115.28 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NDTE: If tax payments are made within three Amount Subject to Tax $ 62, 557.64 months of the decedent's date of death, Tax Rate ~( , O CF~j deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due ~` 2,815.09 nine months after the data of death. PART TAXPAYER RESPONSE 1^ A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain a discount ar avoid interest, or check box "A" and return this notice to the Register of CHECK Wills and an official assessment will be issued by the PA Department of Revenue. ONE C BLOCK B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions ware paid. Complete PART 2~ and/or PART ~ below. PART If indicating a different tax rate, Please state a relationship to decedent: 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 PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID der penalties of perjury, I declare that the facts I have reported above are true, correct a~ntd c mpleteO to the best of my knowledge and belief. HOME C?l~ ) S7 - IU~I/ ~~KCN~C WORK C717 ) ~~"C~~G ~o .`'~. TAXPAYER SIGNATU E TELEPHONE NUMBER DAT ~e TOTAL CEnter on Lin® 5 of Tax Computation) 6 • BUREAU OF INDIVIDUAL TAXES PO BOX 280601 NARRISBURG PA 17128-0601 PENNSYLVANIA INHERITANCE T INFORMATION NOTICE AND ~ti- ,~ - ~~ ~~~ ~;x~ TAXPAYER RESPONSE vcv_tscs a ~cn coe-oe~ 2009 ,Jt11+1 ! 4 PM Z= t S: COR+~K OF V ~~.. ~., DONALD H MOWERY 166 UNION HALL RD CARLISLE PA 17013 FILE N0. 21 09-0219 ACN 09131073 DATE 05-27-2009 EST. OF MARY J MOWERY SSN 196-14-3126 DATE OF DEATH 02-28-2009 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING: TRUST CERTIF. CITIZENS BANK OF PA provided the Departwant with the inforwation below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-pawed decedent, You were a ioint owner/beneficiary of this account. If you feel the inforwation is incorrect, please obtain written correction frow the financial institution, attach a copy to this forty and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Cowwonwealth of Pennsylvania. Please call C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 6200262210 Date LO-04-2002 To ensure proper credit to the account, two Established copies of this notice roust aceowpany pavwent to the Register of Wills. Make check Account Balance $ 1, 932.60 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTES If tax paywents are wade within three AmOUnt Subject to Tax $ 966.30 wonths of the decedent's date of death, 045 deduct a 5 percent discount on the tax due. ~( Tax Rate . Any Inheritance Tax duo will becowe delinquent Potential Tax Due ~ 43.48 nine wonths after the date of death. PART TAXPAYER RESPONSE A. ~ The above inforwation and tax due is correct. Rewit paywent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or check box "A" and return this notice to the Register of CHECK Wills and an official assesswent will be issued by the PA Departwant of Revenue. ONE C B L 0 C K B. ~C The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y ~y to be tiled by the estate representative. C. ~ The above inforwa son is incorrect and/or debts and deductions were paid. Cowplete PART ~2 and/or PART 3~ below. PART If indicating a different tax rate, please state relationship to decedent: 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 $ PART DATE PAID PAYEE DESCRIPTION AMOUNT PAID penalties of perjury. I declare that the facts I to to the bast of my knowledge and belief . have reported -a7bove HOME C / ~7 are t~r`u7e,[~corre~t nd ) -~ / 7 ~ /d ~~ ~K ~?'Z~C1'Ci~'y WORK C 7V7 ) ,57`r`- ~Q ~d ~o '!' .a F -n nrn-urno TEI FPHCINE NUMBER DATE DEBTS AND DEDUCTIONS CLAIMED TOTAL CEnter on Line 5 or iax compucacion~ PENNSYLVANIA iN'HERITANCE T '-. =y INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AN D PD BDX 280601 ,, ~..~ ~-~ D~ Y R,~ RESPONSE W-RRISBURG PA 17128-0601 ~>-J~ ~~.- }/~'"j,,R~~D NOTICE PEV-1543 E% I1FP CO! 30] i ~i..lJ V ~ L+i~ i 1.~~ „~ FILE N0. 21 09-0219 ACN 09129076 DATE 05-14-2009 209 JUN I 0 PM 2~$8. OF MARY J MOWERY SSN 196-14-3126 ~~~(,~ DATE OF DEATH 02-28-2009 ~~'COUNTY CUMBERLAND ~~1~~ /~~. EMIT PAYMENT AND FORMS T0: DONALD H MOWERY lh~ EGISTER OF WILLS 166 UNION HALL RD CUMBERLAND CO COURT HOUSE CARLISLE PA 17013 CARLISLE, PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. SOVEREIGN BANK provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-named decedent, you were a point owner/beneficiary of this account. If you feel the 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. Please call (717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 2895546196 Date 08-09-2008 To ensure proper credit to the account, two Established copies of this notice must accompaw payment to the Register of Wills. Make check Account Balance $ 51 , 087 • 14 payable to "Register of Wills, Agent". Percent Taxable X 100.00 NOTE= If tax payments are made within three Amount Subject to Tax $ 51 , 087 • 14 months of the decedent's data of death, ~( lrj deduct a 5 percent discount on the tax due. Tax Rate , Any Inheritance Tax due will become delinquent Potential Tax Due $ 7,663.07 nine months after the date of death. PART TAXPAYER RESPONSE A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or check box "A" and return this notice to the Register of CHECK Wills and an official assessment will be issued by the PA Department of Revenue. C ONE B L 0 C K B. ~ The above asset has bean or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the estate representative. C. ~ Tha above informs ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART ~ below. PART If indicating a different tax rate, please state relationship to decedent: ~ ,',~~ V 3 ~~ TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS ~", ~''~'~~' '' ~ "'` ~~~i ~,,~, ,,; a ,;~~~~.: I. .,.r ~I;~. LINE 1. Date Established 1 , $ :i' ~i ~ 'i ~ ~''+'ty 2. Account Balance 2 X ~d:,,,r 3. Percent Taxable 3 ~ ~" 1 I~R~~~f i) ~ ~~i~~ ~ ~ I~~~ll~~~tb~ioiti~r~ 4. Amount Subject to Tax 4 ~ ,F ~~ ~~~~ya~~lt~'~ i~lr~~~~~~~~~iul'~~~~~~~iiy~i~~i9. 5. Debts and Deductions 5 - 6. Amount Taxable 6 7. Tax Rate 7 X ' 8. Tax Due 8 $ `° ' PART DEBTS AND DEDUCTIONS CLAIMED Un~el~ CO P1 penalties of perjury, I declare that the facts I have reported above are true, correct and to _to~tlhe,,belst of my k~n~owlLedge~and belief. HOME C_i(~ ) ~(.~_/O G G~YLcr~ ~l ~ G~^'~ l/ WORK C'~ 1 Z ) S7 ~( - /a ~'d ~f o -n nr~uwrnor TFIFPHONE NUMBER A E HATE PAID PAYEE DESCRIPTION AMOUNT PAID ,. BUREAU OF INDIVIDUAL TAXES PO BOX 280601 FYIRRISBURG PA 17128-0601 REV-1543 IX 11FP PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE AND FILE N0. 21 09-0219 r^. ^ ~',•'~ ('~~{R~~fER RESPONSE ACN 09129077 rt .. ~,Y}, ti ~•.~ ~~~, ;,t^ DATE 05-13-2009 Pit.. ~'~+~fi `~.It 6 r~; t.:: ~~7 JUN L O PM Z' ~ ~ST. OF MARY J MOWERY SSN 196-14-3126 DATE OF DEATH 02-28-2009 COUNTY CUMBERLAND tJG~ ~:~ ~ REMIT PAYMENT AND FORMS T0: DONALD H MOWERY L~ REGISTER OF WILLS 166 UNION HALL RD CUMBERLAND CO COURT HOUSE CARLISLE PA 17013 CARLISLE, PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. SOVEREIGN BANK provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-nosed decedent, you were a joint owner/beneficiary of this account. If you feel the 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. Please call C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 2891047133 Dat® 09-05-2003 To ensure prover credit to the account, two Established copies of this notice must accospany payment to the Resister of Wills. Make check Account Balance $ 2,896.59 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $ 1, 448.30 months of the decedent's date of death, t R T ~( • lrj deduct a 5 percent discount on the tax due. a e ax Any Inheritance Tax due will become delinquent Potential Tax Due $ 217 • 25 nine wonths after the date of death. PART TAXPAYER RESPONSE 0 !''' A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or check box "A" and return this notice to the Resister of CHECK Wills and an official assessment will be issued by the PA Department of Revenue. 0 N E ~ C B L 0 C K B. rn( Tha above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ONLY ``/F''~~ to ba filod by the estate representative. C. ~ The above informs Son is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3~ below. PART If indicating a different tax rate, please state relationship to decedent: 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 $ PART DEBTS AND DEDUCTIONS CLAIMED a DATE PAID PAYEE DESCRIPTION AMOUNT PAID penalties of pbrjury, I declare that the facts I have reported above are true, correct and to to the est of my knowledge and belief. HOME C7~7 ) ~~~lO~c WORK C 7/? )S! j~-/aP~ ~ lJ .R SIGNA UR TELEPHONE NUMBER A TOTAL CEnter on Line 5 of Tax Computation) s PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 09-0219 PO BOX 280601 ~- ~ ~'~~'~ ~'~AXPAYER RESPONSE ACN 09124887 HARRISBURG PA 17128-0601 ~ ~~. ~~~~~f~t. ~, ~i~~..~ DATE 04-17-2009 mcv-ts4s oc ~n coe-oe: zoa~ ~uN ~ o ~n ~ t ~ CLEPoC QF FM ** DONALD H MOWERY 166 UNION HILL RD CARLISLE PA 17013 EST. OF MARY J MOWERY SSN 196-14-3126 DATE OF DEATH 02-28-2009 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST O CERTIF. SUSQUEHANNA BANK provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-named decadent, you were a 3oint owner/beneficiary of this account. If you feel the infonation 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. Please call 0717) 787-8327 with questions. COMPLETE PART I BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 405100001313 Date 07-22-2008 Established Account Balance Percent Taxable $ 78,297.89 X 100.00 To ensure proper credit to the account, two copies of this notice must accompatry payment to the Register of Wills. Make check payable to "Register of Wills, Agent". NOTE: If tax payments era ^ade within three Amount Subject to TaX $ 78,297.89 months of the decedent's date of death, Tax Rate X . 045 deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due 3 523.41 ~ nine months after the date of death. P T TAXPAYER RESPONSE ~ 1 A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or check box "A" and return this notice to the Register of C 0 NE ~ Wills and an official assessment will be issued by the PA Department of Revenue. B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ONLY to be filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3~ below. PART If indicating a different tax rate, please state relationship to decedent: TAX RE TURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 ~ ~~`~$' ~yj'- Y~ 6~ ~ i ~' `~ 2. Account Balance 2 $ ,,. '3+' 3. Percent Taxable 3 X ~~~ _ ~~ "`' 4. Amount Subject to Tax 4 +~ 5. Debts and Deductions 5 - 6. Amount Taxable 6 +~ 7. lax Rate 7 X 8. Tax Due 8 $ Und a alties of perjury, I declare that the facts I have reported~'a'7bove are truo~,fcorr/ec and eom le a t~o th,,e bQest of my knowledge and belief . HOME C I l ~ ) ~7 -~v~ U G/Y'^.'cPr( WORK C ~(7 ) _ d G 4~ ~ ,XPAY R SIGNATURE TELEPHONE NUMBER A PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 09-0219 PD BOX 280681 ttr ~' ~'l~ R'AXPAYER RESPONSE ACN 09124886 HARRISBURG PA 17128-0681 ,., „!k~'~ ~#~rff~: ~„ ° e,~ ~~yy,,~~11~- ~y ~~,~, , ;. DATE 04-17-2009 REV-1543 T'S ~f~3+~t X11 ili.i,.;.i. Z~tO~ JUN 10 F~1 Z~ i 9 ~1 " ~ . DONALD H MOWERY 166 UNION HILL RD CARLISLE PA 17013 EST. OF MARY J MOWERY SSN 196-14-3126 DATE OF DEATH 02-28-2009 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. SUSQUEHANNA BANK provided the Departwant with the inforwation below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-pawed decadent, you were a point owner/beneficiary of this account. If you feel the infonation is incorrect, please obtain written correction frow the financial institution, attach a copy to this forty and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Cowwonwealth of Pennsylvania. Please call C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 10005338693 Date 07-19-2008 To ensure proper credit to the account, two Established copies of this notice wust accowpany paywant to the Register of Wills. Make check Account Balance $ 60,258.41 payable to "Register of Wills, Agent". Percent Taxable )( 100.00 NOTE: If tax paywents era ^ade within three Amount Subject to TaX $ 60,258.41 wonths of the decedent's data of death, Tex Rate X .045 deduct a 5 percent discount on the tax due. Any Inheritance Tax due will becowe delinquent Potential Tax Due $ 2,711.63 nine months after the data of death. P RT TAXPAYER RESPONSE A 1 A. ~ The above inforwation and tax due is correct. Rewit paywent to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, ar check box "A" and return this notice to the Register of C ONE ~ Wills and an official assesswent will be issued by the PA Departwant of Revenua. B L D C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the estate representative. C. ~ The above inforwa ion is incorrect and/or debts and deductions were paid. Cowpleta PART ~2 and/or PART ~ below. PART If indicating a different tax rate, Please state relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 2 $ _!' X f 3. Percent Taxable 3 '~`^' 4. Amount Subject to Tax 4 $ ~`` ! 5. Debts and Deductions 5 - ' ~1 6. Amount Taxable 6 $ ~ ~§' § 7. Tax Rata 7 X 8. Tax Due B $ Und enalties of perjury, I declare that the facts I have reported above are true, corrGe~t and eo le a to®t_h~e b t of my knowledge and belief . HOME C 7 ~~ ) s7Y~~CJ~G ~ri~T WORK C ~ ~7 ) 57 -/~Q'G (>S( TAX AVER SIGNATURE TELEPHONE NUMBER A PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID