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Home My WebLink About09-23-09PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 Po Box zaocBl _ .TAXPAYER RESPONSE ACN 09156258 HARRISBURG PA 17128-0601 DATE 09-07-2009 REV-1543 EX. AFP (09=BH]"~'~ GLADYS D RHINEHART 1 HOTPOINT AVE 20U9 SEP 23 ~~I 8~ 27 i r~ ~ `~~ C~ L.1 i'~ UI Cl}P~^, ,- ~ ... PA. SHIPPENSBURG PA 17257 EST. OF HELEN M BOLEN SSN 172-24-8393 DATE OF DEATH 05-06-2009 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. ORRSTOWN 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 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 (717) 787-8327 with questions. COMPLETE PART I BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 320978 Date 09-19-2005 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check ACCOUnt Balance 1 , 619.64 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $ 809.82 months of the decedent's date of death, Tax Rate ~( , 15 deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due $ 121.47 nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain C H E C K a discount or avoid interest, or check box "A" and return this notice to the Register of C ONE 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 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 ~ below. PART If indicating a different tax rate, please state OFFICIAL USE ONLY ~ AAF relationship to decedent:_ PA DEPARTMENT OF REVENUE TAX RE TURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE I. Date Established 1 1 2. Account Balance 2 +~ 2 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ 4 5. Debts and Deductions 5 S 6. Amount Taxable 6 $ y 7. Tax Rate 7 X 7 8. Tax Due 8 $ $ PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, co~r_rec~t a~nyd ~coom~pylete to the best of my knowledge and belief. HOME C`f~~ ~ -~~~(~,L-L! C ~~ (G1/~/~e~~2:~/1 ~ W O R K C L \ TAXPAYER IGNATURE TELEPHONE NUMBER DATE TOTAL CEnter on Line 5 of Tax Computation) S COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: RHINEHART GLADYS D 1 HOTPOINTE AVE SHIPPENSBURG, PA 17257 fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ACN ASSESSMENT CONTROL NUMBER AMOUNT ESTATE INFORMATION: ssrv: i 72-24-a3s3 FILE NUMBER: 2109-0884 DECEDENT NAME: BOLEN HELEN M DATE OF PAYMENT: 09/23/2009 POSTMARK DATE: 09/23/2009 COUNTY: CUMBERLAND DATE OF DEATH: 05/06/2009 REMARKS: SEAL CHECK# 212 09156258 ~ S 121.47 TOTAL AMOUNT PAID: $121 .47 INITIALS: JN RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REV-1162 EX111-961 NO. CD 01 1780 REGISTER OF WILLS