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PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES
Po sox zso6ol »~~ ~ ,~ ~- -~r- AND FILE N0.
HARRISBURG PA 17128-o6o1 _ ~ '_ ~ fL,~G ~ 'TA~~AYER RESPONSE 21 08 - 0744
_•{_ - --• - ACN 09004370
REV-1543 EX AFa f~B~BrB}~ r r 'ti.s1 ,.w ~ .-- DATE
10-16-2009
~V
~~ ~`~ ~~ ~~ ~ Q~ TYPE OF ACCOUNT
EST. OF LOIS M LANTZY
^ SAVINGS
SSN 161-34-2046
^ CHECKING
~~ ~~`~ ~
rk ~ r 1 ~ ~ i '' T
DATE OF DEATH 07-03-2008
^ TRUST
"`' ' ' " i'
COUNTY
~ ~ ~ -'~a CUMBERLAND ^
HELEN CERTIF.
~-'~'" - REMIT PAYMENT AND FORMS T0:
MADIGAN-SEDOR
15501 WHITE WILLOW LN REGISTER OF WILLS
ROCKVILLE MD 20853 CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
WACHOVIA SECURITIES
potential tax due. Records
If you feel the informatio provided the Department with the information below, which has been used in calculatin
indicate that at the death of the above-named deced
i
t
t
g
n
en
he
, you were a
s incorrect, please obtain written correction from the financial institution
ficiary of this account.
and return it to the above address. This account is taxabl
Pennsylv
tt
i
i
,
t
e
b
, a
e
an
ach a co
n accordance with the Inheritance
a. Please call C717) 787-8327 with py to this form
Tax
laws
of
the
questions. commonwealth of
COMPLETE
PART 1
Account N BELOW *
SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
o.
Date 06-13-2008
Account Balance Es tablishe d To ensure proper credit to the account, two
copies of this notice must accompan
Percent Taxable y
20 ~ 016 ~ 87 payment to the Register of Wills. Make check
X payable to "Register of W
ills, Agent".
Amount Subject to Tax 33.333
NOT
Tax Rate (, 672.22
E: If tax payments are made within three
X months of the decedent'
Potential Tax Due s date of death,
12 deduct a 5 percent discount on the tax due
A
~
PART .
$ 0 0 • 6 7
'
ny Inheritance Tax due will become delinquent
nine months after th
1^ e date of death.
TAXPAYER RESPONSE
F ,.~.~ ... ,.. ..
PART If indicating a different tax rate, please state
relationship to decedent:
~. %Y /urf.~y;a~if:`u.9H.'6~r~Y•`•`Y.F~F1£~~~i/:~F
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
0 N E 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
0 N L Y to be filed by the estate representative. paid with the Pennsylvania Inheritance Tax return
C•~he above informs ion is incorrect and/or debts and
Complete PART 2~ and/or PART ~ deductions were paid.
below.
TAX RETURN - COMPUTATION
LINE 1. Date Established
z. Account Balance
3. Percent Taxable
4• Amount Subject to Tax
5. Debts and Deductions
6• Amount Taxable
7• Tax Rate
8. Tax Due
PART
a
DATE PAID
OF TAX ON JOINT/TRUST ACCOUNTS
1
2 $
3 X
4 ~`
5 -
6
7 X
8 ~`
DEBTS AND DEDUCTIONS CLAI~~MED
--- -- ~ ~~ iax computation) $
Under penalties of perjury, I declare that the facts I have reported above are true, co
complete to he best of m knowledge and belief.
~1 ~ ~ y rrect and
7~ HOME (~D I ) ~'~~~ q o~. ~ 4.
~ ~~~ WORK
XPAYER SIGN RE )
0
MBER
DAT-