Loading...
HomeMy WebLinkAbout03-09-10PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21'-~~ a- PO BOX 280601 ~`~ ~~ ~'~~~" HARRISBURG PA lnza-oeol " - ~- ' ~ ~ ~A~;~F'AYER RESPONSE ACN 10107882 ! f i p.4 ~°,~ ~ , n ``"}~~ '"~' DATE 02-11-2010 m:v-1543 IX AF~ "(09~'~eY ~ ~ 11~ - t .~ TYPE OF ACCOUNT ZOfO ~~~ ~~ ~ ~ ~' 2Z EST. OF JOHN NEAL ® SAVINGS SSN 211-36-4593 ^ CHECKING t~t~ yCL~~t~~`~~ir; ~ DATE OF DEATH O 1-15 - 2010 ^ rRUSr n~~ilt'T !t~iiY~u ~v~l~~~ COUNTY CUMBERLAND ^ CERTIF. Lil~a^~r`; T'a'r', F^fl p wi,,:_i~_~+,,.j_, .,,,,.`,r ~t". REMIT PAYMENT AND FORMS T0: LORI NEAL REGISTER OF WILLS 1406 PRINCETON ROAD 1 COURTHOUSE SQUARE MECHANICSBURG PA 17050 CARLISLE PA 17013 MEMBERS 1ST FCU 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 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 C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 238830-0 0 Date 12-18-2003 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 $ 39,503.04 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax Dayments are made within three Amount Subject to Tax $ 6,583.97 months of the decedent's date of death, Tax Rate X , 00 deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential TaX Due $ • 00 nine months after the date of death. PART TAXPAYER RESPONSE 0 CHECK ONE [ BLOCK ONLY 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 Wills and an official assessment will be issued by the PA Department of Revenue. B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 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 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 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under p lties of perj . I declare that the facts I have reported ove are true, correct and compl® ,/t/~ nth best o y knowledge and belief. HOME C ) /1/1/1~~.~ WORK C'L, ) Ian S ~1 TDTAL center On Llne 5 Or IaX 1.0 mpuiailun~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES „~~„ AND FILE NO. 21-~b• Po Box zeo6ol ~" - ~ E !,~~' TAXPAYER RESPONSE ACN 101078 4 HARRISBURG PA 17128-0601 C' ''-'` ~' '.'~ t't+ ~ ~' DATE 02-11-2010 ev-h3sa'tzvKVicai-obi' -_- 201 ~~ -4 kl~ 11 ~ 2~ CLEF ~~ OR~N~~'~ CJU~~' ^^ ~ `~ ~~'' '' Tn Imo!'. C~,-i f G..._ ._ ~. A v .. . LORI NEAL 1406 PRINCETON ROAD MECHANICSBURG PA 17050 EST. OF JOHN NEAL SSN 211-36-4593 DATE OF DEATH 01-15-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST FCU provided the Departeant with the inforeation below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-naeed decedent, you were a ioint owner/beneficiary of this account. If you feel the inforeation is incorrect, please obtain written correction from the financial institution, attach a copy to this fore and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Comeonwealth of Pennsylvania. Please call C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 238830-40 Date 12-18'2003 To ensure prover credit to the account, two Established copies of this notice Bust accoepany payment to the Register of Wills. Make check Account Balance $ 6,190 .64 payable to "Register of Wills, Agent". Percent Taxable X 16 .667 NOTE: If tax payments are made within three Amount Subject to Tax $ 1 , 031 .79 months of the decedent's date of death, Tax Rate ~( , 00 deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due $ • 00 nine months after the date of death. PART TAXPAYER RESPONSE 1^ ~ TOTAL (Enter on Line 5 of Tax Computation) 4 Under~ena ies q~/ perjury, declare that the facts I have reported corral t o hFU ~t of my owledge and belief. un MC WORK C are u®, correct and llrP~J, ~/ad ~~t/ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND FILE PO BOX 280601 art ~' TAXPAYER RESPONSE ACN HARRISBURG PA 17128-0601 - __^ ,~ r,ql' ~ r n ~ DATE ~. -= JtEY-i5C3 H~' I1FV' f OR•Vel' ND. 2L~p-~38' 10107886 02-11-2010 2Q~Q R -9 ~~ I i ~ ZZ :. r v ~,.. v~J~s(i LORI NEAL 1406 PRINCETON ROAD MECHANICSBURG PA 17050 EST. OF JOHN NEAL SSN 211-36-4593 DATE OF DEATH 01-15-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST FCU 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 Cowmonwealth of Penn.rylvania. Please call (717? 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 238830-42 Date 12-18-2003 To ensure prover credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance ~ 4 ~ 027 • 50 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to TaX $ 671.26 months of the decedent's date of death, Tax Rate ~( , 0 0 deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due $ • 00 nine months after the date of death. PART TAXPAYER RESPONSE 0 CHECK ONE [ BLOCK ONLY '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 Wills and an official assessment will be issued by the PA Department of Revenue. B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 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 3LJ 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 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 - 6. Amount Taxable 6 $ 7. Tax Rate 7 X 8. Tax Due 8 $ PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under pen 1 ies o perjury, I declare that the facts I have reported above are tru^e~, correct and complete o th st of my knowledge and belief. HOME C ) WORK C ~l ) ~.....-..~.. ~..... , r TCI FPI-If1NG NIIMAFR neTF TOTAL CEnter on Line 5 or rax compuca a one s PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE NDIVIDUAL TAXES r+ ±Y ~ AND FILE N0. 21..-~0- a~ BUREAU OF I = ~ ~ ' "" Po Box zaosol ~ ~~ ~ ~%' TAXPAYER RESPONSE ACN 10107888 HARRISBURG PA 17128-0601 E ~~~ ~ ,.,p, t1 ~~ ~ 4 ' DATE 02-11-2010 _ J YBtstb43..E% APP' (Od~'OB)° w=. ~, ~~ TYPE OF ACCOUNT Z~fi~ ~~ !~ ~~ ~ EST. OF JOHN NEAL ^ SAVINGS SSN 211-36-4593 ^ CHECKING G~~.~'~f`~ DATE OF DEATH 01-15-2010 ^TRUST 0~~~,--'j~~~ v`v~ ~~T COUNTY CUMBERLAND ~ CERTIF. r~~ta*^t'1'. ~. `~ ~~.. ~~' REMIT PAYMENT AND FORMS T0: LORI NE AL REGISTER OF WILLS 1406 PRINCETON ROAD 1 COURTHOUSE SQUARE MECHANICSBURG PA 17050 CARLISLE PA 17013 MEMBERS 1ST FCU 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 C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 238830-44 Date 12-18-2003 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 $ 597.56 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax paysents are Wade within three Amount Subject to Tax $ 99.60 months of the decedent's date of death. TaX Rate X , 0 0 deduct a 5 percent discount an the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due $ • 00 nine months after the date of death. PART TAXPAYER RESPONSE A. (-]/T(ie above information and tax due is correct. Yp Remit pavnent 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 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 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 3^ below. PART If indicating a different tax rate, please state ~~~yj~~ ~, , relationship to decedent: {,. TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 $ ~~ 2. Account Balance 2 3. Percent Taxable 3 X ~ ' 4. Amount Subject to Tax 4 $ 5. Debts and Deductions 5 - _ $ .x 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due B $ PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of rju , I decl a that the facts I have reported ab ve are truer cor ect and complete t the be o m Howled a and belief. HOME C ) WORK ) ______.._.. .._,....~...,~ rci counuc Al11MRCQ nerG TOTAL CEnter on Line 5 of iax compuia a one s PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND F I LE ND . 21 ^~b ~a3~j ~~- nr• PO BOX 280601 ~~ ~~',,~ J<" TAXPAYER RESPONSE ACN 10107890 HARRISBURG PA 17128-0601 - , °;-r, t~";;;~ 1^ DATE 02-11-2010 edyaic+s~cW=i~oe,de~ rt.,... TYPE OF ACCOUNT ~~~~ ~~~ ^~ ~M ~ ~ ~ ~'~ EST. OF JOHN NEAL ^ SAVINGS SSN 211-36-4593 ^ CHECKING C~~~I~ ~r DATE OF DEATH O 1-15-2010 ^ rRUST ~{P~`i~,iV ~ vJUi~ti COUNTY CUMBERLAND CERTIF. X^ r'F qp ViJp`I["r~ ~ ,'- ,~ ~~_, ,G~'/~+, REMIT PAYMENT AND FORMS T0: LORI NEAL REGISTER OF WILLS 1406 PRINCETON ROAD 1 COURTHOUSE SQUARE MECHANICSBURG PA 17050 CARLISLE PA 17013 MEMBERS 1ST FCU 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 C717) 787-8327 with questions. .COMPLETE PART 1 BELOW * SEE REVERSE SIDE FDR FILING AND PAYMENT INSTRUCTIONS Account No. 238830-52 Date 12-18-2003 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 $ 4, 049.04 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to Tax $ 674.85 months of the decedent's date of death, Tax Rate ~( • 00 deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due $ • 00 nine months after the date of death. PART TAXPAYER RESPONSE 1^ A. ~il~-~ above information and tax due is correct. ~iMJ Remit Davment 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 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 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 relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE I. Date Established 1 2. Account Balance 2 $ 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 3 X 4 $ 5 - 6 $ 7 X 8 $ DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID Under penalt of rjury, declare that the facts I have reported above are/ true, correct and comp to to my k wledge and belief. HOME C~11 ) ~t~3~ ~ ,'1 .U WORK C X1'1 ) Gam, FR TDTAL CtnLer On Llne D oT lax vvmpu~a a wni v BUREAU OF INDIVIDUAL TAXES ^ -'.~, PO BOX 280601 ~~~'-A WIRRISBURG PA 17128-0601 ~~ ~`:~ `L REV-1543 IX AFP COB-OB) PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE '_ !~j} ~ AND FILE N0. 21 _ ~('-a38 TAXPAYER RESPONSE ACN 10107892 '~~ DATE 02-11-2010 201(1 f~AR -9 A~ I ~ = 22 EST. OF JOHN NEAL C~.E~'~~~r SSN 211-36-4593 {}PPi-'~~l',~i w~j~~~~ DATE OF DEATH 01-15-2010 ~~E ,,~ ,~r, t I ~ ~} ~~ COUNTY CUMBERLAND CUfi~. REMIT PAYMENT AND FORMS T0: LORI NEAL REGISTER OF WILLS 1406 PRINCETON ROAD 1 COURTHOUSE SQUARE MECHANICSBURG PA 17050 CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST FCU 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 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 238830-59 Date 02-05-2007 7o ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance $ 576.43 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject t0 Tax $ 96.07 months of the decedent's date of death, Tax Rate ~( , 00 deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax DUe $ • 00 nine months after the date of death. PART TAXPAYER RESPONSE a CHECK C ONE BLOCK ONLY 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 Wills and an official assessment will be issued by the PA Department of Revenue. B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 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 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 DATE PAID PAYEE DESCRIPTION AMOUNT PAID MS TOTAL CEnter on Line 5 of Tax Computation) s Under penalties of perjury, I declare that the facts I have reported above1 are true, correct and comPlet/e/~7.~ol,~y-~/elbest of y knowledge and belief. HOME C ~ ) ) ~~7 ~ ~~ _ / ~ , f - 1~®IJ~ U/ ././ ~ WORK C 7L~ ) un~~S~"~ '7 PENNSYLVANIA INHERITANCE TAX ~.,~IFORMATION NOTICE ~' ,?~ E ~' ~ AND FILE N0. 21 -~ )~-~~,~~ BUREAU OF INDIVIDUAL TAXES PO BOX 280601 7 ' ~ ``}AXPAYER RESPONSE ACN 1o107s94 HARRISBURG PA 17128-0601 q J S ~.~~ `)' `" " DATE 02-11-2010 REV-1543 IX AFP C38-OB) 2010 MAR GL.EFK uF , (+~pR~HAivn iC'~'~ftTaR, l/f.i~;i~' !gym ~VL ., _. 1 LORI NEAL 1406 PRINCETON ROAD MECHANICSBURG PA 17050 EST. OF JOHN NEAL SSN 211-36-4593 DATE OF DEATH 01-15-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SgUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST FCU provided the Departoent with the information 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 Soint owner/beneficiary of this account. If you feel the inforgation is incorrect, please obtain written correction frog the financial institution, attach a copy to this fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Coasonwealth of Pennsylvania. Please call (717) 7B7-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS C. ~ The above infor~a ion is incorrect and/or debts and deductions were paid. Cosplete 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 $ 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 ' 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 $ PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of lax compuia a one $ Under penalti of perjury, I declare that the facts I have reported above are true, correct and complete to e b f my kno ledge and belief. HOME C ) WORK ("~ ) 7 ~..... ...~ :...,. r..n~ TCI CDtJ 1'1 AIC WIIMACD neTF PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE /~ /`~ BUREAU OF INDIVIDUAL TAXES ~} "-;~ +'~(` AND FILE NO. 21., 1O, a /1X PO BOX 280601 ~~~` `3"~~ ~~TAXPAYER RESPONSE ACN l0107896~/U WIRRISBURG PA 17128-0601 ',J ~ _~ ;Mt ; si ~ ~ (? DATE 02- 11 -2010 REV-1543 EXAFP.(OB-08) ZD1~P~AR-9 Q"1l1~ 22 LORI NEAL 1406 PRINCETON ROAD MECHANICSBURG PA 17050 EST. OF JOHN NEAL SSN 211-36-4593 DATE OF DEATH 01-15-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST FCU 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 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 C717) 787-8327 with questions. COMPLETE PART I BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 238830-77 Date 12-18-2003 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Nake check Account Balance g 1 , 630.03 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to Tax $ 271.68 months of the decedent's date of death, TaX Rate X , 00 deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due $ • 00 nine months after the date of death. PART TAXPAYER RESPONSE a A. Rfj'rhe above information and tax due is correct. r~ 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 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 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 ~ ~ ~ 6 D~~ ~ ,, relationship to decedent: ~tsY~ltt~^i•~rt~, rsbss~Ertii 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 Under pen ties f perjur I declare that the facts I have reported a~bo~ complete ~ xhg ~est of m knowledge and belief . HOME C l l WORK C DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID ar/e~tr a, correct and )~J"/~ IIIMAFR i1eTF TOTAL CEnLer on Llne 5 or :ax ~omputac>.on~ v PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES n AND FILE N0. 21 G PO BOX 280601 ~' _? ~ ~ i~'~'EdXPAYER RESPONSE ACN 1010789 ~~D HARRISBURG PA 17128-0601 r, .. ,. ' ` ~ ~ . tip, ' ~' DATE 02-11-2010 REV-1543 IX 11~d ~(Obj bbS~ ~ ' f) t' ~' 2D10 ~~ft -9 Q~ I 1 ~ 22 C~.~r1~C C}- O~~f'S ;,t~~J~T LORI NEAL 1406 PRINCETON ROAD MECHANICSBURG PA 17050 EST. OF JOHN NEAL SSN 211-36-4593 DATE OF DEATH 01-15-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST ® CERTIF. MEMBERS 1ST FCU 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 tha 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. 238830-8 0 Date 03-03-2008 To ensure prover credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance y~ 3 ~ 217.13 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to Tax $ 536.20 months of the decedent's date of death, Tax Rate ~( , 00 deduct a 5 percent discount on the tax due. Anv Inheritance Tax due will become delinquent Potential Tax Due ~ • 00 nine months after the data of death. PaRT TAXPAYER RESPONSE 1^ A. ~fhe above information and tax due is correct. BB~~ 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 assesswent will be issued by the PA Department of Revenue. C ONE 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 intorma ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART I__.1 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 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 - 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 $ PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID WORK ( rl"I~1 ) TOTAL CEnter on line 5 of Tax Computation) s Under penalti7~7 of erjury, I d Blare that the facts I have reported above are Qtru~g,~/ Ccorre~t and complete to /the bq~t of my knoy/~edge and belief. Nf1MF C 111 )~.r"1 / .1~~ i / PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES { •i„L~~ (`(^ AND FILE NO. 21 °"I~~~'~g Po BOX 260601 AXPAYER RESPONSE ACN 1010 900 HARRISBURG PA 17128-0601 ~ p.~-t .., i ~ ~ (, - ~ . .~ ~ _,_. DATE 02-11-2010 miV-1543 IX AFP (OB-OB) 2QID BAR -9 ~~ I! ~ 21 Ci~tP~_ ~v"a'~ v~~~T LORI NEAL 1406 PRINCETON ROAD MECHANICSBURG PA 17050 EST. OF JOHN NEAL SSN 211-36-4593 DATE OF DEATH 01-15-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST FCU provided the Department with the information belay, 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 C717) 787-8327 with questions. COMPLETE PART I BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 238830-90 Date 10-31-2008 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 $ 2, 099.63 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to Tax $ 349.95 months of the decedent's date of death, Tax Rate X , 00 deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due $ • 00 nine months after the date of death. PART TAXPAYER RESPONSE CHECK ONE [ BLOCK ONLY 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 Wills and an official assessment will be issued by the PA Department of Revenue. B. ~ The above asset has been or will be reported and tax Daid with the Pennsylvania Inheritance Tax return 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 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 +t 3 X 4 $ 5 6 $ 7 X 8 $ PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penal ies of perjury, I declare that the facts I have reported complete t~the best Af my knowledge and belief. HOME WORK C are true, correct and ~l„~,~? y`~~, )~c,~~- 'G~RtT~ ne TOTAL CEnL@r On LlnB 7 OT IaX l.OmpuTailvnJ v PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES ,~ AND FILE N0. 21 /~~~ a PD BOX 280601 ~~~ ~~,~ ~1~'~ TAXPAYER RESPONSE ACN 10107902 HARRISBURG PA 17128-0601 `~ ~ `~ i f `''~~' ~ DATE 02-11-2010 ~• ~ 1:t.~..'A REV=155S`EX"11FV"'lOb- mri' 10 t 0 ~~R -9 A~ 1 l ~ 21 LORI NEAL 1406 PRINCETON ROAD MECHANICSBURG PA 17050 EST. OF JOHN NEAL SSN 211-36-4593 DATE OF DEATH 01-15-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST FCU provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at tha 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 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 238830-91 Date 10-31-2008 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 $ 3,158.52 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are wade within three AmOUnt Subject to Tax g 526.43 months of the decedent's date of death, Tax Rate ~( , 00 deduct a 5 percent discount on the tax duo. Any Inheritance Tax due will become delinquent Potential Tax Due $ .00 nine months after the date of death. P T TAXPAYER RESPONSE ~ 1 A. The above information and tax due is correct. Ramit 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 Wills and an official assessment will be issued by the PA Department of Revenue. ONE 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 31__1 below. PART If indicating a different tax rate, please state ~ relationship to deceden t: TAX RE TURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 - 6. Amount Taxable 6 $ 7. Tax Rate 7 X 8. Tax Due 8 $ PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE P AID PAYEE DESCRIPTION AMOUNT PAID Under enalties of erjury, I declare that the facts I have reported above arert~r/u"e~, c~or~rfe~cQt and comp a e/~tA~the be of my knowledge and belief. HOME C~ ) (n"~ / ~i y'~) ~ \ / 118 1 WORK C-;~1t1 )G, 1 f T A TOTAL CEntar on Line 5 of Tax Computation) S BUREAU OF INDIVIDUAL TAXES PO BOX 2806D1 HARRISBURG PA 17128-0601 PENNSYLVANIA INHERITANCE INFORMATION NOTICE ~- AND ~'"-' -.% "~ TAXPAYER RESPONSE r~"t~'~ i+_ ~t ~V-1543 IX AFP (OB-0e) - T FILE N0. 21`~~-a'"f~ ACN 10107904 DATE 02-11-2010 20101~lAR -9 AM 11= 21 EST. OF JOHN NEAL ,~ SSN 211-36-4593 ~!~-~~fi i`'~ DATE OF DEATH O 1-15 - 2010 d~~~ ~ ~"~~)~~ COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: LORI NEAL REGISTER OF WILLS 1406 PRINCETON ROAD 1 COURTHOUSE SQUARE MECHANICSBURG PA 17050 CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST © CERTIF. MEMBERS 1ST FCU provided the Department with the information below, which has been used in calculating the potential tax dua. 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 fon and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Cosmonwealth of Pennsylvania. Please call (717) 787-6327 with questions. COMPLETE PART I BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 238830-92 Date 12-06-2008 To ensure vroper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check AceOUnt Balance $ 2, 091 .31 payable to "Register of Wills, Agent". Percent Taxable X 16 .667 NOTE: If tax payments are ^ade within three Amount Subject t0 Tax $ 348 .56 months of the decedent's date of death, TaX Rate ~( ,DO deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential TaX Due $ .00 nine months after the date of death. P T TAXPAYER RESPONSE ~ 1 A. a 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 Wills and an official assessment will be issued by the PA Department of Revenue. ONE 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 IJ below. PART If indicating a different tax rate, please state ,~ relationship to decedent: ~ y~ ~"~ _, 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 +fi PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penyy~~lties of perjury, I declare that the facts I have reported complete /t~ the I~st of my Knowledge and belief. unuc ove are true, correct and WORK ~' )~~ ) rr, rnnnur u~~un TOTAL CEnter on Line 5 of Tax Computation) B PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 -..~u~~ Po BOX 280601 ~ ~ ~ "~'-''~'~ ~t RESPONSE ACN 10107906 HARRISBURG PA 17128-0601 ?' ~. r-!~.~~"tyE- REV-1543 IX I1FP coi,-oe, ; jLi ~' ~ ` `v ' f ~ ~ DATE 02 -11- 2010 ~~}} TYPE OF ACCOUNT ~~~~ ~~R -~ ~~ ~ # ES~+. OF JOHN NEAL ^ SAVINGS $$lY 211-36-4593 ^ CHECKING ~(-~~~( ~~ DATE OF DEATH O 1-15-2010 ^ TRUST a~~~-{~~` j ~`~}E~J~~'COUNTY CUMBERLAND ~ CERTIF. ~^{ (~~~~t-I~~ 3'`1 '~',i 1 ,MIT PAYMENT AND FORMS T0: LORI NEAL ~+~ REGISTER OF WILLS 1406 PRINCETON ROAD 1 COURTHOUSE SQUARE MECHANICSBURG PA 17050 CARLISLE PA 17013 MEMBERS 1ST FCU 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 inforeation 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. 238830-94 Date 12-26-2008 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 $ 3, 130.38 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are ^ade within three Amount Subject to Tax $ 521.74 months of the decedent's date of death, Tax Rate ~( , 00 deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due $ • 00 nine months after the date of death. PART TAXPAYER RESPONSE a A. ~ L(e above information and tax due is correct. ~(Y 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 C 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 paid with the Pennsylvania Inheritance Tax return D N L Y to be filed by the estate representative. C. ^ The above inforea 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 .y jy '3; k 2 relationship to decedent: wy,,.,, Y„ 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 WORK C TOTAL CEnter on Line 5 of Tax Computation) 8 Under penalties of perjury, I declare that the facts I have reported a/b~o~v are? true, c rrect and complete~o th~xpest of/Jmy knowledge and belief. unMr r ;/1~ ~ 1~~~ ~ ~ ~1 ~`~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AN D PO BOX 280601 r~ ~"~~ ~+f-`TAXPAYER RESPONSE HARRISBURG PA 17128-0601 e ~~ ~„ :,~ F ~ t (~ m~v-ice ~c'~t~D~co~oe~ _. FILE N0. 21- ~~'~i ACN 10107908 DATE 02-11-2010 2010 MAR -9 ~~1~~ 22 ~LER~ C oR~~~~~#,s }c,~u~~~A, LORI NEAL C,~~. ~" 1406 PRINCETON ROAD MECHANICSBURG PA 17050 EST. OF JOHN NEAL SSN 211-36-4593 DATE OF DEATH 01-15-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST FCU 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 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 C717) 7B7-8327 with questions. COMPLETE PART I BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 238830-95 Date 01-05-2009 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 ~ 3 ~ 095.32 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to Tax $ 515.90 wonths of the decedent's date of death, ~( , 00 deduct a 5 percent discount on the tax due. TaX Rate Anv Inheritance Tax due will become delinquent Potential TaX DUe y~ • 00 nine months after the date of death. TAXPAYER RESPONSE PART CHECK ONE [ BLOCK ONLY above information and tax due is correct. Remit Dayment 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 Wills and an official assessment will be issued by the PA Department of Revenue. B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 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 RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 2 $ 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 - 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due B PART nwTr peTn PAYEE DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID Under penalti of per3ury, I declare that the facts I have reported above ar Rtrue, correct and complete to be t f my k wledge and belief. HOME C`~l~ )~ /~ s~ ~ I ~-\ v~'1.~i~ ~ _ WORK C71~ ) G~s~t'~ LS~~/[~ N IYINL 1C11~v1 vll ,. a..v r ... -.. PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 , ~~ • a~ PD Box zso6ol ~ :'~``~J~ 'TAXPAYER RESPONSE ACN 10107910 HARRISBURG PA 17128-0601 r ._, ~, ~`- ~ tk t ~ (~. DATE 02' 11-2010 F t ~ ma/-15ka -0F.Af'P' ~Oe306)t ~ s ~.~~ 2010 MAR -9 AM I i = 22 t,,t„~f'tl~ ~~ QRP~~~'S.~ ~~~RT A LORI NEAL 1406 PRINCETON ROAD MECHANICSBURG PA 17050 EST. OF JOHN NEAL SSN 211-36-4593 DATE OF DEATH 01-15-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST FCU 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 fors 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. 238830-96 Date 01-30-2008 To ensure vroper credit to the account, two Established copies of this notice must accowpany payment to the Register of Wills. Maka check Account Balance $ 3, 099.29 vayable to "Register of Wills, Aaent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject t0 Tax $ 516.56 months of the decedent's date of death, ~( , 00 deduct a 5 percent discount on the tax due. TaX Rate Any Inheritance Tax due will become delinquent Potential Tax Due $ • 00 nine months after the date of death. PART TAXPAYER RESPONSE 0 A. ~fhe above information and tax due is correct. I {J Remit payment to the Register of Wills with two copies of this notice to obtain / a discount or avoid interest, or check bax "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 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 L-.J below. If indicating a different tax rate, please state ;~~ jj$ ~} ~ .:.;~ 5 PART 2 relationship to decedent: `` " ~'' I3F ~C"'Ff~,t 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 Herr oern PAYEE DESCRIPTION AMOUNT PAID DEBTS AND DEDUCTIONS CLAIMED Under pen ies f peri7~dry, I declare that the facts I have reported abovel arel~t{rue,''~~o~rrje~ct and eomplete~t~i~ ~my knowledge and belief . HOME C~ { ) y f ~ ~7 s"'~/ 1 UUUUUUAAAAAA////// WORK C 79, 7 ~ IUTAL lCll~u,- u~~ ~. a~~ -