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PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21"jD~D3$3
PO BOX 280601 T PAYER RESPONSE ACN 10114367
FY-RRISBURG PA 17128-0601
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""t" DATE 03-11-2010
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** VICKIE MORRIS CU~'~~~~'~D C~.,
311 KERRSVILLE ROAD
CARLISLE PA 17015
EST. OF RUBY MORRIS
SSN 255-44-4623
DATE OF DEATH 02-27-2010
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 the information is incorrect, please obtain written correction frow the financial institution, attach a copy to this forty
and return it to the above address. This aerount is taxable in accordance with the Inheritance Tax laws of the Comwonwealth of
Pennsylvania. Please call C717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 352382-1 1 Date 03-23-2009
` To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 00 payment to the Register of Wills. Nake check
payable to "Register of Wills, Agent".
Percent Taxable X 100.00
Amount Subject to Tax $ ~ 00 N07E: If tax paynents are made within three
months of the decedent's data of death,
Tax Rate X .045 deduct a 5 percent discount on the tax due.
Potential Tax Due $ ~ 00 Any Inheritance Tax due will become delinquent
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
CHECK a discount or avoid i nterest, 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.
BLOCK ~
0 N L Y 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 incorr
ect 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:
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
0
DATE PAID PAYEE DESCRIPTION eMniiur oern
U er penalties of perjury, I declare that the facts I have reported above are,~/true/, correctGand
omple to the best of my knowledge and belief. HOME C7~7 )~lST ~S
WORK C ) - Sf ID 1
TAXPAYER SIGNATURE TELEPHONE NUMBER DATE
•-.^~ ."~•®~ a,n mina ~ yr lax 1.O111PULaLlOn) 4