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OUREAU OF INDIVIDUAL TAXES p•;;-n~~
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NARRISBURC PA 1 7120-06 01 ~ ~~(`•~,r ~ t ~ L~a~+fi
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INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE N0. 21 - ~U ~~Jd~
ACN 10125605
DATE 05-06-2010
2010 MAY 25 PM 3= 24,
CLERK QF
C~P#iAN'S COURT
CU~~~~~~~~fl ~~ , ~~,
JACgUELIN A SHEEHAN
123 WILSON ST
CARLISLE PA 17013
EST. OF JACK STAMETS
SSN 210-16-4538
DATE OF DEATH 03-28-2o1Q
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
SUSQUEHANNA BANK provided the Depmrtment with th• infonation below, which has bean used
potential tax due. Records indicate that at th• death of the above-nomad decedent, you ware a ioint owner/banaf~
If you foal the infonation is incorrect, please obtain written correction from the financial institution, sttae
and return it to the above address. This account is taxable in secordsne• with th• Inheritane• Tax laws of th•
Pennsylvania. Plesse call C717) 707-0327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRU
Account No. 1207953706
Account Balance
Percent Taxable
Amount Subiect to Tax
Tax Rat•
Potentisl Tax Duo
Date 05-11-2009
Established
~ 10,608.46
X 100.00
~ 10,608.46
X .15
$ 1,591.27
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
in ealeulatine the
:isry of this account.
• copy to this form
ommom,eslth of
IONS
To ensure proper credit o the account. two
copies of this notice mu t sccompalpr
payment to the Reoister f Wills. Make chock
paysbl• to "ReOister of ills, Apent".
NOTEI If tax payments a roads within three
months of the decedent's ate of death,
deduct a 5 percent diseou t on the tax due.
Any Inharitane• Tsx due w 11 become delinquent
nine ronths after the dot of death.
A. ~ The above information and tax dw is corset.
Remit payment to the Register of Wills with two copies of this notice to obtai
CHECK a discount or avoid i nterest, or cheek box "A" and return this notice to the R eistor of
ONE Wills and an official assessment will b• issued by the PA Department of Revehu .
~
C
BLOCK B. ~ The above asset has been or will be sported and tax paid with the Pennsylvania In ~eritanee
0 N L Y to be filed by the estate repssantative.
C. ~ TM sbova informs ion is
Cw
let• PART ~2
nd/or incorrect and/or debts end deductions woe paid.
PART ~ b
low
p
a .
e
PART If indicating a different tax rata, please state
relationship to dacadant:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Data Established 1
2. Account Balance 2 ~
3. Percent Taxable 3 X
4. Amount Subiect to Tax 4
5. Dobts and Deductions 5
6. Amount Taxable 6 ~
7. Tax Rate 7 X
8. Tax Dua 8 ~
Tax return
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL CEnter on Line 5 of Tsx Computation) t~
Under penalties of periury, I declare that the facts I have reported above era true, corr~ct and
co}glot• to the bast of my • knowlgNJge and belief . una1G / 9i rl ~ . ) ll . ~ .~ h r J
WORK ( )