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PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AN D
Po cox 2BO6o1 "~}' ~AYER RESPONSE
FIARRISBUR6 PA 17128-0681 tt~`{~~~~~'~~ ((~'+,
a:v-isas oc ~FifPili-Y~ - V~ i~~i.l
2018 JUL -8 PM i ~ 5~
arc of
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NANCY CRAMPTON
PO BOX 218
FUNKSTOWN MD 21734-0218
FILE N0. 21 10-0344
ACN 10132199
DATE 06-09-2010
EST. OF GILBERT K SHIRK
SSN 179-09-9036
DATE OF DEATH 01-08-2010
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
FIRST NB OF PENNSYLVANIA provided the Departaent xith the inforaation below, which has been used in calculating the
potential tax due. Records indicate that at the death of the above-naaed decadent, you ware a point owner/beneficiary of this account.
If you foal the inforaation is incorrect, please obtain written correction free 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 Cowaonwealth of
Pennsylvania. Please call C717) 767-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 701702862 Data 01'01-1970 To ensure proper credit to the account, two
Established copies of this notice gust accoapany
payaent to the Register of Wills. Make check
Account Balance $ 16,566.96 payable to "Register of Wills, Agent".
Percent Taxable X 16.667
NOTE: If tax payaents are wade within three
Asount Subjaet to Tax $ 2, 761.22 aanths of the decedent's data of death,
Tax Rata ~( , O 4 5 deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will becoae delinquent
Potential Tax Due ~- 124.25 nine aonths after the data of death.
PART TAXPAYER RESPONSE
u 3 ,,
A. ~ The above inforaation and tax due is correct.
Resit payaent 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
C 0 N E ~ Wills and an official assessaent will be issued by the PA Dapartaent of Revenue.
BLOCK B. ® The above asset has bean ar will be reported and tax paid with the Pennsylvania Inheritance Tax return
0 NL Y to be filed by the estate representative.
C. ~ The above inforaa ion is incorrect and/or debts and deductions were paid.
Coaplete PART ~2 and/or PART ~ below.
PART If indicating a different tax rate, please state ~ ~i
relationship to decedent: 5 ~
i
2 ~ ~~ ~`
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS ~•~ ~ '~`~'~ `"
LINE 1. Data Established 1 ~ ''~`• a
2. Account Balance 2 $ ~'" '
3. Portent Taxable 3 X
4. Asount Subjaet to Tax 4 ~ ~~' •~ x`"
' .+•r«
5. Debts and Deductions 5 ; ~~~ ~ ~~$~ '
~ ~ ~~'!~ s F ~ ~y. ~ S Jay
11 $II III ' ~~' ~~ ~ t'
6. Amount Taxable 6 $ •_ j~a«.oi s ~ ~ ~
7. Tax Rate 7 X ~ '" r
8. Tax Due 8 ~ »~~~ , ~ ,g
Under penalties of perjury, I declare that the facts I have reported above are truer correct/and :1
coaple'te to the best of sy knowledge and belief. HOME C,3d j ) rJ3~' ~7~r ~ ~~~"f(/
0.,,.t~l ~}„ l'~y WORK C )
AYE SIGNATURE TELEPHONE NUMBER DATE
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID