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PENNSYLVANIA INHERITANCE T
"~' INFORMATION NOTICE
6UREAU OF INDIVIDUAL TAXES ~ AN D
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FIARRISBURG PA lnze-o6o1 ~;__. ~• ~ ~~- ~ TAXPAYER RESPONSE
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FILE N0. 21-'ja "~ ~Q
ACN 10150393
DATE 09-09-2010
2014 SEP 15 PM 3~ 19
~~S COURT
CUMB~Rt.ANC CO., PA
PATRICIA WILLIAMS
32 TEXACO RD
MECHANICSBURG PA 17050
TYPE OF ACCOUNT
SAVINGS
CH
TRUST
CERTIF.
EST. OF MABEL I BRENNE~MAI~I
SSN 199-34-77515 ',
DATE OF DEATH 06-07-210110
COUNTY CUMBERLAND] ',
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
Md,T BANK provided the Depsrtaent with the infonation below, which has bean us d in calculating the
potential taoc due. Records indicate that at the death of the above-naNd decedent, you ware a ioint owner/b~ana iaiary of this account.
If you feel the inforaation is incorrect, plssse obtain written correction frog the financial institution, a~tt ch a copy to this fora
and roturn it to the above address. This account is taxable in accordance with the Inheritance Tax laws ofl,the~ Coaaonwealth of
Pennsylvanis. Plisse call (717) IA7-B3ETYrith"questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT IN~'TRUCTIONS
Account No. 858625 Date 08-0 3-2004 To ensure proper cra~di to the sceount, two
Established copies of this notice uat aeeoapany
payaent to the Regi~te of Wills. Make check
Account Balance $ 493 .45 payable to "Registert o I Wills, Agent".
Percent Taxable X 50 .000
NOTES If tax payaer~ts era ^ade within three
Amount Subject to Tax $ 246 .73 aonths of the deud~jnt' s data of death,
Tax Rate X , 045 deduct a 5 percent bis
' ount on the tax due.
du
Ary Inheritance Tsx will becoae delinquent
Potential Tax Duo $ 11 • 10 nine aonths after tl~s eta of death.
A.~ The above inforaation and tax due is correct.
/yam` Raait payaent to the Register of Wills with two copies of this notiu to'ob~ain
s discount or avoid interest. or chock box "A" and return this notice toithc Register of
V M C V R Wills and an official assessaent will be issued by the PA Departaent of ~tev nue.
C ONE
BLOC K B. ~ The above asset has boon or will be reported and tax Daid with the Pennsylvahia' Inheritance Tax return
ONLY to be filed by the estate representative.
C. ~ The above infon ion is incorrect and/or debts and deductions ware paid.
Coaplete 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. Aaount 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
^S I
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TUTAL ctnter on a ne s or iax compuca a one
Under penalties of perjury, I declare that the facts I have reported above arert_
complete to the bast of my knowletl9e and belief. HOME C-1~'1 ) ~,p
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erect and
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