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6UREAU OF INDIVIDUAL TAXES
PO BOX 280601 ~~~
HARRISBURG PA 17128-0601 `- .~• ~~
fl.'1: IY fF i~~~l~~~~
PENNSYLVANIA INHERITANCE T
INFORMATION NOTICE
AND
1(. TAXPAYER RESPONSE
1010 SEP ! 5 PM 3= ! 9
aE~K O~
ORPHAN'S COURT
CUMRER~.A:'VJ C~J . PA,
PATRICIA WILLIAMS
32 TEXACO RD
MECHANICSBURG PA 17050
EST. OF MABEL I BRENNEMAN
SSH 199-34-7755
DATE OF DEATH 06-07-20];0
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
M8T BANK provided the Department with the intonation 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 ]oint owner/b~ne~ieisry of this account
If you feel the infonation is incorrect, please obtain written correction from the financial institution, a~kta h 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 Coaonwealth.of
PennsYlvenia. Pleasr eels C717) 7B7-83P9-~i1HF questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INS~'RUCTIONS
Account No. 858625 Data 08-03-2004 To ensure proper cra~lit'to the account, two
Established copies of this notice cyst accomparar
Account Balance 45 payment to tho Rsgistar',of Wills. Make check
493
.
payable to "Register of !Wills, Agent".
Percent Taxable X 50.000
Amount Subject to 7 3 NOTES If tax payments are made within three
Tax $
24 6
.
months of the decedent's date of death,
TaX Rate X , 0ls~j deduct a 5 percent dijscqugt on the tax due.
Potential TeX Due Any Inheritance Tax due Mill become delinquent
~ 11 .10 nine months after the date of death.
P
T TAXPAYER RESPONSE
a
1
A. ~ Th• above infonation and tax due is correct. ' ',
Rant payment to the Register of Wills with two copies of this notice to olbtapn.
CHECK a discount or avoid interost, or check box "A^ and return this notice to the I~egistar of
C ONE ~ Wills and an official assessment will be issued by the PA Department of ReNenWe.
BLOCK B. ~ Tha above asset has bean or will be reported and tax paid with the Pennsylvani~e Inheritance Tax return
ONL Y to b• filed by the estate representative.
C. ~ The above infona ion is incorrect and/or debts and deductions ware paid.
Complete PART 2~ and/or PART a below.
PART If indicating a different tax rate, please state
relationship to decedent:
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. Debts and Deductions 5 -
6. Amount Taxable 6 $
7. Tax Rate 7 X
8. Tax Due 8 $
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION ANOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation) ~ t l
Under penalties of perjury. I declare that the fade r tia..d rannr~*nA .w,...e --- ~....- ....- .-_~ __~
FILE N0. 21-1v'O`j~0
ACN 10150393
DATE 09-09-2010
e to the befit of my knowledge and be HOME C "T ~"I )
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