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Home My WebLink About02-24-11BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 ~F('~~ ~^ >>+ _:', :,. ~V--1543 EJ( AFP (O~~qB) PENNSYLVANIA INHERITANCE INFORMATION NOTICE AND _~ TAXPAYER RESPONSE TAX F I L E N 0. 21 d l (~ `~` `~ `''~ ACN 11109713 DATE 02-15-2011 F ~~ ~ ti~ ~ `IU~T D I A N E R K I~@I ~ R ~~ . ~ -~ ~~ ~ ~ ~~~ 16 BELLAIRE AVE CARLISLE PA 17013 EST. OF JOYCE D MEASLER SSN 162-24-3691 DATE OF DEATH 12-01-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS © CHECKING TRUST CERTIF. ORRST OWN BANK 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 joint owner/benefic:iary of this account. If you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of Pennsylvania. Please call C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 143000280 Date 04-29-2003 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wi11s. Make check Account Balance $ 305.28 payable to "Resister of Wills, Agent". Percent Taxable X 16.667 NOTE: It tax payments are made within three Amount Subject t0 Tax $ 50.88 months of the decedent's date of death, Tax Rate ~( 1~j deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential TaX Due ~` 7 • 63 nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO REaPOHD WI1L RESULT IN AN OFFICIAL TAX ASSESSMENT A. ^ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain C H E C K a discount or avoid interest, or check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. ONE B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inhieritance Tax return 0 N L Y to be filed by the estate representative. C. ~ The above information is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3LJ below. PART If indicating a different ta~~~~~X state /~ ~<O ~ 1 OFFICIAL USE ONLY ~ AAF a relationship to decedent: C{ F1~1° ( ~Q l PA DEPARTMENT OF REVENUE TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1. Date Established 1 1 2. Account Balance 2 $ 2 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ 4 5. Debts and Deductions 5 - 5 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X 7 8. Tax Due 8 PART DEBTS AND DEDUCTIONS CLAIMED a DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported aboiive are true, correct and complete toVthe best of my knowledge and belief. HOME C ~ l~ ) ,~-~~C~GV ~~'~ 'TAXPAYER SIGNATURE TELEPHONE NUMBER DATE TOTAL CEnter on Line 5 of Tax Computation) S