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Home My WebLink About03-07-11 (2)COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 014085 STOUFFER DONALD M 292 STEELSTOWN ROAD NEWVILLE, PA 17241 -------- fold ESTATE INFORMATION: SSN: 204-02-1478 FILE NUMBER: 211 1-0300 DECEDENT NAME: STOUFFER AMY E DATE OF PAYMENT: 03/07/201 1 POSTMARK DATE: 03/07/201 1 COUNTY: CUMBERLAND DATE OF DEATH: 1 1 /21 /2010 REMARKS: ACN ASSESSMENT CONTROL NUMBER REV-1162 EX111-96) AMOUNT 11114206 ~ 522.61 11114205 ~ 522.65 11114208 ~ $22.58 11114209 ~ $22.86 11114207 ~ 522.95 11114201 ~ $75.51 1 1 1 14203 ~ $15.01 11114199 ~ 522.77 TOTAL AMOUNT PAID: $226.94 CHECK# 6014 INITIALS: HMW SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES A N D PO BOX 280601 TAXPAYER RESPONSE HARRISBURG PA 17128-0601 REV-1543 EX AFP (08-OB) PENNSYLIOANIA INHERITANCE TAX EST. OF AMY E STOUFFER SSN 204-03-1478 DATE OF DEATH 11-21-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST ~~CERTIF. ACNB 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/beneficiary 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. 5990415 Date 12-02-1998 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance 1 004.70 payment to the Register of Wills. Make check ~ payable to Register of Wills, Agent . Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $ 502.35 months of the decedent's date of death, Tax Rate )( .045 deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due $` 22. bl nine months after the date of death. PART TAXPAYER RESPONSE 1 A. ~ The above information and tax due is correct. Remit Dayment 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 0 N E Wills and an official assessment will be issued by the PA Department of Revenue. B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART ~ below. PART If indicating a different tax rate, please state relationship to decedent: ~ TAX RETURN - COMPUTATION OF TAX ON JOINTITRUST ACCOUNTS \ \ ~ '' `' \~ ~~~~~~~~•~\\ \~ LINE 1. Date Established 1 ~°~ 2. Account Balance 2 $ ~~ ~ 3. Percent Taxable 3 X ~\\ 4. Amount Subject to Tax 4 \ a 5. Debts and Deductions 5 - \ \ 6. Amount Taxable 6 ~ \~ ~ \ 7. Tax Rate 7 X ~~ . ~~ 8. Tax Due 8 +fi ~ ~ \ ~~~. ~ PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME C~/`7 ) 7~~ -'6l7/ WORK C 3 AXPAYER SIGNATUR TELEPHONE NUMBER DA E DONALD M STOUFFER 292 STEELSTOWN RD NEWVILLE PA 17241 FILE N0. 21"' f ' ~~CG~ ACN 11114206 DATE 03-02-2011 TOTAL CEnter on Line 5 of Tax Computation) ~ INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES A N D Po sox 2aosol TAXPAYER RESPONSE HARRISBURG PA 17128-0601 REV-1543 EX AFP <08-08) PENNSYLVANIA INHERITANCE TAX EST. OF AMY E STOUFFER SSN 204-03-1478 DATE OF DEATH 11-21-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SgUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. ACNB 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/beneficiary 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 (717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 5990425 Date 12-08-1998 To ensure proper credit to the account, two Established copies of this notice must accompany 62 payment to the Register of Wills. Make check Account Balance $` 1 006 ~ . payable to 'Register of Wills, Agent Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $ 503 31 . months of the decedent's date of death, Tax Rate X .045 deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due ~` 22.65 nine months after the date of death. PART TAXPAYER RESPONSE 0 \~ ~ 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 0 N E Wills and an official assessment will be issued by the PA Department of Revenue. B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inherit n T t a ce ax re urn 0 N L Y to be filed by the estate representative. C. ~ The above informs ton is incorrect and/or debts and deductions were paid. Complete 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. Amount 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 a DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. H 0 ME C ~ / 7 WORK C ~ XPAYER SIGNATURE TELEPHONE NUMBER DA E DONALD M STOUFFER 292 STEELSTOWN RD NEWVILLE PA 17241 F I L E N0. 21" 1 `~- ~3W ACN 11114205 DATE 03-02-2011 IUTAL ctnLer on Lane 5 of Tax Computation) $ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES A N D Po eox 2sosol TAXPAYER RESPONSE HARRISBURG PA 17128-0601 REV-1543 EX AFP (08-OB> DONALD ~ STOUFFER 292 STELSTOWN RD NEWVILLE PA 17241 FILE N0. 21° r (- a'~Q(} ACN 11114208 DATE 03-02-2011 EST. OF AMY E STOUFFER SSN 204-03-1478 DATE OF DEATH 11-21-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. ACNB 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/beneficiary 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. 4990458 Date 01 -19 -1999 To ensure proper credit to the account, two Established copies of this notice must accompany 1 ~ 003.73 payment to the Register of Wills. Make check Account Balance '$` payable to Register of Wills, Agent Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $ 501 .87 months of the decedent's date of death, Tax Rate )( .045 deduct a 5 percent discount on the tax due. Anv Inheritance Tax due will become delinquent Potential Tax Due ~` 22.58 nine months after the date of death. P~T TAXPAYER RESPONSE A. {~ The above information and tax due is correct. ~L~1 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 0 N E Wills and an official assessment will be issued by the PA Department of Revenue. B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the estate representative. C. ~ The above informs ion is incorr~ect and/or debts and deductions were paid. t-,a Complete PART 2~ andlor PART I~ I 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. Amount Subject to Tax 4 $ \ \ ~~ 5. Debts and Deductions 5 - ~~ ~ ~ ~~~ .~~ ~ \ 6. Amount Taxable 6 $ "~.~~\ ~ ~ ~~~~~ 7. Tax Rate 7 X \~ ~ \~ ~ ~ ~' 8. Tax Due 8 $ ~~ O~\~ \ \\ ~~ ~~ ~ ~ ~ PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief . HOME C7/ ]~ ) ~ 7~ -- G/7'/ WORK c ~ XPAYER SIG ATURE TELEPHONE NUMBER DAT IUTAL ~tnLer on Line 5 of Tax Computation) S PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES A N D PO sox 28obo1 TAXPAYER RESPONSE HARRISBURG PA 17128-Ob01 REV-1543 EX AFP (08-OB) /~ DONALD .-W~- STOUFFER 292 STEELSTOWN RD NEWYILLE PA 17241 FILE N0. 21' /'' ~~~ ACN 11114209 DATE 03-02-2011 EST. OF AMY E STOUFFER SSN 204-03-1478 DATE OF DEATH 11-21-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST 0 CERTIF. ACNB 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/beneficiary 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. 173833 Date 08-25-2008 To ensure proper credit to the account, two Established copies of this notice must accompany 1 ~ 01 6.14 payment to the Register of Wills. Make check Account Balance $ payable to Register of Wills, Agent Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to TaX $` 508.07 months of the decedent's date of death, Tax Rate X .045 deduct a 5 percent discount on the tax due. Anv Inheritance Tax due will become delinquent Potential Tax Due $ 22.86 nine months after the date of death. PART TAXPAYER RESPONSE ~ ~~ ~ ,,mo~tt A. ~N~~ The above information and tax due is correct. II~~JJ Remit payment 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 0 N E Wills and an official assessment will be issued by the PA Department of Revenue. BLOCK B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3~ 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. Amount Subject to Tax 4 $ \\~ \\ 5. Debts and Deductions 5 \ 6. Amount Taxable 6 $ \ ~ 7. T a x R a t e 7 X ~\~ ~~ ~, ~~\ ti~ 8 . Tax Due 8 $ ;\~ ~ ` ~~~~ PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief . HOME C 7t ] ~ 7 ~'~ -- ~ / T WORK C ) 3 T XPAYER SIGNATURE TELEPHONE NUMBER AT IUTAL ~tnter on Line 5 of Tax Computation) S PENNSYLVANIA INHERITANCE TAX EST. OF AMY E STOUFFER SSN 204-03-1478 DATE OF DEATH 11-21-2o1D COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES A N D Po Bax 28o6a1 TAXPAYER RESPONSE HARRISBURG PA 17128-0601 REV-1543 EX AFP (OB-OB) TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. ACNB 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/beneficiary 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 (717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 4990734 Date 12-04-1999 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance 00 payment to the Register of Wills. Make check 1 020 ~ . payable to Register of Wills, Agent Percent Taxable X 50.000 Amount Subject to NOTE: If tax payments are made within three Tax $ 510 00 . months of the decedent's date of death, Tax Rate ~( . 045 deduct a 5 percent discount on the tax due. Potential Tax Due Any Inheritance Tax due will become delinquent $ 22.95 nine months after the date of death. P T TAXPAYER RESPONSE ~ 1 .~~ ~~ . ~ ~, ~ 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 0 N E Wills and an official assessment will be issued by the PA Department of Revenue. B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritanc T t 0 N L Y e ax re urn to be filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PA RT 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. Amount Subject to Tax 4 $ ~ ~ 5. Debts and Deductions 5 - , \ \ ~°' ~,\ ~ ~ 6. Amount Taxable 6 \ \ 7. Tax Rate 7 X \\\ ~ ~\ \ ~ ~ ~ 8 . Tax Due 8 $ \~\ ~ ~ 0 \ \ ... •; ~ ~ ~~ ~ . PART DEBTS AND DEDUCTIONS CLAIMED DATE P AID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best/of my knowledge and belief. HOME C7! ~ ) 7 ~~ --,~~ 7/ e~. ~I ~__ _ WORK ( ) 7 `"TAXPAYER SIGNATURE %% TELEPHONE NUMBER D TE DONALD M STOUFFER 292 STEELSTOWN RD NEWVILLE PA 17241 FILE N0. 21_,~.~~,~~ ACN 11114207 DATE 03-02-2011 iuiAG ctnter on Line 5 of Tax Computation) 8 PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AN D Po BOX 28D601 TAXPAYER RESPONSE HARRISBURG PA 17128-Ob01 REV-1543 EX AFP (88-08) DONALD M STOUFFER 292 STEELSTOWN RD NEWVILLE PA 17241 FILE N0. 21~ I ~~~~~~ ACN 11114201 DATE 03-02-2011 EST. OF AMY E STOUFFER SSN 204-03-1478 DATE OF DEATH 11-21-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. ACNB 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 ]oint owner/beneficiary 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 1717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 4990887 Date 07-01-2000 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance 50 payment to the Register of Wills. Make check $ 10 Ob7 ~ . payable to "Register of Wills, Agent". Percent Taxable X 16.6b7 Amount Subject to NOTE: If tax payments are made within three Tax $ 1 b77 95 ~ . months of the decedent's date of death, TaX Rate ~( .045 deduct a 5 percent discount on the tax due. Potential Tax Due Any Inheritance Tax due will become delinquent ~` 75 • 51 nine months after the date of death. P T TAXPAYER RESPONSE a ~ ., \ ~ o, .... ~~~~ . ~, A. ~ The above information and tax due is correct. Remit payment 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 ONE Wills and an official assessment will be issued by the PA Department of Revenue. B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylva i I h it T 0 N L Y n a n er ance ax return to be filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3~ below. PART If indicating a different tax rate, please state e\ ~ relationship to decedent: ~ . ~~~~ ~ \i \ \ TAX RETURN - COMPUTATION OF TAX \ ~ ON JOINT/TRUST ACCOUNTS ~'~' ~~~ ~~~:~~~ \ LINE 1. Date Established 1 ,~ ~ ~ .\~\ \\ ~ 2. Account Balance 2 $ \ ~~\~ ~\O\, 3. Percent Taxable 3 X \~ ~\ ~~~ ~ ~\ ~ 4. Amount Subject to Tax 4 $ \ ~\\\ ~ ~\ 5. Debts and Deductions 5 - ~ '\~~,: ~~ \ ~ 6. Amount Taxable 6 .~`r ~ ~ ~\ \,~~~~~~ ,~o~~ 7. T a x Rat e 7 X '\~~~"`~ 7 ~ ~~~~~~\ ~\ 'O\~.. ~ ~.. ~ \ 8. Tax Due 8 $ $ ~\\\~~ ~ ~~ ~~ s ~. ~ PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE P AID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best Hof.. my knowledge and belief. HOME ~,~~~ ~ ~6 --fp j ~' o~rnc i~l~. ~;-l~ W O R K C ~ ~ iAxrAYtR 516NAIURE /~ TELEPHONE NUMBER DATE IUTAL ctnter on Line 5 of Tax Computation] S PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES A N D Po Box 280601 TAXPAYER RESPONSE HARRISBURG PA 17128-0601 REV-1543 EX AFP (OB-08) FILE NO. 21-r l I ~-~~(~~ ACN 11114203 DATE 03-02-2011 EST. OF AMY E STOUFFER SSN 204-03-1478 DATE OF DEATH 11-21-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. DONALD M STOUFFER 292 STEELSTOWN RD NEWVILLE PA 17241 ACNB 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 ]oint owner/beneficiary 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 wa.th questions- COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 5990409 Date 11-15-1998 To ensure proper credit to the account, two Established copies of this notice must accompany 2 ~ 0 0 0 . $3 payment to the Register of Wills. Make check Account Balance ~` Payable to Register of Wills, Agent Percent Taxable X 16.667 NUTE: If tax payments are made within three Amount Subject to TaX $ 333.48 months of the decedent's date of death, Tax Rate X . 045 deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due $` 15.01 nine months after the date of death. PART TAXPAYER RESPONSE ~ ~~ ~ ~ ~. A. ~ The above information and tax due is correct. Remit payment 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 0 N E Wills and an official assessment will be issued by the PA Department of Revenue. B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3~ below. PART If indicating a different tax rate, please state \ ~`~ a 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. Amount Subject to Tax 4 +fi \~ ~~ 5. Debts and Deductions 5 ~ ~~0~ .~ 6. Amount Taxable 6 $ ~ ~ ~ ~.~~~ 7. T a x R a t e 7 X ~~ \ ~~~°~Q~ ~~ "`\ ~~~ ~~\~ 8 . T a x Due 8 $ \ ~~~~~\\\\~ ~ ~~ PART DEBTS AND DEDUCTIONS CLAIMED - ~: DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME C71~ ) 77~w"~lT~ ., v~~ ,~ WORK C 3 AXPAYER SIGNATURE TELEPHONE NUMBER A E IUTAL ~tnLer on Line 5 of Tax Computation) $ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AN D Po aox z8o6o1 TAXPAYER RESPONSE HARRISBURG PA 17128-0601 REV-1543 EX AFP (08-08) FILE N0. 21~ I ~`~,~~'~ ACN 11114199 DATE 03-02-2011 EST. OF AMY E STOUFFER SSN 204-03-1478 DATE OF DEATH 11-21-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FDRMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. DONALD M STOUFFER 292 STEELSTOWN RD NEWVILLE PA 17241 ACNB 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/beneficiary 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 1717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS ONE BLOC K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the estate representative. Account No. 4990b16 Date 07-25-1999 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance 3 036 51 Payment to the Register of Wills. Make check , . payable to Register of Wills, Agent . Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to Tax $ 506.10 months of the decedent's date of death, Tax Rate )( .045 deduct a 5 percent discount on the tax due. Potential Tax Due $ 22.77 Anv Inheritance Tax due will become delinquent nine months after the date of death. PART TAXPAYER RESPONSE A. ~ The above information and tax due is correct. L-~1 Remit payment 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 Wills and an official assessment will be issued by the PA Department of Revenue. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3~ 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 ,~~ o 2. Account Balance 2 $ ~ ~ ~ ~ \ 3. Percent Taxable 3 X ~~ ~ 4. Amount 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 DATE P AID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief . HOME C 7f~ ) 77~ G / /~~ _ ~ woRK c ~ _~__71~ TAXPAYER SIGNATURE TELEPHONE NUMBER DATE TDTAL (Enter on Line 5 of Tax Computation) ~