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HomeMy WebLinkAbout05-23-11 PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES £ AND F I L E NO. - ~ ~-a~'Z Po Box 2so6o1 ~ TAXPAYER RESPONSE ACN HARRISBURG PA .tP~.M'~ w.'` t ~ ~ DATE REY-1543 EX AFP (08-OB) ~ ~ TYPE OF ACCOUNT ~ EST. OF H L CLEMEN S ® SAVINGS ~ SSN ? CHECKING DATE OF DEATH - 4 - ? TRUSr COUNTY CUMBER AND ? CERTIF. ~ REMIT PAYMENT AND FORMS T0: DONNA NISSEL REGISTER OF WILLS SUGAR MAPLE CT 1 COURTHOUSE SQUAR NEW CUMBERLAND PA CARLISLE PA I I MEMBERS 1ST FCU provided the Department with the information below, which haslbeen 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 i~ax laws of the Commonwealth of Pennsylvania. Please call C717) with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. Date O1 - To ensure grope credit to the account, two Established copies of this otice must accompany Account Balance 2 ~ Payment to the egister of Wills. Make check payable to "Reg ster of Wills, Agent". Percent Taxable X lb.bb7 NOTE: If tax p yments are made within three Amount Subject to Tax $ months of the d cedent's date of death, Tax Rate . deduct a perc nt discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due $ nine months aft r 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 notic to obtain C H E C K a discount or avoid interest, or check box "A" and return this notic 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 Penns lvania 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 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 Date Established 1 Account Balance 2 $ X e Percent Taxable 3 Amount Subject to Tax 4 Debts and Deductions 5 - Amount Taxable 6 Tax Rate 7 X Tax Due 8 $ ~ PART DEBTS AND DEDUCTIONS CLAIMED ~ DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computatian~ S Under penalties of perjury, I d re hat the facts I have reported above are tr e, correct and complete to the best of my k wl g belief. H 0 M E C ) ~ ~v WORK c ~ TAXPAYER SIGNATURE avl o , sq. TELEPHONE NUMBER DA - _ _ PENNSYLVANIA INHERITANCE TAX ~NFOR{MATION NOTICE i BUREAU OF INDIVIDUAL TAXES ^ ~i r ~ i f.'?~"~"t~~ ~D FILE N0. ~ I-o,~}a Po Box zao6ol ^ ~ ~AXP~~ ~'R RESPONSE ACN HARRISBURG PA , r'6;:.i.~J DATE REV-1543 EX AFP ~ ~~i ~ TYPE OF ACCOUNT ~c©r~ n~ EST. OF H L CLEMEN S ® SAVINGS vt,.GnK ~r $$1V ~ CHECKING ~~j'DATE OF DEATH - 4 - ~ TRUST E~~~RE.a C~., ~UNTY CUMBER AND ~ CERTIF. REMIT PAYMENT AND FORMS T0: DIANE WAY REGISTER OF WILLS RIVERE CR 1 COURTHOUSE SQUAR LEWISBERRY PA CARLISLE PA ~I MEMBERS 1ST FCU 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 owmer/beneficiary of this account. If you feel the information is incorrect, Please obtain written correction from the financial instituti¢n, 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) with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. - Date O 1 - - To ensure grope credit to the account, two Established copies of this otice must accompany 0 0 0 . 3 2 payment to the egister of Wills. Make check Account Balance payable to "Reg star of Wills, Agent". Percent Taxable X lb . b67 NOTE: If tax p vments are made within three Amount Subject to Tax $ months of the d cedent's date of death, Tax Rate ~ deduct a fi perc nt discount on the tax due. Any Inheritance Tax due will become delinquent Potential TaX Due $ nine montt?s aft r 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 notic 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 BLOC K B. ~ The above asset has been or will be reported and tax paid with the Penns lvania 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 and/or PART below. PART If indicating a different tax rate, please state a relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE Date Established 1 Account Balance 2 $ Percent Taxable 3 X Amount Subject to Tax 4 Debts and Deductions 5 - Amount Taxable 6 Tax Rate 7 X Tax Due 8 $ PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) S Under penalti ~ury, d c re that the facts I have reported above ar•e tr e, correct and complete to t o best of y n wl a and belief. H O M E C ? woRK C ~ 7 TAXPAYER SIGNATURE David H. Stone, Esq TELEPHONE NUMBER DATE PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE /~h BUREAU OF INDIVIDUAL TAXES AND F I L E NO . ~ ~ ~ ^ v PO BOX } ~ ~AXPAYER RESPONSE acN HARRISBURG PA ~ ~ ~ fi !.ik,tt#{ ~ DATE REY-1543 EX AF~~(d'Ba M+ p TYPE OF ACCOUNT ~ i j~ EST. OF H L CLEMEN S © SAVINGS $$N ~ CHECKING DATE OF DEATH - 4 - ~ TRUST ~~~p~~ COUNTY CUMBER AND ~ CERTIF. ~ REMIT PAYMENT AND 1=0RMS T0: DONNA NISSEL REGISTER OF WILLS SUGAR MAPLE CT 1 COURTHOUSE SUGAR NEW CUMBERLAND PA CARLISLE PA MEMBERS 1ST F CU 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 owmer/beneficiary of this account. If you feel the information is incorrect, please obtain written correction from the financial institutidn, 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 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. - Date 0 1 - - To ensure grope credit to the account, two Established copies of this otice must accompany Account Balance payment to the egister of Wills. Make check $ payable to "Reg ster of Wills, Agent". Percent Taxable X NOTE: If tax p yments are made within three Amount Subject to Tax $ months of the d cedent's date of death, Tax Rate deduct a fi perc nt discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due $ nine montFis aft r 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 notic 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 Penns lvania Inheritance Tax return 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 ~ 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 Date Established 1 Account Balance 2 $ Percent Taxable 3 X Amount Subject to Tax 4 $ Debts and Deductions 5 Amount Taxable 6 $ Tax Rate 7 X Tax Due 8 $ PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) S Under penalties of perjury, I d cl e t t the facts I have reported above are tr e, correct and complete to the best of my kno e e a 1"ef. HOME C ) WORK c ) TAXPAYER SIGNATURE David H. S on , Esq. TELEPHONE NUMBER DATE - - _ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES ~ ~~,i°~) AND F I L E N0. ~ Po eox 2BO6o1 .~{~k'~' ~ YER RESPONSE ACN HARRISBURG PA ~ ; t" w ~ i i} ~ - DATE REV-1543 EX pFP COB-08) f TYPE OF ACCOUNT rr ~~pp~~ EST. OF H L CLEMENTS © SAVINGS L~~GI'11~~ SSN ~ CHECKING ~~~D~ ~C DATE OF DEATH - - ~ TRUST COUNTY CUMBERL ND ~ CERTIF. REMIT PAYMENT AND FORMS T0: DIANE WAY REGISTER OF WILLS RIVERE CR 1 COURTHOUSE SQUARE LEWISBERRY PA CARLISLE PA ~I MEMBER S 1ST F CU 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 3oint ownier/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? with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT NSTRUCTIONS Account No . - Date To ensure proper credit to the account, two Established copies of this n tice must accompany Account Balance $ 3 payment to the R gister of Wills. Make check ~ payable to "Regi ter of Wills, Agent". Percent Taxable X 1b.667 NOTE: If tax pa ments are made within three Amount Subject to Tax ~ 5b9.92 months of the de edent's date of death, Tax Rate . deduct a 5 perce t discount on the tax due. Any Inheritance ax due will become delinquent Potential Tax Due $ b5 nine months afte 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 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 f Revenue. ONE B L 0 C K B. ® The above asset has been or will be reported and tax paid with the Pennsv vania 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 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 Date Established 1 ~ ~ Account Balance 2 X ~ Percent Taxable 3 Amount Subject to Tax 4 Debts and Deductions 5 - Amount Taxable 6 Tax Rate 7 X Tax Due 8 $ PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computations 8 Under penalties of perj 1 re that the facts I have reported above are tr e, correct and complete to the best of, my kno e e and belief. H 0 M E C ? WORK c ~ 7 c~S'~j _ TAXPAYER SIGNATURE 1 O ~ SCj. TELEPHONE NUMBER DATE PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND FILE N0. Q~/~"' PD Box 2so6ol ~ ~(I~A~AYER RESPONSE ACN HARRISBURG PA ' .,,y, ~ ~ DATE REV-1543 EX AFP u '~.i:" k'~~`~. TYPE OF ACCOUNT P~I ILs EST. OF H L CLE:MEN S ~ SAVINGS SSN ~ CHECKING DATE OF DEATH - 4 - ~ TRUST pp ~ COUNTY CUMBERLAND 0 CERTIF. ~~~N~~ ~ REMIT PAYMENT AND FORMS T0: DONNA NISSEL REGISTER OF WILLS SUGAR MAPLE CT 1 COURTHOUSE SQUARE NEW CUMBERLAND PA CARLISLE PA MEMBERS 1ST FCU 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 point owner/beneficiary of this account. It you feel the information is incorrect, please obtain written correction from the financial institutipn, 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) with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT NSTRUCTIONS Account No. Date O1 To ensure grope credit to the account, two Established copies of this otice must accompany Account Balance $ payment to the egister of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 1b.667 NOTE: If tax p ments are made within three Amount Subject to Tax $ months of the decedent's date of death, Tax Rate . deduct a perce t discount on the tax due. Any lnheritance ax due will become delinquent Potential Tax Due 1 , . 8b nine months afte 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 notic 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 f Revenue. ONE B L 0 C K B. ® The above asset has been or will be reported and tax paid with the PennsY vania 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 .I Complete PART 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 Date Established 1 Account Balance 2 $ Percent Taxable 3 X Amount Subject to Tax 4 Debts and Deductions 5 - Amount Taxable 6 Tax Rate 7 X Tax Due 8 $ ~ PART DEBTS AND DEDUCTIONS CLAIMED i DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computations S Under Pena r declare that the facts I have reported above ar•e tr e, correct and complete. to a be t o my k wledge and belief. H O M E C WORK C ) - TAXPAYER SIGNATURE e, sq. TELEPHONE NUMBER DAT i PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND F I L E NO. r ~ Po Box z8o6o1 ~ ~ ? 'TAXPAYER RESPONSE ACN HARRISBURG PA ~,~~~~~C DATE REV-1543 EX AFP (68-OB~Y~' } p~ TYPE OF ACCOUNT EST. OF H L CLEMENTjS ~ SAVINGS $$N ~ CHECKING Qfi DATE OF DEATH - - ~ TRUST ~f~ ~f COUNTY CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FORMS TO: DIANE WAY REGISTER OF WILLS RIVERE CR 1 COURTHOUSE SQUARE LEWISBERRY PA CARLISLE PA 17013'x, MEMBERS 1ST FCU 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 T:vc laws of the Commonwealth of Pennsylvania. Please call with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT $NSTRUCTIONS Account No. Date O1 To ensure proper credit to the account, two Established copies of this n tice must accompany 0 4 4 2 Payment to the R gister of Wills. Make check Account Balance $ ~ payable to "Regi ter of Wills, Agent". Percent Taxable X lb . b67 NOTE: If tax pa ments are made within three Amount Subject t0 Tax $ ~ • months of the de edent's date of death, Tax Rate X . deduct a 5 perce t discount on the tax due. Anv Inheritance ax due will become delinquent Potential Tax Due $ 1 ~ • nine months afte the date of death. PART TAXPAYER RESPONSE a ~ A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this noticeito 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 pf Revenue. ONE 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 andtor PART below. PART If indicating a different tax rate, please state ~ a relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE Date Established 1 Account Balance 2 $ Percent Taxable 3 X Amount Subject to Tax 4 Debts and Deductions 5 Amount Taxable 6 Tax Rate 7 X Tax Due 8 PART DEBTS AND DEDUCTIONS CLAIMED a DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) S Under penalties of perjur a that the facts I have reported above are tree, correct and complete to the best of no le nd belief. H O M E C ~ WORK t ~ TAXPAYER SIGNATURE DAvi H;. tone eS ~ TELEPHONE NUMBER' DATE ~ q - PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND FILE N0. (7(~~a Po Box 2so6o1 . ' ~'pAYER RESPONSE ACN HARRISBURG PA REY-1543 EX AF ~CDB'68)+ ~ ~S~ DATE ~~f ~ ~~Y TYPE OF ACCOUNT t EST. OF H L CLEMENT~S ? savlNGs SSN ? CHECKING DATE OF DEATH - - ? rRUST ~~~'-~~Y~S ~T COUNTY CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FORMS IiTO: DONNA NISSEL REGISTER OF WILLS SUGAR MAPLE CT 1 COURTHOUSE SQUARE NEW CUMBERLAND PA CARLISLE PA MEMBERS 1ST F CU 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 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. Date To ensure proper? credit to the account, two Established copies of this notice must accompany b20.29 payment tai the gister of Wills. Make check Account Balance $ ~ payable tai "Regi ter of Wills, Agent". Percent Taxable X . b67 NOTE: If tax pa ments are made within three Amount Subject to Tax ~ months of the de~Cedent's date of death, Tax Rate X . deduct a 5 perce~t discount on the tax due. Anv Inheritance max due will become delinquent Potential Tax Due $ 1 ~ nine months afte~• the date of death. PART TAXPAYER RESPONSE a ~ ~ A. ? The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this noticeito obtain C H E C K a discount or avoid interest, or check box "A" and return this noticeito the Register of Wills and an official assessment will be issued by the PA Department bf Revenue. ONE B L 0 C K B. ® The above asset has been or will be reported and tax paid with the Pennsvllvania 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 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 Date Established 1 Account Balance 2 $ Percent Taxable 3 X Amount Subject to Tax 4 $ Debts and Deductions 5 Amount Taxable 6 $ Tax Rate 7 X Tax Due 8 ~ ~ ~ PART DEBTS AND DEDUCTIONS CLAIMED i 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) S Under penalties of perjury, 1 e that the facts I have reported above are true, correct and complete to the best of m knowl nd belief. H O M E C WORK C ~ f..~ TAXPAYER SIGNATURE awl one, Esq. TELEPHONE NUMBER DATE PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES r~l_ i'1~" ~ AND F I L E NO. f ~ Po Box zso6ol ~~~AYER RESPONSE AcN HARRISBURG PA a ~ DATE - - ~..?~.r s v~1 • e ~~~.l.,rJ REV-1543 EX AFP TYPE OF ACCOUNT ~ ~ l EST. OF H L CLEMENT~S ~ SAVINGS $$N ~ CHECKING ~~K ~F DATE OF DEATH - 2I4 - ~ TRUST O~~AN ~ GC}~lRT COUNTY C U M B E R LAN D XC~ CE RT I F. `+"'T'~~~~ tr~•. i"I'~. REMIT PAYMENT AND FORMS I,TO: DIANE WAY REGISTER OF WILLS RIVERE CR 1 COURTHOUSE SQUARE! LEWISBERRY PA CARLISLE PA MEMBERS 1ST FCU 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 inst:itutian, 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) with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS i Account No . - Date O 1 - 0 9 - To ensure proper'i credit to the account, two Established copies of this nootice must accompany Account Balance $ payment to the R~gister of Wills. Make check ~ payable to "Regi ter of Wills, Agent". Percent Taxable X NOTE: If tax palrments are made within three Amount Subject to Tax $ ~ months of the de edent's date of death, Tax Rate . deduct a 5 perce~t discount on the tax due. Any Inheritance ax due will become delinquent Potential Tax Due $ 1 ~ nine months afte the date of death. PART TAXPAYER RESPONSE a 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 {~f Revenue. ONE B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsv~vania Inheritance Tax return 0 N L Y to be filed by the estate representative. C. ~ The above informs zon is incorrect and/or debts and deductions were paid.',. Complete PART and/or PART L___I below. PART If indicating a different tax rate, please state relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE Date Established 1 Account Balance 2 X Percent Taxable 3 Amount Subject to Tax 4 $ Debts and Deductions 5 - s Amount Taxable 6 $ ~ Tax Rate 7 X Tax Due 8 $ ~ ~ a ~ ~ PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) 8 Under penalties of perjury, I decla hat the facts I have reported above are trye, correct and complete to the best of wle belief. H 0 M E C ) WORK c TAXPAYER SIGNATURE Davi H, one, Esq. TELEPHONE NUMBER'', DATE i - - - - r PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND FILE N0. 1 Po Box zao6ol E ~ `Jj' AVER RESPONSE ACN HARRISBURG PA C DATE y, REY-1543 EX 0.FP -8M'~ ~ I 'f,,,~~~ tr~~.~`~ ; TYPE OF ACCOUNT P~ I~: EST. OF H L CLE:MENTS ? SAVINGS SSN 184-12-x,4830 ? CHECKING C~ Q~ DATE OF DEATH - - ~ TRUST `s COUNTY CUMBERL4AND ~ CERTIF. REMIT PAYMENT AND F~ORMS'TO: DONNA NISSEL REGISTER OF WILLS SUGAR MAPLE CT 1 COURTHOUSE SQUAREI NEW CUMBERLAND PA CARLISLE PA MEMBERS 1ST FCU 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 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 82b63- Date To ensure propert credit to the account, two Established copies of this notice must accompany payment to the F~egister of Wills. Make check Account Balance $ , payable to "Regijster of Wills, Agent". Percent Taxable X NOTE: If tax papiments are made within three Amount Subject to Tax $ months of the deicedent's date of death, Tax Rate X . deduct a g. percelnt discount on the tax due. Anv Inheritance Tax due will become delinquent Potential Tax Due nine monthis aftelr the date of death. PART TAXPAYER RESPONSE a A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this noticq 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 BLOC K B. ® The above asset has been or will be reported and tax paid with the Pennsyilvania 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 and/or PART below. PART If indicating a different tax rate, please state ~ relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINTlTRUST ACCOUNTS LINE Date Established 1 ~ Account Balance 2 $ Percent Taxable 3 X Amount Subject to Tax 4 $ Debts and Deductions 5 - Amount Taxable 6 $ Tax Rate 7 X Tax Due 8 $ ~ ~ ~ ~ ~ ~ PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) S Under penalties of perjury, I d th facts I have reported above are trove, correct and complete to the best of my know dge a d 1 H O M E C woRK c ~ ~ , TAXPAYER SIGNATURE David H. Stone, Esq. TELEPHONE NUMBER DATE PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21~~~'d.~`~o~ Po BOX ~s~~~~~ ~?XPAYER RESPONSE ACN HARRISBURG PA ~ ` ~ , t,rr ~~C DATE REV-1543 EX AFP 4 ~ ~ F , TYPE OF ACCOUNT EST. OF H L CLEMENT,S ~ SAVINGS C~ ~ SSN - 12-j4830 ~ CHECKING DATE OF DEATH - 2I4 - ~ TRUST COUNTY CUMBERLAND ~ CERTIF. T/'1 REMIT PAYMENT AND FORMS iTO: DIANE WAY REGISTER OF WILLS RIVERE CR 1 COURTHOUSE SQUAREI, LEWISBERRY PA CARLISLE PA MEMBERS 1ST FCU 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 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 826b3- Date O 1 - To ensure grope credit to the account, two Established copies of this n tice must accompany payment tai the R gister of Wills. Make check Account Balance $ payable tai "Regi ter of Wills, Agent". Percent Taxable X NOTE: If tax pa~ments are made within three Amount Subject to Tax $ months of the de edent's date of death, Tax Rate X deduct a 5 perce t discount on the tax due. Any Inheritance ax due will become delinquent Potential Tax Due $ nine months afte 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 Wills and an official assessment will be issued by the PA Department f Revenue. ONE 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 xon is incorrect andlor debts and deductions were paid.'I Complete PART ~ and/or PART 3LJ below. PART If indicating a different tax rate, please state ~ relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE Date Established 1 Account Balance 2 Percent Taxable 3 X Amount Subject to Tax 4 Debts and Deductions 5 Amount Taxable 6 Tax Rate 7 X Tax Due 8 DEBTS AND DEDUCTIONS CLAIMED PART DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) ~ Under enalties of pe ury, 1 r t at the facts I have reported above are tree, correct and p complete to the best f m know e e a belief. H O M E ( ~ WORK c ~ 7 ~ TAXPAYER SIGNATURE Da ~ one, Esq. TELEPHONE NUMBER, DATE _ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES ~ AND F I L E N0. ~ PO Box ~,i ~ , TAXPAYER RESPONSE AcN HARRISBURG PA ,,.«.;...t , ~`)~~'-~t' - t t~ DATE REV-1543 EX I1FP (~-a8)`'f l~ ~ ~~Y TYPE OF ACCOUNT EST. OF H L CLEMENT~S ~ SAVINGS SSN ~ CHECKING ~ DATE OF DEATH - - ~ TRUST COUNTY CUMBERLAND ~ CERTIF. ~'YV~ ~ REMIT PAYMENT AND FORMS ',TO: DONNA NISSEL REGISTER OF WILLS SUGAR MAPLE CT 1 COURTHOUSE SQUARE, NEW CUMBERLAND PA CARLISLE PA MEMBERS 1ST F CU 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 ownier/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 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT $NSTRUCTIONS Account No. Date To ensure properly, credit to the account, two Established copies of this nptice must accompany 4 1 0 1 payment to the Register of Wills. Make check Account Balance $ , payable to "Register of Wills, Agent". Percent Taxable X NOTE: If tax pa~tments are made within three Amount Subject to Tax $ months of the decedent's date of death, Tax Rate deduct a 5 percent discount on the tax due. Any Inheritance i}ax due will become delinquent Potential Tax Due $ nine months afteq~ 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 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. BLOC K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return O N L Y to be filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were paid.l Complete PART and/or PART below. PART If indicating a different tax rate, please state a relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE Date Established 1 Account Balance 2 $ Percent Taxable 3 X Amount Subject to Tax 4 Debts and Deductions 5 Amount Taxable 6 Tax Rate 7 X Tax Due 8 $ PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) ~ Under penalties of perjury, I de lore that the facts I have reported above are true, correct and complete to the best of kno d e and belief. H O M E C woRK c ~ ~ TAXPAYER SIGNATURE one, sq. TELEPHONE NUMBER DA E PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES t"l;,;,~'" AND FILE N0. ' //"D~,~ Po Box 2so6o1 ~ ~ PAYER RESPONSE ACN HARRISBURG PA ~r~:L.~ • ~ DATE REV-1543 EX AFP (OB-08) ~ TYPE OF ACCOUNT G. EST. OF H L CLE:MENTS ~ SAVINGS t,~~Gnn Vr $SN - ~ CHECKING DATE OF DEATH - z4 - ? TRUST ~rY~ {yi. COUNTY CUMBERLAND ~ CERTIF. r"[~ i71 REMIT PAYMENT AND FORMS T0: DIANE WAY REGISTER OF WILLS 6b5 RIVERE CR 1 COURTHOUSE SQUARE LEWISBERRY PA CARLISLE PA MEMBERS 1ST F CU 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 T:ax laws of the Commonwealth of Pennsylvania. Please call C717) with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. Date To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance ~ ~ . b 1 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X NOTE: If tax payments are made within three Amount Subject t0 Tax $ b7 , months of the decedent's date of death, Tax Rate . deduct a 5 percent discount on the tax due. 0 2 4 2 4 Anv Inheritance Yax due will become delinquent Potential Tax Due $ 3 ~ nine months afteh the date of death. PART 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 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. oNE 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 and/or PART below. PART If indicating a different tax rate, please state ~ relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINTlTRUST ACCOUNTS LINE Date Established 1 ~ Account Balance 2 $ ~ X ~ Percent Taxable 3 Amount Subject to Tax 4 Debts and Deductions 5 - Amount Taxable 6 Tax Rate 7 X Tax Due 8 $ ~ PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computations 8 Under penalties o , cl re that the facts I have reported above are true, correct and complete to the bes of my no 1 dg and belief. H 0 M E C ) WORK c ) - I f'- TAXPAYER SIGNATURE DaVi ~tcne, Esq. TELEPHONE NUMBER DATE