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Home My WebLink About06-20-11 (2)BUREAU OF INDIVIDUAL TAXES PO BOX 280601 Penns HARRISBURG PA 17128-0601 REY-1543 EX (PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE AND FILE N0. 21 11-0092 ~ e~~~~'~XPAYER RESPONSE ACN 11141603 "~4i~1~'~ DATE 06-17-2011 CLERK OF ORPHAN'S COLfRT AUDREY L LIPPERT Cl~~~~~t~~ ~~" FA 520 N BEDFORD ST CARLISLE PA 17013-1913 EST. OF LARRY E LIPPERT SSN 161-34-4537 DATE OF DEATH 11-27-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. CITIZENS BANK OF PENNSYLVANIA provided the department with the information below, which was used in calculating the inheritance tax due. Records indicate that at the death of the above named decedent, you were a joint owner/beneficiary of this account. If y0U are the spOUSe Of the deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2. If you believe 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. Please call 717-7g7-8327 with questions. COMPLETE PART 1 BELOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 6140887674 Date 03-29-1990 7o ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 2, 163.46 payment to the Register of Wills. Make check Percent Taxable X payable to "Register of Wills, Agent". 50.000 Amount Subject to TaX $ 1 ~ 081.73 NOTE: If tax payments are made within three Tax Rate X months of the decedent's date of death, . 1 5 deduct a 5 percent discount on the tax due. Potential Tax Due $ 162.26 Any inheritance tax due will become delinquent nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO REySD WILL ~2FSULT It~k 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 CHECK a discount or avoid interest, or return this notice to the Register of Wills and 0 N E ~ 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 filed by the estate representative. PART If i_______„ - ~,r„~ taz ra ,please s ate relationship~to decedent: (+~ ©C1 C~ TAX RETURN - CALCULATION 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. lax Rate ~ X 8. Tax Due 8 $ r,vrt i 0 DATE PAID PAYEE OFFICIAL USE ONLY ~ AA~ PA DEPARTMENT OF REVENUE PAD 1 2 3 4 5 6 7 8 DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) g Under penalties of perjury, I declare that the facts I reported above are true, cor ect and mplete to the best of my kncywledge and belief. ~p HOME ( ~'] I Z ) a 3 ~ TAX AYER SIGNA RE WORK ( ) TELEPHONE NUMBER DATE C. ~ The above informs ion is incorrI~e~ct and/or debts and deductions were paid. Complete PART 2~ and/or PART L__I below.