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Home My WebLink About06-13-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: ADAMS TRUDY S 6 LOCUST STREET CARLISLE, PA 17015 fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: SSN: 187-16-4255 FILE NUMBER: 211 1-0667 DECEDENT NAME: STONE LEE N DATE OF PAYMENT: 06/13/2011 POSTMARK DATE: 06/13/2011 COUNTY: CUMBERLAND DATE OF DEATH: 03/25/201 1 ACN ASSESSMENT CONTROL NUMBER AMOUNT 11122998 ~ 516.05 11122999 ~ 529.95 11123000 ~ 59.21 11123001 ~ 52.10 11123002 ~ 5137.39 11123004 ~ 5107.13 TOTAL AMOUNT PAID: REMARKS: CHECK# 1305 SEAL INITIALS: CJ 5301.83 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REV-1162 EX111-96) NO. CD 014560 REGISTER OF WILLS PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21-- ~ (~- 0 ~~ PD Box zso6ol TAXPAYER RESPONSE ACN 11122998 HARRISBURG PA 17128-0601 DATE 04-06-2011 REV-1543 EX AFP (8B-88) TRUDY ADAMS 6 LOCUST HOLLOW LANE CARLISLE PA 17015 EST. OF LEE N STONE SSN 187-16-4255 DATE OF DEATH o3-25-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. 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. 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. 123010 - OO Date 10 -21-1991 To ensure proper credit to the account, two Established copies of this notice wust accompany payment to the Register of Wills. Make check Account Balance $` 750 • 08 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax Payments are made within three Amount Subject to Tax g 375.04 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 $ 16 • 88 nine months after the date of death. PART TAXPAYER RESPONSE FAILUR ~ 70 . ~SPONIL(,~\RESCILT IN A~~ OF~IC11~L,a~AX ASSBFS~~°FIT\ A. The above information and tax due is correct. LLLLLLJJJJJJ Rewit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or check box "A" and return this notice to the Register of C H E C K Wills and an official assesswent will be issued by the PA Department of Revenue. C 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 ~2 and/or PART ~ below. PART If indicating a different tax rate, please state .. _. OFFICIAL US ONL AAF relationship to decedent: PA DEPARTMENT OF REVENUE TAX RE TURN - 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 $ b 7. Tax Rate T X ~ a° 8. Tax Due 8 0 PART DEBTS AND DEDUCTIONS CLAIMED neTF PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I e have reported abov are t r ue, correct and compl a to he best of my knowledge and belief. - f HOME C ~~ ! [ ~ ) ~ ( 9 "2 ~~,f ..-- • L WORK C ) 2, (, cco / TAXPAYE SI ATUR TELEPHONE NUMBER DATE iuiA~ itncer vn zinc PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU DF INDIVIDUAL TAXES AND FILE N0. 21-~~ ~~(~(~~ Po Box zaocol TAXPAYER RESPONSE ACN 11122999 HARRISBURG PA 17128-0601 DATE 04-06-2011 ecv-~cG{ FY AFP (88-88) TRUDY ADAMS 6 LOCUST HOLLOW LANE CARLISLE PA 17015 EST. OF LEE N STONE SSN 187-16-4255 DATE OF DEATH 03-25-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. 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 C717) 7B7-8327 with questions. COMPLETE PART I BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 12301 O - 02 Date 11 - 16 - 1999 To ensure proper credit to the account, two Established copies of this notice roust accowpany payment to the Register of Wills. Make check Account Balance $` 1,401.00 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax paywents are wade within three Amount Subject to Tax $` 700 • 5O wonths 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 $ 31 • 52 nine wonths after the date of death. PART TAXPAYER RESPONSE FAI,L~U~ff T~ SP01#U i~}Ii: ARE LT I~~ 14FOFFICIAL~TAX °~ \~SSME~T A. ~e above information and tax due is correct. LLLJJJ Rewit paywent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or check box "A" and return this notice to the Register of C H E C K Wills and an official assessment will be issued by the PA Department of Revenue. C 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 inforwa 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 LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS PAD 1 2 3 X 4 5 6 '~ 7 X 8 $ OFFICIAL SSE ONLY ~°AAF° PA DEPARTfi~t£NT OF REVENt!£ i _. 2 4 5 6 -- 7 PART DEBTS AND DEDUCTIONS CLAIMED a nerc porn PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, c1orre/!ct and comple o the best f my knowledge and belief. HOME C ( ) ~ /' ~ `G WORK C ) ~, f TAXPAY R SIGN TURE TELEPHONE NUMBER DATE IUIPI \CnIC ,- ~,~ ~s~~c ~ ~ -• PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND F I L E ND . 21- ( (~ Q(p (~~ PD Box zso6ol TAXPAYER RESPONSE ACN 11123000 HARRISBURG PA nlza-ocol DATE 04 - 06 - 2011 REV-1543 EX AFP (08-OB) TYPE OF ACCOUNT EST. OF LEE N STONE ^ savlNGs $SN 187-16-4255 ® CHECKING DATE OF DEATH 03-25-2011 ^ TRUST COUNTY CUMBERLAND ^ CERTIF. REMIT PAYMENT AND FORMS T0: TRUDY ADAMS REGISTER OF WILLS 6 LOCUST HOLLOW LANE 1 COURTHOUSE SQUARE CARLISLE PA 17015 CARLISLE PA 17013 MEMBERS 1ST FCU Drovided 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 ioint 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. 1230 1 0 - 1 1 Date 10 -21 - 1991 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance g 430.61 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax ~}` 215.31 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 $ 9 • 69 nine months after the date of death. PART TAXPAYER RESPONSE FAILURE T.,O JtESkID W~L~,~RES~ILT I~~~N OFFICIAL TAX ASS~SS,MENT A. The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or check box "A" and return this notice to the Register of C H E C K Wills and an official assessment will be issued by the PA Department of Revenue. C 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. C. ^ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3^ below. If indicating a different tax rate, please state ~ °@~C3FFjEjA ~JSE 0 PART ' relationship to decedent: PA DEPARTfiENT OF REVENUE TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1. Date Established 1 ~ 1 2. Account Balance 2 $ 2 A 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ ~ 4 5. Debts and Deductions 5 S 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X 7 ~~ , 8. Tax Due 8 $ 8 PART DEBTS AND DEDUCTIONS CLAIMED 3^ nerF Pe7n PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported abov-e7 are true, co2rrect and comple he best of my knowledge and belief. H OME C ~ / ) ~ v-~)~ /~ ~~-r3~e WORK C ~J~t ) lL, .fi .7 ~ TAXPA ER NATURE TELEPHONE NUMBER DATE IUTAL lCflle(- V~~ ~i~~c .+ - - PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE /N~~~ BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21-~~~~P~1 PD Box z8o6o1 TAXPAYER RESPONSE ACN 11123001 HARRISBURG PA 17128-0601 DATE 04-06-2011 REV-1543 EX AFP (OB-OB) TRUDY ADAMS 6 LOCUST HOLLOW LANE CARLISLE PA 17015 EST. OF LEE N STONE SSN 187-16-4255 DATE OF DEATH 03-25-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. 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 (717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account Na. 123010-05 Date 08-07-1992 To ensure prover credit to the account, twa Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance $ 37U • 61 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax paynents are made within three Amount Subject to Tax $ 185 • 31 months of the decedent's date of death, )( .045 deduct a 5 percent discount on the tax due. Tax Rate Anv Inheritance Tax due will become delinquent Potential Tax Due $ 8 • 34 nine months after the date of death. PART TAXPAYER RESPONSE O W I~ ~ ` T $ I C I' L AX l~(S T\ a ~ g A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or check box "A" an d return this notice to the Register of C H E C K Wills and an official assessment will be issued by the PA Department of Revenue. ONE C B L 0 C K B. ~ The above asset has been or will be reported and tax Daid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the estate representative. C. ~he 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 ~ OFFIC:~A~. i)~'aE ON~.~ _~jAA relationship to decedent: PA' i?EPA$T~4ENT t3F KfyEk3}jE ON JOINT/TRUST ACCOUNTS PAD TAX RE TURN - COMPUTATION OF TAX ~ " i LINE 1. Date Established 1 , ~ S ~~ C` ~ 2 2. Account Balance 2 ' - , X '~ ~ 3 3. Percent Taxable 3 ~ a $ ~~- ~ ~ 4 -" 4. Amount Subject to Tax 4 ~ - f ~ 5 5. Debts and Deductions 5 $ 7 ~ ~ y4 6 6. Amount Taxable 6 ~ . -~~ X h y~ 7 7. Tax Rate 7 e ~ ~ t~ "~ 8 \ _ 8. Tax Due 8 - . ~ ~ ~ PART DEBTS AND DEDUCTIONS CLAIMED neTF Parn PAYEE DESCRIPTION AMOUNT PAID IUTAL ltnier on une ~ u, ,~~r...a ~+~•~- Under penalties of perjury, I declare that the facts I have reported above are true, correct acnd compl he b t of my knowledge and belief. HOME C ~(~ ) t7 c( ~ ~" ~ T WORK C ) 1- Z _ S TAXPAY R IG ATURE TELEPHONE NUMBER DATE PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE AND FILE N0. 21-~~' ~tQ, BUREAU OF INDIVIDUAL TAXES ACN 11123002 PD eox zao6ol TAXPAYER RESPONSE HARRISBURG PA 17128-0601 DATE 04-06-2011 REV-1543 E% AFP (88-087 EST. OF LEE N STONE SSN 187-16-4255 DATE OF DEATH 03-25-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. TRUDY ADAMS REGISTER OF WILLS 6 LOCUST HOLLOW LANE 1 COURTHOUSE SQUARE CARLISLE PA 17015 CARLISLE PA 17013 1ST FCU provided the Department with the information below, which has been used in calculating the t MEMBERS cords indicate that R . at the death of the above-named decedent. You were a joint owner/beneficiary of this accoun e potential tax due. If you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form ith the Inheritance Tax laws of the Commonwealth of d and return it to the above address. This ance w account is taxable in accor Pennsylvania. Please call C717) 787-8327 with questions. SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS COMPLETE PART 1 BELOW * Account No. 1230 1 0-40 Date 10-21-1991 To ensure proper credit to the account, two tablished copies of this notice must accompany E s payment to the Register of Wills. Make check Account Balance $ 6 ~ 428 • 89 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $ 3,214.45 months of the decedent's date of death, 0 4 5 deduct a 5 percent discount on the tax due. Tax Rate . X Any Inheritance Tax due will become delinquent Potential Tax Due $ 144.65 nine months after the date of death. TAXPAYER RESPONSE PART ILUR T ILL C, r S A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or check box "A" and return this notice to the Register of CHECK Wills and an official assessment will be issued by the PA Department of Revenue. C 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 ~2 and/or PART ~ below. PART If indicating a different tax rate, please state , ~ OFFICI L USE.QNLY,_,, relationship to decedent: PA DEf'ART#1ENT flF REVEtt~/E TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1. Date Established 1 1 2. Account Balance 2 $ ~'~ 2 .a 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ ~ 5. Debts and Deductions 5 - 5 6. Amount Taxable 6 $ ~ ~ '~ 7. Tax Rate T X \c~ 7 8 $ 8 ~ 8. Tax Due PART DEBTS AND DEDUCTIONS CLAIMED 0 ...~~ ,,.r„ aev~G DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and compl the est of my knowledge and belief. HOME C 7~ 7 ) ~ Y ~ ~ 7 WORK C ~ ~ ( ~~ TAX AYER S ATURE TELEPHONE NUMBER DATE PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE AND FILE N0. 21 -~~-044'7 BUREAU OF INDIYIDUAL TAXES ACN 11123003 Po eox zso6ol TAXPAYER RESPONSE HARRISBURG PA 17128-0601 DATE 04 - 06 - 2011 REV-1543 E% AFP (OB-OB> EST. OF LEE N STONE SSN 187-16-4255 DATE OF DEATH 03-25-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: TRUDY ADAMS REGISTER OF WILLS 6 LOCUST HOLLOW LANE 1 COURTHOUSE SQUARE CARLISLE PA 17015 CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST F CU provided the Department with the information below, which has been used in calculating the t potential tax due. Records indicate that at the death of the above-named decedent, tion from the . you were a joint owner/beneficiary of this accoun financial institution, attach a copy to this form If you feel the information is incorrect, please obtain written correc ce with the d i Inheritance Tax laws of the Commonwealth of and return it to the above address. This an n accor account is taxable Pennsylvania. Please call C717) 787-8327 with questions. SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS COMPLETE PART 1 BELOW * Account No. 123010-43 Date 01-27-2009 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance ~` 10 ~ 437.63 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $ 5 r 218 • 82 months of the decedent's date of death, 045 deduct a 5 percent discount on the tax due. Tax Rate X . Arty Inheritance Tax due will become delinquent Potential Tax Due $ 234.85 nine months after the date of death. TAXPAYER RESPONSE PART ^ ~ \IL E ~ D I ~ ~, IC N~~ A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or check box "A" and return this notice to the Register of CHECK Wills and an official assessment will be issued by the PA Department of Revenue. C 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 O N L Y t be filed by the estate representative. C. ~e above informs ion is incorrect and/or debts and deductions were paid. Comvlete PART ~2 and/or PART ~ below. ~ r PART If indicating a different t d tax rate, please state _ OF~IC1Al„U'SE. p1~L7. ,,~ ~AAF EYENl1E " : en relationship to dece R PA DEPAtYT~tENT flF TRUST ACCOUNTS 'PAD TAX RE TURN - COMPUTATION OF TAX ON JOINT/ _L _, tablished 1 E t D LINE 1. s e a $ ^i ~ 2 v t Balance 2 ~~ ~ ~ ~ ` 'S 2. Accoun X , _ rC a ~ 3 t Taxable 3 L J 3. Percen `~ p ~i ~~ ` ~ 4 4. Amount Subject to Tax 4 ' a o d Deductions 5 - ~ ~~~ ~ Z ~ 5. Debts an $ 6 6. Amount Taxable 6 ~ 7. Tax Rate 7 X ( ~ `Pl 7 8. Tax Due 8 $ ~ " PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID .~ . t .,~. _ o'D _>i-- TOTAL (Enter on Line 5 of Tax Computation) 8 Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to best of my knowledge and belief. HOME C ~l ~ ) ~Y ~ 7-" ~~ J ~ ~Q~ WOR K ~ ~/ 7 ~ )-L G S 3 oZ. f TAXPAY R SI ATUR TELEPHO E NUMBER DATE PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE AND FILE N0. 21 -~ ~"~(pG7 BUREAU OF INDIVIDUAL TAXES ACN 11123004 Po Box zaocol TAXPAYER RESPONSE HARRISBURG PA 17128-0601 DATE 04-06-2011 REV-1543 EX AFP (08-08) EST. OF LEE N STONE SSN 187-16-4255 DATE OF DEATH 03-25-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: TRUDY ADAMS REGISTER OF WILLS 6 LOCUST HOLLOW LANE 1 COURTHOUSE SQUARE CARLISLE PA 17015 CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. 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 (717) 787-8327 with questions. - _- COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 1230 1 0-44 Date 08-04-1992 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance ~` 5 ~ 012 • 06 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax Payments are made within three Amount Subject to Tax $ 2,506.03 months of the decedent's date of death, deduct a 5 percent discount on the tax due. Tax Rate ~( .045 Any Inheritance Tax due will become delinquent Potential Tax Due $ 112 • 77 nine months after the date of death. PART TAXPAYER RESPONSE 0 FkILURE '~~ RESPOt#~ WILL RESULT Ib AN OFFICIAL. TAX. ASSESSMENT A. ~cr-ine above information and tax due is correct. LLJJ Remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or check box "A" and return this notice to the Register of C H E C K Wills and an official assessment will be issued by the PA Department of Revenue. C 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 2~ and/or PART ~ below. PART If indicating a different tax rate, please state "~ OFFICIAL USE LY ~ ~ AAF relationship to decedent: 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 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) 8 Under penalties of perjury, I declare that the facts I have reported above are true,/correct and com o the est of my knowledge and belief. HOME C ~ 7 ) '7 ~~ ~~ WORK C ~ ~`-L ~ TA AVER I NATURE TELEPHO NUMBER DATE