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~~ PENNSYLVANIA INHERITANCE
~ INFORMATION NOTICE
BUREAU OF INDI kJ14i`,'TAX~~ ' - -~' ~ ''
Po Box zso6ol '.~ _'.. .-~ ~~ ~/(,Vd111d AND
HARRISBURG PA I~~~B~-o~641 _ .p~~A~ SENT OF REVENUE TAXPAY E R RE S P 0 N S E
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REV-1543 EX AFP (05-11)
TAX
FILE NO. 21 -i ( ~;1(.j
ACN 11140461
,DATE 06-14-2011
CLERK ~`f'
ORPH,~~'~ CCt.1RT
Cl ~P~~BEP ~"~I~ ~`~'~ , PAS
EDWIN L RICE
b03 S BEDFORD ST
CARLISLE PA 17013
EST. OF NAOMI J RICE
SSN 184-38-0989
DATE OF DEATH 12-24-2010
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS TD:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
S 0 V E R EIG N BAN K 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 yoU acre 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 717-787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account. No. 0311091660 Date 04-30-2008 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 $ 2, 663.08 payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NDTE: If tax payments are made within three
Amount Subject to Tax $ 1 , 331.54 months of the decedent's date of death,
Tax Rate ~( 1 rj deduct a 5 percent discount on the tax due.
Any inheritance tax due will become delinquent
Potential Tax Due $ 199.73 nine months after the date of death.
PART TAXPAYER RESPONSE
FAILURE RE~PON~~~:~WILL 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 return this notice to the Register of Wills and
0 N E 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
0 N L Y 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 DNLY ~ AAF
relationship to decedent: PA DEPARTMENT OF REVENUE
TAX RETURN - CALCULATION 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 $ g
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perju
complete to the~~ of~
TAXPAYER SIGNA
re that the facts I reported above are true, correc a??n~.
and belief . HOME ( ~~~ ~ ~4-~"~ `)~~
WORK C
TELEPHONE NUMBER DATE
TOTAL CEnter on Line 5 of Tax Computation) $