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Home My WebLink About06-27-11 (2)\ \\ ~ .~ BUREAU OF INDIV~/~~ ,TaQXFS ~.-~ PO BOX 280601 ~ '.., ,~~~ Lvania HARRISBURG PA ~ ~ 8r~0601 _ D,E`p~Rfif~NT OF REVENUE REV-1543 EX AFP (05-11) PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE N0. 21 • ~ ~ rl ~~` AND ACN 11140465 TAXPAYER RESPONSE DATE 06-14-2011 ,~. ,_ < , -, ~, CLERK ~~ GF~PNa~~'S CQ~~RT Ctl~~~E~-. A~3C' t;;~ . PA~ EDWIN L RICE 603 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 T0: REGISTER OF WILLS 1 COURTHOUSE SgUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. S 0 V E R EIG N B A N 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 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 bey 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. 1675204620 Date 11 - 02- 1989 To ensure proper credit to the account, two Established copies of this notice must. accompany Account Balance $ 1 0 , 897.22 payment to the Register of Wills. Make check payable to Register of Will:;, Agent Percent Taxable )( 50.000 Amount Subject to Tax NOTE: If tax payments are made within three $ 5, 448 61 . months of the decedent's date of death, Tax Rate X ~ 1 rj deduct a 5 percent discount on the tax due. Potential Tax Due Any inheritance tax due will become delinquent $ 817.29 nine months after the date oi= death. PART TAXPAYER RESPONSE 1^ FAILURE TO RESPOND WILL RESULT I~'1 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 acid 0 N E an official assessment will be issued by the PA Department of Revenue. B L 0 C K ONLY B. ~ The above filed by asset has been or will be reported and tax paid with the Pennsylvania inh~er:itance tax return the estate representative. ~--y( C. ~[~ The above ~/'~i Complete informs ion is PART ~2 and/or incorrect and/or debts and deductions were paid. PART ~ below. PART If indicating a different tax r ~ , e,~as state ` OFFICIAL USE °~~ONLY relationship to decedent: ~ AAF 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 $ ~ 5. Debts and Deductions 5 - 5 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X 7 8. Tax Due g $ $ PART DATE PAID PAYEE DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AM~l1NT PATT1 Under penalties of pe jury, I eclare that the facts I reported above are true, correct nd complete to a best my know dge and belief. HOME ~~],~ ) ~~~ -~ ~~ ~~ WORK ( ) _~ 1 TAXPAYER SI A E TELEPHONE NUMBER DATE ~u~~aL .CnLer on Llne 5 of lax Computation) $