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Home My WebLink About06-27-11 (5)~ ~~. BUREAU OF INDIVIDUAL TAXES ('` t~f`,!~' •;-'- PO BOX 280601 j"~~1~~1~$~~V`~~~ HARRISBURG PA 17128-0601 ~-(SE'R~ARTMENT OF REV @ ~ REV-1 ~~i3 EX `AFP (0~-k•k~° PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE AND TAXPAYER RESPONSE FILE N0. 21 - ~ ~ -~ ~~ ~-- ACN 11140462 DATE 06-14-2011 ,i + °~ ^7 CLERK 0;= ORPHq~~'S COURT 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 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 yc)u 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 717-787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 1671015517 Date 12- 17- 1982 To ensure proper credit to the account, two Establ ished copies of this notice must: accompany Account Balance $ 34 , 792.72 Payment to the Register of Walls. Make check Percent Taxable payable to "Register of Wi.ll~s, Agent". X 50.000 Amount Subject to Tax $ 17, 396.36 NOTE: If tax payments are made within three months of the decedent's dlate of death, Tax Rate ~( ~ 14j deduct a 5 percent discount on the tax due. Potential Tax Due $ 2, 609.45 Any inheritance tax due will become delinquent nine months after the date oi= death. PART TAXPAYER RESPONSE FAILURE T4I RESPOND MILL RESULT IN AN OFFICTAL 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. B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheriitance 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 ~ and/or PART ~ below. PART If indicating a different tax rate, please state OFFICIAL USE ONLY ~ AAF relationship to decedent: PA DEPARTMENT OE REVENUE TAX RETURN - CALCULATION OF TAX N JOINT/TRUST ACCOUNTS PAD LINE i. Date Eatdbiished i 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 )( 7 8. Tax Due g $ $ PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION nMnki~iT owr„ Under penalties of per" ry, I d Clare that the facts I reported above are true, correct and complete to a est~.p my know i dge and belief. HOME C~l~ ~ C~~~ --~r~l~j WORK C ~ _,{ ~~ ~~ 1 1 TAXPAYER SI TELEPHONE NUMBER DAT