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Home My WebLink About07-11-11BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 ~~ nn ~~"'REY-I543 E% AFP ,,(00-`~8) PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE ~~ AND FILE TAXPAYER RESPONSE ACN l DATE N0. 21~- i~ -~~JL~~ 11130289 05-04-2011 ~~tl Jv'~. 1 ~ FE~.IL' ~J CLERK OF CUM~~R~AS~~ Ott RTC ANTHONY L ANDREOLI 640 POTTS HILL ROAD LEWISBERRY PA 17339 EST. OF ROSALIE ANDREOLI SSN 184-12-2668 DATE OF DEATH 04-20-2011 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 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. 127006-11 Date 04-30-2007 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 $ 11 ~ 977 • 15 payable to "Register of Wills, Agent". Percent Taxable X 8.333 NOTE: If tax payments are made within three Amount Subject to Tax $ 998.06 months of the decedent's date of death. Tax Rate ~( , 04j deduct a 5 percent discount on the tax due. Any Inheritance Tax due will become delinquent Potential Tax Due $ 44.91 nine months after the date of death. PART TAXPAYER RESPONSE FAI~.IfRE~~~T \E SP N °W~ILL RE, LT IN A ,OFFICI~L~T,4 ASSESSM~T ~~ 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 BLOC K B. ~ The above asset has been or will be reported and tax Daid with the Pennsylvania Inheritance Tax return O 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 ~~ ~~ g FjC~I~L USE ONLY ~ AAE relationship to decedent: PA DEPARTMENT DF REVENUE TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD p-~ 1 _. __ __ _ LINE 1. Date Established i 2. Account Balance 2 $ ~. ~7• ~5 2 3. Percent Taxable 3 X 3 3 4. Amount Subject to Tax 4 $ 9 9 + y~ 4 5. Debts and Deductions 5 ~~'~~ • JrZ 5 6. Amount Taxable 6 $ ~'~ ~ 6 X 04S d 7 7. Tax Rate 7 ~ $ 8. Tax Due $ c 0 . ~~ n .~ ~ `~ ~ 0 DEBTS AND DED UCTIONS CLAIMED PART DATE PAID PAYEE DESCRIPTION AMOUNT PAID ~.O II C p y 's U.Q I+4~ /17TlRG ~ 2 2 i ~~ i ~~ YF// ~osr 7/D E6MA~/S Ni'7eAZ TYKE f~t1-L~ v ~ wakE- «-KC~ 2 . z 5 •4 •, ., ., .-~ L7 1 V 1 ML ° Under penalties of perjury, I declare that the facts I have reported above are QtrueQ, correct Jand com lete to the best o my knowledge and belief. HOME C ~~~ ) 7 30-'S~3 `~ ~~ WORK C ) ~~~ 7 7 /~ .X PAYER SIGNATURE TELEPHONE NUMBER DATE ,t. ~. a USA F ~ 5 _ '~5! ,_ ~ ~ [[ y y ,. ,.~ T'7 ~,, ~,, ,1'!~ ~~ I } 3 d~ m =, M ~ ~ .~ A ~. A ~ ~ J i ~ 1^ \ ti d~` W ~ ~ ~ 1 J ~~ M ~ ~ a ~r a ~~ ~ ~_ ,aC ~ J o ~~ ~u ~C -. Q ~J J J iii iii i~ ~t •t.~