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PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE FILE N0. 21 - jJ --]`]~
~ ~~' ~ ?-~-%FT PAYERNRESPONSE ACN 11144324
( DATE 06-30-2011
~I 1,
BUREAU OF INDIVIDUAL TAXES ,
PO BOX 280601 p@1111S~/~F
HARRISBURG PA 17128-0601 DEPARTMENT~~e
REV-1543 EX Ri~,
~f'° i .~~~. { 2 t~'~ ~~?o a
CLERK 0~
~~~~5 COURT
~1~~ER~ .wND G~ PA
MARILYN M MYERS
17 HAZEL CIR
MECHANICSBURG PA 17050
EST. OF RUTH M WEAKLEY
SSN 202-20-5039
DATE OF DEATH 09-30-2010
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
METRO BANK 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 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 he 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. 538300484 Date 09-09-2008 To ensure proper credit to the account, two
Established copies of this notice must accompany
1 3 9 . 9 5 payment to the Register of Wills. Make check
Account Balance $ 1 ~ payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 569.98 months of the decedent's date of death,
Tax Rate X , lrj deduct a 5 percent discount on the tax due.
Any inheritance tax due will become delinquent
Potential Tax Due $ 85 • 50 nine months after the date of death.
PART TAXPAYER RESPONSE
1^ ~ ~~
FAILURE PTO F~ESP~~ID MILL R ~~~LT ~.IN~.AN OF AL 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
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 filed by the estate representative.
C. 1=1 The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART ~2 and/or PART ~ below.
J
PART If indicating a different tax rate, please state
2 relationship to decedent:
TAX RETURN - CALCULATION
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 1
2 $ 2
s X 3
4 $ 4
5 - 5
6 $ ~ - 6
7 X ~ °~ 7
$ ~ Q r 8
~ \
PART
^3
OFFICIAL USE~~Ju,.~ ~ AAF
PA DEPARTMENT OF REVENUE
DEBTS AND DEDUCTIONS CLAIMED
naTF PATD PAYEE DESCRIPTION AMOUNT PAID
TA PAYE SIGNA E TELEPHONE NUMBER DATE
Under penalties of perjury, I declare that the facts I reported above are true, correct and
complete to th best of my knowl~edge and belief. HOME C 1 ~~ ) ~/`(~y' i~~
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