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° PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE FILE No. 21 11-0625
BUREAU OF INDIVIDUAL TAXES ~!'~. c
Po Box zaocol perm ~ r ', ~ ~`'~1L {~- AND ACN 11145671
HARRISBURG PA 17128-0601 DEPARTMENT ~.~tE'yENUE f~. I C`S'AX P AY E R R E S P O N S E
DATE 07-08-2011
REV-1543 EX AFP~(O~i•-1 tT' ~ ~ ~.'.~,1f
TYPE OF ACCOUNT
~.~,+~ i ~~~ ~~ ~'" ~` ~°~ EST. OF ROBERT E PARKER ~ SAVINGS
$$N 174-18-2512 ® CHECKING
C~ER~ CF DATE OF DEATH 04-08-2011 ~ TRUST
tO~pH'~N~Sr~~(fRT COUNTY CUMBERLAND ~ CERTIF.
Ct)~~~~~'.,'~f`',~~' ~;~ pp. REMIT PAYMENT AND FORMS T0:
VANESSA P SHENK REGISTER OF WILLS
5 HILLTOP RD 1 COURTHOUSE SQUARE
BOILING SPRINGS PA 17007-9709 CARLISLE PA 17013
PN C BANK NA 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 sp0U5e 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 Ts incorrect, please obtain written correction from the financial institution, attach a copy to this form and return
it to the above address. Please call 717-7$7-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 5004893953 Date 06-29-2006 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 $` 12, 192 • 00 payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax ~` 6, 096.00 months of the decedent's date of death,
Tax Rate X .045 deduct a 5 percent discount on the tax due.
Any inheritance tax due will become delinquent
Potential TaX Due $ 274 • 32 nine months after the date of death.
PART TAXPAYER RESPONSE
FAILURE TO RESPOND wILI 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
an official assessment will be issued by the PA Department of Revenue.
C ONE
B L 0 C 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/ar debts and deductions were paid.
Complete PART 2~ and/or PART ~ below.
PART If indicating a different
relationship to decedent:
CALCULATION OF tax rate, Please state
TAX ON JOINT/TRUST ACCOUNTS OFFICIAL USE ONLY ~ AAF
PA DEPARTMENT OF REVENUE
PAD
TAX
LINE RE
1. TURN -
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 $ $
PART
DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I reported above are true, correct and
complete t t best of my k edge and belief. HOME C
woRK c 717 ~ 77 -7
YER SIGN TURE era ~ 'TELEPHONE NUMBER DATE
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