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Home My WebLink About05-09-11 (5)~~~\` PENNSYLVANIA INHERITANCE TAX _ INFORMATION NOTICE FILE N0. 21"~~"~~~~ BUREAU OF INDIVIDUAL TAXES i"~~ "~~ I ~ M~`~~ ~~ AND Po Box zso6ol penr~ ~~''~~~ ACN 11145927 HARRISBURG PA 17128-0601 DEPARTME~ ~~E~u~, - `~4'!` ~ C~ TAXPAYER RESPONSE DATE 07-13-2011 ORP~-1 t~N ~ ~F '~ C0~_1RT Cl1~~E~1 r~~~#~ ~~ . PA BARBARA STOUTLEITZEL 613 N EAST ST CARLISLE PA 17013-2012 EST. OF EVELYN E STOUT SSN 152-14-0346 DATE OF DEATH 05-22-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS TD: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. CITIZENS BANK OF PENNSYLVANIA 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 de artment 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. 6247706052 Date 01-20-2006 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 $ 106,294.10 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to Tax $ 17, 716 • 04 months of the decedent's date of death, Tax Rate ~( ~ ], Cj deduct a 5 percent discount on the tax due. Anv inheritance tax due will become delinquent Potential Tax Due $ 2, 657.41 nine months after the date of death. PART TAXPAYER RESPONSE 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 return this notice to the Register of Wills and CHECK an official assessment will be issued by the PA Department of Revenue. 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/or debts and deductions were paid. Complete PART ~2 and/or PART ~ below. PART If indicating a different tax rate, please state `~` ~ \~ ~ ~~ `\ ~\ relationship to decedent: ~ \\ ~ ~ ~ ` \ ~\ ~~~~ ~ TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS ~ ~~~~\~`~\~~°`~"~~ ~\ `~~~~`~" ~` ~~ LINE 1. Dato Established 1 2. Account Balance 2 $ ~ `~ ~~°~~ \ e 3. Percent Taxable 3 X \ 4. Amount Subject to Tax 4 $ \ \ \\ \ \\~' \ \\a \~~ \ \ 5. Debts and Deductions 5 - 6. Amount Taxable 6 `~ \ \\\~ ~ \\S~\~~~~a\ S\\ X ~~ ~ ~~ \ ~~...~~~ ~ ~~ 7 . T a x Rat e 7 ~ ~~~~~~ ~~o ~ ~ ~\~ 8 . Tax Due 8 $ .~,.. ~~~.....:..._ .,~ ~\~\ ~~\ PART DEBTS AND DEDUCTIONS CLAIMED a DATE PAID PAYEE DESCRIPTION AMOUNT PAID TDTAL (Enter on nine 5 or iax ~ampuLaLivni p Under penalties of perjury, I declare that the facts I reported above are true, co }rrect and a~mplete to the best o_f my knowledge and belief . HOME C ~~7 ~ 7~.7- `~~~~ ~ WORK ( 3 / TAXPAYER'SIGNA R TELEPHONE NUMBER TE