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Home My WebLink About05-09-11 (6)BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 PENNSYLVANIA INHERITANCE TAX .~ ~~ jj ss ~~ INFORMATION NOTICE FILE N0. 21'1 "~1~~1 • ~+ AND ACN 11145928 P~~(~(L~~r~~ ~t>'~ ~~ DEPARFM,t~~OE=~REYE(?tUE , ,;k3 ~ ~ TAXPAYER RESPONSE DATE 07-13-2011 RE1-°P543')~if' APP •(~05~531) CLERK QF CJRPNA.~'S COURT C~)~IB~~~_~~'R~~ CCU.. PA EUGENIA G MILLER 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 F()RMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST a 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 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. 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 . b67 NOTE: If tax payments are made within three Amount Subject to Tax $ 17, 71b • 04 months of the decedent's date of death, Tax Rate ~( 1 rj deduct a !i 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 ,,. .,~ ~ , The above information and tax due is correct. A. ~ Remit payment to the Register of Wills with two copies of thin notice to obtain a discount or avoid interest, or return this notice to the ReS~ister of Wills and C H E C K n official assessment will be issued by the PA Department of Revenue. 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. ~ 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 t d tax rate, please state ~~\ \\\ a en : relationship to dece \ \ \ TAX RE TURN - CALCULATION OF TAX ON JOINT/TRUST ~ ACCOUNTS \~~ LINE 1. Date Established 1 .. 2. Account Balance 2 X - ~ 3. Percent Taxable 3 3 4. Amount Subject to Tax 4 $ 4 \ 5. Debts and Deductions 5 5 ~ \ 6. Amount Taxable 6 $ X \ 7 7. Tax Rate Y 8. Tax Due 8 `~ - \ \\ PART nwrr owrn PAYFF DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I reported above are true), correc /~an~l ,~ complete to he bast of my knowledge and belief . HOME C l ~ SOS ~~'~` CI/ C.~ ~ /~~~ WORK ( ~ Q .O,LL . ~ l TA AYER S,GNATURE TELEPHONE NUMBER TE