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Home My WebLink About05-09-11 (7)~~~ ~ BUREAU OF INDIVIDUAL TAXES ' PU Box zso6ol pennsy HARRISBURG PA 17128-0601 DEPARTMENT REV-1543 EX AFp~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE N0. 21--'tJ--a~Q~~ _ ,, ,:.,~-~~~ AND ACN 11145929 ~' ~' ~" ' '~~CPAYER RESPONSE `•~'~ `" DATE 07-13-2011 r~r 'i .a ,h gi i. .. r~r 1.~.~ _ __ y~'~~ # ~ ,~~L 2D f' 3~ CI:E~K ~QURT ~1l~~~ BARBARA STOUTLEITZ 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 T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCUUN~ 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. 6250435868 Date 04-04-2007 Established Account Balance $ 57,774.14 Percent Taxable X 16.667 Amount Subject to Tax $ 9, 629.22 Tax Rate ~( lrj Potential Tax Due $ 1 , 444.38 To ensure proper credit to the account, two copies of this notice must accompany payment to the Register of Wills. Make check payable to "Resister of Wills, Agent". NOTE: If tax payments are made within three months of the decedent's date of death, deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent nine months after the date of death. PART TAXPAYER RESPONSE s ~aS~IdENT ~. A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two co pies of this notice to obtain a discount or avoid interest, or return this notic e to the Register of Wills and C H E C K an official assessment will be issued by the PA De partment of Revenue. ONE B L 0 C K B. ~e above asset has been or will be reported and tax p aid 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 de ductions were paid. Complete PART 2~ and/or PART ~ below. \ PART If indicating a different tax rate, please state relationship to decedent: ~~\\~\ \ \. „l~ ~ \ ~~`\\~~ \ ~ `~~~~ ~~~~~ ~ ~ \~ ` `~ ~~ ~ ~~`~ • ~~`~\,~""~~" TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS - LINE 1. Date Established 1 ~ ~ ` ~~\ \ \ 2. Account Balance 2 $ ~ \~~\ \\ \\ \\ \e\\\\S\ 3. Percent Taxable 3 X ~~~~ . ~ ~~ ~ s~ 4. Amount Subject to Tax 4 $ ~ \ \\\\` \\ \ \\ \ \ \\\ 5. Debts and Deductions 5 - \ \ \\ as \ \~~\\\ \\\ 6. Amount Taxable 6 $ ~ ~~~~5~ .~~ ` S~ ~ ~ ~~~~ x Rat e 7 7. Ta X . , . ~ . 8. Tax Due 8 ~ - TOTAL CEnter on Lane 5 of iax compuLaLion~ Under penalties of perjury, I declare that the facts I reported above are true, correct and r~omplete to Athe best of my knowledge and belief. HOME C 7~/~ ~ ~~~ ~~~~ /,, - - W O R K C ~ `7 ~- AXPAYER SIG R TELEPHONE NUMBER DATE PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID