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Home My WebLink About05-09-11 (8)~\~~` PENNSYLVANIA INHERITANCE TAX / _ INFORMATION NOTICE FILE N0. 21"`'~•'~10~7 BUREAU OF INDIVIDUAL TAXES ~~ ~i~-~ ~ ;~-- ~~ Po Box zso6ol penn5~/~ ~ ~- ~ ~'vE ~F AND ACN 11145930 HARRISBURG PA 17128-0601 DEPARTMENT OF li~~; ~""~ > `" N.,~~(~~eXPAYER RESPONSE DATE 07-13-2011 REV-1543 EX AFP (05-11) ~ I J~'L 2 ~1 ~~' 3~ c ~, CLERK Q~ QR~'HA~1'S CQURT CUMREP~ AJ~~~ ; C;~ , 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 FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQIJARE CARLISLE PA 1-T013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST a CERTIF. CITIZENS BANK OF PENNSYLVANIA provided the department with the i nformati on below, which was used i n calculating the i nheri tance 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 bel~~w 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 717-787-83?.7 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 6250435868 Date 04-04-2007 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 $ 57,774.14 payable t~~ "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to Tax $ 9, 629.22 months of the decedent's date of death, Tax Rate ~( ~ lj deduct a !5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential TaX Due $ 1 , 444.38 nine months after the date of death. PART TAXPAYER RESPONSE ,, ;. ~ ...... .. ~ ~ ESSMEt~T The above information and tax due is correct. A. ~ 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 informa ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART ~ below. If indicating a different tax rate, please state ~ \ .~:: PART ~ to decedent: shi ti l ' \ \ \ \ .~ ~~ p on a re ~ T \ `~\ ~ , TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS . \\ LINE 1. Date Established 1 - ~ \ ~ \~ ~\ \ ~ 2. Account Balance 2 $ \ ~ ~ ~ ~ ~ ~~` 3. Percent Taxable 3 X - \ \ 4. Amount Subject to Tax 4 ~ \ \ \ ~ ~ \ \ \\\\ 5. Debts and Deductions 5 - ~ 6 ~ ~ \~~\\\\\ ~ bl $ T \ ~0\\\\\ \\\\\\ ~ e ~.\\\\\\\`„\~ axa 6. Amount ~\\~ ~ \ ~\ 7. Tax Rate ~ X ~ ~ ~ ~ \\,~ , ~.~\ o.~ 8 $ 8 . Tax Due - .. ~~~ ~~~~~.. ., PART DEBTS AND DEDUCTIONS CLAIMED 0 nwTC Darn PAYEE DESCRIPTION AMOUNT PAID 7 V I AL CtnLer On L1fle 7 V I ~ tlw ~.v~~~M4 ~o ~i v,~• Under penalties of perjury, I declare that the facts I reported above are true, correct. and t--~ complete to the best of my knowledge and belief. HOME C ~ ~ ~~ ~ _ ~ l/D WORK ( ~ ~~ TA AYER SIGNATURE TELEPHONE NUMBER DAT