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Home My WebLink About05-09-11 (10)BUREAU OF INDIVIDUAL TAXES PD BOX 280601 pe HARRISBURG PA 17128-0601 DEPA REV- .`~ ~~, ~~~~A~ PENNSYLVANIA INHERITAN E INFORMATION NOTICE • - AND ~' = 4C~ ~~ T`L~1=~R;E1yEf+T~UE`.~ .`.,tip 3 ~ TAXPAYER RESPONSE .~ .: ~, ~~~U ~ ~ ~~~ ~~ r i i ~• C r.1 CLERK OF ORPFlA1~1`~ COURT C11~^fi~~~l.r~~1~ Ct~ , PA EUGENIA G MILLER b13 N EAST ST CARLISLE PA 17013-2012 EST. OF EVELYN E: STOUT SSN 152•• 14- 034b DATE OF DEATH (15-22-2011 COUNTY CUMBERLAND REMIT PAYMENT AND F~~RMS T0: REGISTER OF WILLS 1 COURTHOUSE SQIJARE 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. b25043b104 Date 01-22-2007 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 $ 2b ~ 141 • 01 Payable to "Register of Wills, Agent". Percent Taxable X lb . b67 NOTE: If tax payments are made within three Amount Subject to Tax ,ti` 4, 35b . 92 months of the decedent's date of death, Tax Rate ~( 1j deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due $ b53.54 nine months after the date of death. PART TAXPAYER RESPONSE ~I':A ~ T,.: ~ ~ '.\~ 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 Re~~ister of Wills and C H E C K an 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 th~a 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. Date Established 1 2. Account Balance 2 '~ 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 $ 5. Debts and Deductions 5 - 6. Amount Taxable 6 7. Tax Rate ~ X 8. Tax Due 8 $ PART nATC owrn PAYFF TAX FILE N0. 21 '" 1r `'~6~~~ ACN 11145932 DATE 07-13-2011 DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID I U I AL ltnier un L1IIC 7 v l , on ..,,r...-' ~--••- Under penalties of perjury, I declare that the facts I reported above are true, correct and complete to the best of my knowledge and belief. H O M E C ~~~ ) ~ ' WORK C J ,~~ J TA AYER SI NATURE TELEPHONE NUMBER DAT E