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Home My WebLink About09-26-11. r°° ~~ BUREAU OF INDIVIDUAL TAXES PD BDX 280601 pennsy~ HARRISBURG PA 17128-0601 DEPARTMENT OFF REV-1543 E% AFF PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE N0. 21 11-0847 ~~" ' ' ' 1,r ~? AND ACN 11159773 ll~. ~i~AXPAYER RESPONSE F1 _~,.,~ DATE 09-05-2011 ~ _i `t~ t s ~ ~'~ EST. OF BERNICE M PREDMORE SSN 193-36-2573 ~,(..ER~t~~ ~~~ DATE OF DEATH 0 7 - 24 - 2 011 Cjr ~L~I ~ ~~ iit ~J' ~~n~ COUNTY CUMBERLAND Cl~,,,!-'•.~! ~ ~- '' Y REMIT PAYMENT AND FORMS TD: MARTHA P MACADAM REGISTER OF WILLS 1 TEPEE CIR 1 COURTHOUSE SQUARE CONESTOGA PA 17516-9510 CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. PN C BANK N A 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. 5140050483 Account Balance Percent Taxable Date 02-16-2007 Established $ 4,994.00 X 16.667 To ensure proper credit to the account, two copies of this notice must accompany payment to the Register of Wills. Make check payable to "Register of Wills, Agent". NOTE: If tax payments are made within three Amount Subject to Tax $ 832.35 months of the decedent's date of death, Tax Rate )( .045 deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due $ 37.46 nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT A. ^ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain C H E C K a discount or avoid interest, or return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. C ONE ~ • ' B L 0 C K ~{ ., B. ~J~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return ONLY /1~-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 LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS PAD 1 2 $ 3 X 4 5 6 7 X s $ OFFICIAL USE ONLY ~ AAF PA DEPARTMENT OF REVENUE 1 Z_ - - - - 3 4 5 6 7 8 PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID DATE C' TOTAL CEnter on Line 5 of Tax Computation) S Under penalties of perjury, I declare that the facts I reported above are true, correct and completeQto t//he~~~~b~~est~~of my knowledge and belief. HOME C ) BUREAU OF INDIVIDUAL TAXES PO BOX 260601 HARRISBURG PA 17128-0601 i ~~ ' - pennsylv~nia DEPARTMENT OF REVENUE REV-1543 EX AFP (05-I1) ;~ !- f PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE N0. 21 11-0847 "? ',~. ~~: AND ACN 11159775 ' ~ ~~AXPAYER RESPONSE DATE 09-05-2011 . t'J r'` ^~ r n l.'LCfi}~ /^r' ~`~' oA TYPE OF ACCOUNT EST. OF BERNICE M PREDMORE ~ SAVINGS SSN 193-36-2573 ~ CHECKING DATE OF DEATH 07-24-2011 ~ TRUST COUNTY CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FORMS T0: MARTHA P MACADAM REGISTER OF WILLS 1 TEPEE CIR 1 COURTHOUSE SQUARE CONESTOGA PA 17516-9510 CARLISLE PA 17013 PN C BANK NA 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 y0U 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 writter, 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. 5005034296 Date 03-30-2007 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check oc~o(int Balance $ 12,659.00 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to Tax $ 2 ~ 109.88 months of the decedent's date of death, Tax Rate )( .045 deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential TaX Due $ 94.94 nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX. ASSESSMENT A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain C H E C K a discount or avoid interest, or return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. C 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 3^ below. PART If indicating a different tax rate, Please state OFFICIAL USE ONLY ~ AAF relationship to decedent: \ PA DEPARTMENT OF REVENUE TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1. Date Established 1 ~ 1 2. Account Balance 2 +~ 2 - .._ _ __ ._ _ _._-._~..,__.___ ~_ 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ ~+ 5. Debts and Deductions 5 5 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X 7 8. Tax Due 8 `~ S PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID AYER SIGNATURE i ELErriu DATE TOTAL CEnter on Line 5 or iax t,omputacivn~ p Under penalties of perjury, I declare that the facts I reported above are true, correct and c~~o~~mpl~~eQQte t,oQth~ej,,best of my knowledge and belief. HOME C ) /LG~d> /. /~"! WORK ( )