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Home My WebLink About09-29-11.• BUREAU OF INDIVIDUAC~TA34ES PO BOX 266661 :_ ~ penrr~Yarna HARRISBURG PA 17128,71601 oernarMENT 6`r aevewuE REV-1543 EX AGP (05-11) PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE N0. 21 ~ ~ "~~~ AND ACN 11156411 TAXPAYER RESPONSE ~ DATE os-24-2011 ~" ... Vii. +f = PA TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. ELIZABETH M PATTERSON 4908 FRANKLIN ST HARRISBURG PA 17111 EST. OF BERNICE M PREDMORE SSN 193-36-2573 DATE OF DEATH 07-24-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 METRO B ANK 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 farm 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. 537809295 Date 07-31-2007 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $` 6,343.41 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $ 3, 171.71 months of the decedent's date of death, Tax Rate ~( . lrj deduct a 5 percent discount on the tax due. Any inheritance tax due wi:Ll become delinquent Potential Tax Due $ 475.76 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. 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 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 ^FFICIAL USE DNLY ~ AAF relationship to decedent: PA DEPARTMEN ~ OF REVENUE I TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1. Date Established 1 1 2. Account Balance 2 $ Z 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ 4 5. Debts and Deductions 5 - i 5 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X ~ 8. Tax Due 8 $ ~ $ PART DEBTS AND DEDUCTIONS CLAIMED ^3 DATE P AID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts co le a to the best of my knowledge and belief. ______ I reported above are true, correct and ~ S -~ ~ , v~~L. / G~t~~{~~ WORK C ~ ~ ~ % TAXPAYER - - SIGNATURE TELEPHONE ~ NUMBER D~ o , rulAL tinter on Line 5 of Tax Computation) S