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Home My WebLink About09-29-11BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 ,_• Pennsylvania DEPARTMENT OF REVENUE REV-1543 E% AFP (OS-11) PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE N0. 21 ' 11- ~L`-~2 AND IACN 11160465 TAXPAYER RESPONSE iDATE 09-07-2011 JOHN K BUSH 3108 HARVARD AVE CAMP HILL PA 17011 EST. OF SHIRLEY R BUSH SSN 184-26-4208 DATE OF DEATH 02-15-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. SOVE R IG BANK provided the department with the information below, which was used in calculat ng the inheritance tax due. Records icate 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 th)s form and return it to the above address. Please call 717-787-8327 with questions. COMPLETE PART I BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 2331029865 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due Date 03-05-1999 Established $ 10,116.84 X 50.000 $ 5,058.42 X .15 $ 758.76 To ensure proper credit to the account, two copies of this notice muse: accompany payment to the Register o1' Wills. Make check payable to "Register of Wills, Agent". NOTE: If tax payments are made within three months of the deceden~ (late of death, deduct a 5 percent digc`_b on the .tax due.. J-~_ Any inheritance tax dcFQ_w,1 become~delingptlrit~-~ nine months after the ,tlafi~7of deatFt:') i P~T TAXPAYER RESPONSE - trn ~,,, ~ FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSM~HT`. ~") A. ^ The above information and tax due is correct. ~ l ---'~1 ~- ,. Remit payment to the Register of Wills with two copies of this notice to obt)a~7~ ~'~ C H E C K a discount or avoid interest, or return this notice to the Register of Wills aryd ~~'.) ;;j,.l C 0 N E ~ an official assessment will be issued by the PA Department of Revenue. L . ~'~ T 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 3^ below. PART If indicating a different tax rate, please state OFFICIAL USE ONLY ~ AAF relationship to decedent: ~nQ(~ «° T PA DEPARTMENT OF REVENUE TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1. Date Established 1 3~ S 1 Y~ `~ 1 2. Account Balance 2 ~ ~~. l~~ ,~~ 3. Percent Taxable 3 X ,~-(pj.~('I[j 3 4. Amount Subject to Tax 4 $ ,SU J17 ~~~ G 5. Debts and Deductions 5 - 5 6. Amount Taxable 6 $ So ~g ,7~ 7. Tax Rate 7 X //~ 7 8. Tax Due 8 +C CJ g PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I reported above are true, correct :and q mplete to the best~of my knowledge and belief. HOME C ~('7 ) ~~~ - ~~" l ~' ~,.,_ W O R K ( ) l~ ~-v. ~ - '{ZIT ~ ~d X YER SIGNA UR TELEPHONE NUMBER DATE ~( TOTAL (Enter on Line 5 of Tax Computation) ~- ~. .. "w n ~ a~ ~ , O0 0 x ~, °~~~' ~~`~- a ~.. ,.... ~ .,; ..__ ~~':4 ~ ;:s. ~ ~ ~ {.,1 ' i;~~i ~ iii '1 ~.a, ~ ~ i ~, ~ - x, ~ ~~' ;~- ~ ~ o ~ ~ w ~ ~a; Yr,. ~:ry ~:, ~~~ ~S ~~t 9f 9k i ;~~ 44~ ` 6 Ftt A }~ ~ ~~ 1!'y R3 ~ a } 'i ..~ qFb ¢ ~Y ~r_ ~C~'~~!i