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Home My WebLink About10-12-11~, PENNSYLVANIA INHERITANCE BUREAU DF INDIVIDUl~F~AX~S INFORMATION NOTICE PD Box 2BB6Ul pen~1~ania AND HARRISBURG PA I~IZS~o,cb#_ oEaARrnrer~r,,FREVeNUE TAXPAYER RESPONSE REV-1543 E% AFP (OS-ll) TAX' FILE N0. 21 ~ ~~ -1U~U ACN 11163684 DATE 09-27-2011 ~ ~.~ v~r EST. OF FERNE V HENRY w SSN 159-24-9467 CLE~'< ~~ O~~~nr,~~,~ ~^~1~~ l DATE OF DEATH 09-17-2011 C1~(~~!~C';; ~;~, ~-} ,~(~, ~Q COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: LOUIS M COLONNA REGISTER OF WILLS 500 CRANES GAP RD 1 COURTHOUSE SQUARE CARLISLE PA 17013-9602 CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS © CHECKING TRUST CERTIF. MEMBER S 1ST FCU provided the department with the information below, which was used in calculatin5 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. 67730 - 11 Date 11 - 08- 1986 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance 1 571 .74 payment to the Register of Wills. Make check ~ payable to "Register of Wills, Agent". Percent Taxable X 16.667 Amount Subject to Tax $ 261 .96 NOTE: If tax payments are made within three months of the decedent's date of death, Tax Rate )( .045 deduct a 5 percent discount on the tax due. 1 1 . 7 9 Any inheritance tax due will become delinquent Potential Tax Due $ 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 information is incorrect and/or debts and deductions were paid. ~~ff``''~~~..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 $ 4 5. Debts and Deductions 5 - tj 6. Amount Taxable 6 +fi 6 7. Tax Rate 7 X 7 8. Tax Due 8 PART DEBTS AND DEDUCTIONS CLAIMED ^3 DATE PAID PAYEE DESCRIPTION AMOUNT PAID ~a_- Lc i~ ~ 109% 9b n- ~ G a.~~ of 3o r- ~ ~ ~o_ o IUTAL tinter on Line s of iax Computation) 5 Under penalties of perjury, I declare that the facts I reported above are true, correct and complek to the b e st of~ !ledge and belief. // l HOME C ~~ ~ ~ p2 ~ 3 ~ 0 ~, ~ ~ /~'` s~!/ ~ WO R K C ~ 6~/ TAXPAYER SIGNATURE TELEPHONE NUMBER DATE