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Home My WebLink About10-12-11 (2)i BUREAU OF' INDIYIDUALf7~4~CES '. i ~~ PO BOX 280601 r ~ - , penn~s~l nia HARRISBURG PA 17128-OSp1 ~ DEPnRTMEN(F_dF, EvENUE REV-1543 EX RFP (OS-11) PENNSYLVANIA INHERITANCE TAXI INFORMATION NOTICE jFILE r~o. 21 --II-10~~ AND ACN ll1b3685 TAXPAYER RESPONSE DATE 09-27-2011 ,. i ~.~ 19 .: ~ 1~ ti "~ v ~~ V~JLJ! DARLENE COLONNA 500 CRANES GAP RD CARLISLE PA 17013-9602 EST. OF FERNE V HENRY SSN 159-24-9467 DATE OF DEATH 09-17-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. MEMBERS 1 ST FCU 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 BELDW * $CE REVERSE SIDE FOR FILING AND PAYMENT INSTRUC-PIONS Account No. 67730 - 11 Date 11 - 08 - 1986 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 $` 1 , 571.74 payable to "Register of Wills, Asent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to Tax $ 261 .96 months of the decedent's date of death, Tax Rate )( .045 deduct a 5 percent discount: on the tax due. Any inheritance tax due willl become delinquent Potential Tax Due $ 11.79 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 a discount or avoid interest, or return this notice to the Register of Wills and C H E C K an official assessment will be issued by the PA Department of Revenue. C 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 ONLY filed by the estate representative. ,~/~ C. pV The above 7-Complete informs ion is incorrect and/or debts and deductions were paid. 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 DF REVENUE TAX RE TURN - 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 S 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X 7 8. Tax Due 8 $ 8 PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID ~ PAYEE DESCRIPTION AMOUNT PAID x2 1~ ~ u 1r /d a ~~ ~ , ~20C~ 00 ~~ ~ / "~ ~ 1 ~ ~n ~i~r/i ~Q LLi' e n 3 0n a-.S Fl~~~-Z~~`~yOTAL (Ent6~h on Line 5 of Tax Computation) S Under a alties of perju y, I dare that the facts I reported above re a true, c o rrect a~ n d comp t to, he b st my o~belief. r l HOME ( /~~ ~ [ ) i~Z~~ L (~~ / ' ~V~l / G..(i / WORK ( ) TAX ER SIGNATURE TELEPHONE NUMBER DA E