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Home My WebLink About10-26-11 (3)BUREAU OF INDIVIDUAL TAXES PO BOX 280601 rri. HARRISBURG PA 17128-0601 i -~ PENNSYLVANIA INHERITANCE TAXI INFORMATION NOTICE pennrlvania AND oE~,~r TOFREVENUE TAXPAYER RESPONSE ,~. ¢EV-15Gf E% RFP (05-111 FILE N0. 21 (f- ~ ~`~ ACN ll1b6737 DATE 10-10-2011 _ .JL _~ I - //'~~ ~ „ C~~'~- Pa REETA OTTO 106 SUNSET DR NEW CUMBERLAND PA 17070-3059 EST. OF GEORGE R OT~TO SSN 197-24-3060 DATE OF DEATH 09-01-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRJST CERTIF. CITIZENS BANK OF PENNSYLVANIA 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 lax 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 I BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 6244045276 Date 01-20-2004 To ensure prover- credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance $ 63, 090.30 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax ~` 31,545.15 months of the decedent's date of death, Tax Rate X 15 deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due $ 4 ~ 731.77 nine months after the date of death. PART TAXPAYER RESPONSE 0 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. ~ 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 JJ~~~--'''~~~--"""``` informs ion is incorrect and/or debts and deductions were paid. d/ PART b l 2~ Complete ow. an or ~ e PART PART If indicating a different tax rate, please state I ~ OFFICIAL USE ONLY ~ AAF relationship to decedent: ze T pA DEPARTMENT OF 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 +fi 4 5. Debts and Deductions 5 5 6. Amount Taxable 6 `S 6 7. Tax Rate 7 X 7 8. Tax Due 8 $ 8 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 _ complet to the best of my knowledge and belief. HOME C ~ ~ / ) ~-~~' ~ ~=~ G c~ ~, ~%-~ WORK C 7 /(~~2/f/~Gi/ TAXPAY R SIGNATURE TELEPHONE NUMBER DATE TOTAL CEnter on Line 5 of Tax Computation) S