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Home My WebLink About11-02-11'~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES ~,~~i, r Po Box zao6ol @1'~1S dl"Ila ~ r Ur AND HARRISBURG PA 17128-0601 ~ ,.~ T V p w y DEPARTM~~1T ~F REVENUE --* j~ 1 A/kr,•-At { E~ I~~1S~~N S ~ REV-1543 E)! RFP (05-11) iE FCCYIS FILE N0. 21 11-0246 ACN 11107783 DATE 10-20-2011 EST. OF BETTY J EARNER SSN 195-24-5713 V~ ERK ~~'~ DATE OF DEATH 03-21-2010 ~~ ~ j~~ ~ '~~ ~T COUNTY CUMBERLAND Cl)~ ~. ~?I ~ =~ - REMIT PAYMENT AND FORMS T0: MELVIN W EARNER REGISTER OF WILLS 216 REESER RD 1 COURTHOUSE SQUARE CAMP HILL PA 17011-1923 CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. SOVEREIG N BANK 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 y0U 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 717-7A7-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 2335541401 Account Balance Percent Taxable Date 11-09-2007 Established $ 1,201.92 X 50.000 To ensure proper credit to the account, two copies of this notice must accompany payment to the Register of Wills. Make check payable to "Register of Wills, Agent". NOTE: If tax payments are made within three Amount Subject to Tax $ 600.96 months of the decedent's date of death, Tax Rate ~( , ~ 0 deduct a 5 percent discount on the tax due. Anv inheritance tax due will become delinquent Potential Tax Due $` , 00 nine months after the date of death. PART TAXPAYER RESPONSE 1^ FAILURE TO~,ESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT A. b(~ The above information and tax due is correct. 'L~ 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 0 N E ~ BLOC K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return D 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 relationship to decedent: TAX RETURN - CALCULATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS 1 2 s X 4 +fi 5 - 6 $ 7 X 8 PAD OFFICIAL USE ONLY ~ AAF PA DEPARTMENT OF REVENUE 1 2 3 - 4 5 6 7 8 PART DEBTS AND DEDUCTIONS CLAIMED ^3 TOTAL (Enter on Line 5 of Tax Computation) S Under penalties of perjury, I declare that the facts I reported above are true , correct and co lete p ~ to the best {/ o y knowledge and belief . A HOME C ,! ? ^^ ) /,3 ..~© ~ - Z- - ~'J / ~ ~r-r\ " V ~ ~1J3,.~ WORK C l ~~ ) ~ 3 ~ -rte ca3 Z TAXPAYER SIGNATURE TELEPHONE NUMBER DATE. DATE PAID PAYEE DESCRIPTION AMOUNT PAID r~rr~, , ~, ::. __: ~. 0~ ,~ ~ ' ` COURT ~. c~,~ ~ ~~r co. P~ .~: ..~. ~ c ~.: ~~ ~ ~ ~~~ ~~ 3 ~ ~ ~ " ~ © ~ ~ •t,~ ~ a ~~:: ~.~ .~ ~ h tr( r~:~ n ~ p v V ..~•~ ~ ~ ~ ~> ~, a _._...