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Home My WebLink About10-24-11 (5)PENNSYLVANIA INHERITANCE TAX BUREAU DF INDIVIDUAL TAXES „ ~ ,- (_ INFORMATION NOTICE FILE N0. 21 11-0991 PO BOX 280601 ~ ~ ~+` HARRISBURG PA 17128-0601 ~.(nnsytvar~ias C_ J. AND ACN 11167314 DEI~~AFi'FMENT OF REVENUE ~ n TAXPAYER RESPONSE rr _,,~ DATE 10-12-2011 REV-143 EX ~AFP (05-11) F TYPE OF ACCOUNT EST. OF MARY R DUNLEVEY ~ SAVINGS SSN 166-14-9832 ~ CHECKING C~--E~! ~ h'~ DATE OF DEATH 08-28-2011 ~ TRUST { OI i11~ 1 1 I'~~T R ~~~ r,~~- ~ COUNTY CUMBERLAND ~ CERTIF. , p ~~~~~r~ n '{~~ ri P r1 REMIT PAY MENT AND FORMS T0: CHARLES DUNLEVEY REGISTER OF WILLS 3423 BEDFORD DR 1 COURTHOUSE SQUARE CAMP HILL PA 17011-2714 CARLISLE PA 17013 P SECU 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 I 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 BELOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS. Account No. 0166149832-S53 Date 01-02-2007 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 $` 16 ~ 060.11 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $ 8 r 030.06 months of the decedent's date of death, Tax Rate )( . 045 deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due $ 361 .35 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 C 0 N E ~ an official assessment will be issued by the PA Department of Revenue. B L 0 C K B. ~7he above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return ONLY KK-~~ 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: PA DEPARTMENT OF REVENUE TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1. Date Established 1 I 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 $ {, 7. Tax Rate 7 X 7 8. Tax Due 8 $ g PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I reported above are true, correct and co ete to the best of my knowledge and belief. HOME C/~> ) /G 3 ~ ~~i 6 WORK ( ) O Z ~ //~ ,X PAYER SIGNATl1RF TFI FPH(1NF NIIMBFR DATF TOTAL (Enter on Line 5 of Tax Computation) S