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Home My WebLink About11-02-11r' ~ BUREAU OF INDIVIDUAL TAXES PO BOX 280601 r! HARRISBURG PA 17128-Ok`0~- PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE N0. 21 - ~'~- `1`6~ ~~n~l~~~a yp ~/~AND /~~~ ACN 11150360 OEPASiTMENT~Of ENUE * * ~A/k{-~ i L,P4. ~~~~r4~\ S ~ * * DATE U 8 - U 4 - 2 U 11 ICCYI~CU 11.C REV-1543 EX pFR~05-11) ., i ~~ ~~~ ~-~ ~~P~,~~; ;~~ i ;RT ClJ" ~:~: ' ~ ~ r ANNA M LIGHTNER 109 COCKLEYS DRIVE MECHANICSBURG PA 17055 EST. OF THOMAS M BOSNJAK SSN 177-14-0983 DATE OF DEATH 07-17-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. MEMBERS 1ST F CU 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 ou believe the information is incorrect lease obtain written correction from the financial institution attach a co to this form and ret rn y , p it to the abcve address. Please call 717-787-8327 with questions. , py u COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 227908-1 1 Date 03-18-2003 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance 5 719 02 payment to the Register of Wills. Make check " " . ~ payable to Register of Wills, Agent . Percent Taxable X 50.000 Amount Subject to Tax g 2 859 51 NOTE: If tax Dayments are made within three ' , . 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 $ 128.68 nine months after the date of death. PART TAXPAYER RESPONSE L 'TD £5 4N WI i~SULT IN AN Q L T S A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two c opies of this notice to obtain C H E C K a discount or avoid interest, or return this noti ce to the Register of wills and an official assessment will be issued by the PA Department of Revenue. C ONE BLOCK 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 informs ion is incorrect and/or[debts and deductions we~- re nab 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 a~Da~S- z S _. S -7 / 9 ~ ooh 3 X 4 $ s - l~ n ~ ~'. Dye 6 ~ X 8 ~~ CIFfICIAL USE:ONI.I' AA PA DEPARTMEi#T OF REVENUE AD 1 ,-=~ z 3 4 5 6 7 PART DEBTS AND DEDUCTIONS CLAIMED ~er penalties of perjury, I declare that the facts I omplete to-the best of kn wl dge and belief reported above are true, correct and f,J(/~~ r f2~f~t~~.-~1j~-c,~~ ~ . / \ r HOME C ~ ~ n .. / - ~ ~ WORK ( I 1 1~ ;PAYER SIGNATURE TELEPHONE NUMBER AT DATE PAID PAYEE DESCRIPTION AMOUNT PAID MEMBERS 1St FEDERAL CREDIT UPIION July 28, 2011 PA Department of Revenue Bureau of Individual Taxes ATTN: Robin Graff Dept. 280601 Harrisburg, PA 17128-0601 RE: Notice of Decedent Account Status Correction Dear Ms. Graff, A Notice of Decedent Account Status form was submitted on July 20, 2011 for Thomas M. Bosnjak with a date of death of July 17, 2011 and a social security number of 177-14-0983. The account balance reported for 227908-11 was reported incorrectly. The correct date of death balance for account 227908-11 should have been reported as $5,719.02. Please update your files to reflect the correct balance at date of death.. Please do not hesitate to contact me at 795-5139 should you have any questions Very truly yours, ~~ ~~~~~~ ~-z~ ~~~~ "Y Leigh-Anne Stallings Lending Insurance Support Specialist cc: Anna M. Lightner 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org