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Home My WebLink About11-15-116UREAU OF INDri1IDWL TAXES PO !Ox 280601 P~ ' HARRISBURG PA 17128-0601 new PENNSYLVANIA INHERITANCE T INFORMATION NOTICE AND TAXPAYER-RESPONSE ~~I I t~7Y 15 P~ I ~ E LE€~K GF t~R HAWS COURT CUMBFRt.ANG CO„ PA MARY L VALLATI 119 N 28TH ST , CAMP HILL PA 17011-2929 FILE N0. 21--1 ~`l~30 ACN 11173695 DATE 11-0~-_2:411 EST. OF VERLIN V VALLATI SSN ~ 174-a0~58o1 DATA OF DEATH 04-02'-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FDRMS T0: REGLSTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE: OF ACCOUNT SAVINGS ® CNECKIN6 TRUST CERTIF. SOVERE i8N $ANK provided the department with the information below, which was used in calculating the inheritance tex due. Records indlcaLe that at Lhg deatq.of Lhe above named decedent, you were a point owner/beneficiary of this account. If you are the SpOUSe Of the decea;ed aml.any aawunt other than zero 1s reflected below on the Potential Tax Due line, note no tax B-ay be,due., but you smst notify the d`eCartBlent of yaur relationship to the deceased by checking Box G ih PART 1 below and writing "spo'use" 1n PART 2. If you believe the information is incorrect, please obtain written correction from the financial institution,-attach a copy o this form and return it to the atiove address. Please call 717-781-8327 with Questions. COMPLETE PART I BELOW * SEE REVERSE SIDE FOR FiLING AND,FAYR~~iT INSTRUCTIONS Account No. 0351181032 Data 10-1fl-2008 To ensure proper. credit to the account, two Established copies of this notice east accowargr Account Balance ~ 7, 345.55 pavmont to the Rgpfster of Wills. Make check $ paarable to -Register of Wills. Aient". Percent Taxable X 50:0'00 ' NDTEs If taoc payments aro wade within three A~eount Subject to Tax $. 3,672.78 months of the decedent's date of death, Tax Rata ~( , 15 deduct a 5' percent discount on the tax due. Aral inMcftance tax'dq~ will become delinpwnt Potential TiX Due ~ 550.92 nine months aftor thi date of death. PART » .. ,, , , RAYE E P ,: ;, ~~ A. ~ Ths above intonation snd tax due is correct. Remit payment to the Register of Wills with~two copies. of this notice to obtain. CHECK a discount or avoid interest, or rtturn this notice to tAd Re9fster of Wills and C ONE- ~ an official assessment will be issued by the PA D.partment of Revenue. BLOCK B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return 0 N L Y ~l.d by the estate representative. C. ~he above info ion is incorr ct and/or debts and deductions wero paid. .. Complete PART ~ and/or PART ~ below. PART If indicating a different tax rate, please state •rela'tionship'to decedent: ~ M2fLLSiv TAX RETURN - CALCULATION OF TAX ON JOINTITRUST ACCOUNTS`::. LINE 1. Date Eatabliahsd ~ 1 - 2. Account Balance 2 ~ 3. Percent Taxable 3 -X --- 4. Amount Subject to Tax 4 5. Debts and Deductions 5 - 6. Amount Taxable 6 ~ 7. Tax Rste 7 X 8. .lax- Due 8 ~ PART DE$TS AND .:DEDUCTION'S ' CLAIMI=D ' DATE °PAID PAYEE DESCRIPTION AMOUNTY~PAID ,.. - , ' TOTAt,. CED ar• °on: Line 5 of tsu CcNPU#atia~a) - .r~..~ .r.. - .. ~ • ~ Under penaltibs of per3urY, I d~clars t~-it the fact I raport'ed above'are true, correct and , co eta to the t mY knotirl•dgr and beiiof. i WORIE C ) - ~. , TA PAY R GNAT RE TELEPHONE NUMBER DATE