HomeMy WebLinkAbout11-30-11BUREAU OF INDIVIDUAL TAXES
PO BOX 260601
HARRISBURG PA 17128-0601
~ennsy(vari~~
DEPARTMENT OF REVENUE
REV-1543 EX AFP (05 -11)
PENNSYLVANIA INHERITANCE
INFORMATION NOTICE
i `„ ), ~~
~~~ _ ~ AND
TAX~~YER RESPONSE
.J
TAX
FILE N0. 21 - ~ _ ' ~~y
ACN 11176871
DATE 11-23-2011
`EST. OF SI R I'AK
SSN 221-50-1396
C' cr ~ ,,;
r~ ~
DATE OF DEATH 03-27-2011
~' r `` ' ~ %' ~~'~ COUNTY CLIMBERLAND
BARBARA p I( -~ ` n ) P,`1 REMIT PAYMENT AND FORMS T0:
40 BULLOCK CI~ REGISTER OF WILLS
CARLISLE ' PA 17015-7616 1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
^ SAVINGS
® CHECKING
^ TRUST
^ CERTIF.
CITIZENS BANK OF PENNSYLI~ANIA
Records indicate that at the deat of the aboveVnamedtdecedenttment with the information below, which was used in calculating the inheritance tax due.
notif you were a joint owner/beneficiary of this account. If
deceased and any amount othe than zero is reflected below on the Potential Tax Due line, note no tax may be due
y the department of you relationshi you are the spouse of the
If you believe the information is incorrect, please obtain written correction from the financial institution, attach a co
p to the deceased by checking Box C in PART 1 below and writing "spouse" 1n PART 2.
it to the above address. Please all 717-787-8327 with questions. bUt yoU mUSt
COMPLETE PART 1 B LOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS form and return
Account No. 621940 830
Date 01-09-2008
Established 7o ensure proper credit t
Account Balance
Percent Taxable
Amount Subject to Taxl
Tax Rate
Potential Tax Due ~~
PART
~ Leal
A. ^ 7
CHECK
ONE ~I
BLOCK
ONL Y B ^ fi~
C. ~ Th$
11
$50 copies of this notice must accompanynt, two
payme
t
~( ~
, ~ 9
50
000 n
to the Register of Wills. Make check
payable to "Register of Wills
A
"
$
.
5, 925.05 ,
gent
.
NOTE: If tax payments
)(
1 5 are Bade within three
months of the decedent's date of d
• eath,
deduct a 5 percent discount
$ $ $ , 7 6 on the tax due.
Anv inheritance tax due will becom
TAXPev~Q orc•s.,...._ e delinquent
nine months after the date of death.
T~~~~,POr~D A~vr~.t <~E~irt~ x~ :~-x o~~_xc~~. T~xe ~s~ s
above information and tax due is correct. T
Remit payment to the Register of Wills with two copies of this notice to obtain
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.
above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return
d by the estate representative.
above informs ion is incorrect and/or debts and deductions were paid.
late PART 2~ and/or PART 3^
below.
PART If indicating a dif Brent tax rate,
relationship to dec~dent:eplease state
TAX RETURN - CALCULATI~]N OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established
I 1
2. Account B
a l an c e 2 $ 1 --------~--+~,
3. Percent Taxable 3 X 2
4• Amount Subject to Ta
5. Debts and Deductions) 5 - 4 ~
6. Amount Taxable '' 6 $ 5
7. Tax Rate ~'i ~ X 6
8. Tax Due 8 ~ 7
PART $ ~
', ~ 1
DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAY E
DESCRIPTION
AMOUNT PAID
TOTAL CEnter on Line 5 of Tax Computation)
Under penalties of S
perjury I declare that the facts I reported above are
complete to the best f myiknowledge and belief.
l true, correct and
~C.: ~ ~ ~ ', HOME ('~/-f) ~ S~.S= ~SG.3
XPAYER SIGNATURE WORK ( ~
'i TELEPHONE NUMBER ~/ ~$ //
DATE
~ OPF I ~~ ~1S ONL
PA DEP'ARTMENT' (TE REVENUE
PAD
BUREAU OF INDIVIDUAL TAXES. •
PO BOX 280601 pennsy(van9
HARRISBURG PA 17128-0601
DEPARTMENT OF REVENUE
REV-1543 EX aF p5-11
~~~
r~-1.i ~+ ti~r r;
v i 1 t
11:
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BARBARA P' K Ci.L,,, ., ~ ,_r ,y ~ {,; ~ P,q
40 BULLOCK CI~
CARLISLE ', PA 17015-7616
FILE N0. 21 - ~ J - lo~ ! 1
ACN 11176872
DATE 11-23-2011
!EST. OF SI R I'AK TYPE OF ACCOUNT
SSN
DATE O 2.?1-50-1396 ^ SAVINGS
® CHECK
F
COUNTY DEATH 03-27-2011 ING
^ TRUST
REMIT PAYM CUMBERLAND
ENT AND ^ CERTIF.
FORMS T0:
REGISTER
1 OF WILLS
COURTHOUSE SQUARE
CARLISLE
PA 17013
CITIZENS BANK OF PENNSYL ANIA
Records indicate that at the deat of the above-named decedent,
provided the department with the information below, which wa:; used in calculating the inheritance tax due.
notify the department of you were a ,ioint owner/beneficiar
deceased and any amount othe than zero is reflected below on the Potential Tax Due line, note no tax ma
you, relationship to the deceased by checking Box C 1n PART 1 below and writin
If you believe the information is'incorrect, please obtain written correction from the financial ~nstitutionCCattach al co OU are the SpoUSe Of the
it to the above address. Please all 717-7g7-8327 with puestions.
Y be due, but you must
COMPLETE PART 1 B 9 "spouse" in PART 2.
LOW * SEE REVERSE SIDE FOR FILING py to this form and return
account No 62504377ntt AND P~vWru~'
- Y°1e 01-09-2008 --~-"' ~n"RUVI-IONS
Established 7o ensure proper cred't
Accou t
n Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
PART
CHECK
ONE
BLOCK
ONLY
A. ^
$ 2,458.21
X 50.000
$ 1,229.11
X .15
$ 184.37
TAXPAYER RESPON;
----,~,
PENNSYLVANIA INHERITANCE T
INFORMATION NOTICE
~r~-,~„-: ~ AND
,, -, -,
'1`11~~,~ER RESPONSE
- ~1
~ .t~~su~`r,,~IH
> to the account, two
copies of this notice oust accompany
payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
NOTE: If tax payments are made within three
months of 'the decedent's date of death,
deduct a 5 percent discount on the tax due.
Any inheritance tax due will become delinquent
nine month<, after the date of death.
above information and tax due is correct. •~ rlA~k~SM~~'IT
Remit payment to the Register of Wills with two copies of this notice to obtain
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.
B' ~ Th above asset has been or will be re orted and tax
fi~ed by the estate representative. p paid with the PE.nnsylvania inheritance tax retu
C• ~,7he above informs ion is incorrect and/or debts and deductions were rn
Com late PART 2~ and/or PART 3^ below.
paid.
PART If indicating a dif Brent tax rate
a relationship to dec dent: ~ Please state
~!~ S~
TAX RETURN - CALCULATION OF TAX ON JOIN
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4• Amount Subject to Ta>¢
5. Debts and Deductions'
6. Amount Taxable ~'
7• Tax Rate
8. Tax Due
PART
DATE PAID
PA
T/TRUST ACCOUNTS
1
2 $
3 X
4 $
6 $
7 X
8 $
~ oFl~IC _ sF L
PA DEPAitTtIENT LsF REVEN~ AAF
PAD
~1
2
~i" _~!L )
4 - -
5
6
7
" 8 ~ w ~
DEBTS ADD De'i~UVTIONS CLAIMED
DESCRIPTION
Under penalties of perjury,
complete to the best of my
. ~ i ~
TOTAL CEnter on Line 5 of Tax Computation)
I declare that the facts I
nowledge and belief.
AMOUNT PAID
S
reported above are true, <:orrect and
HOME ( ~/ ~ ~~~~~ j C
WORK ( ~
TELEPHONE NUMBER ~/ ~-8 iI
DATE
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601 Penl'~,sy,~j(;
REV-}yqs {% i1FP x(05-1;)~
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND FILE N0. 21 - l~ - ~ ~~q
';'F ~~ TAXPAYER RESPONSE ACN 11176873
' `~' DATE 11-23-2011
-, TYPE OF ACCOUNT
~ ~ ~~~'~~ ~='~ ~~ ~ 1 ~ ~ ~ - EST. OF SI R F'AK
SSN ~ SAVINGS
_ 221-50-1396
(`' ~ „ DATE OF DEATH 03-27-2011 ^ CHECKING
(`~ ~~ ~ `; J'' ',~?' COUNTY CUMBERLAND ^ TRUST
BARBARA ~ ~t ~%''~ REMIT PAYMENT AND FORMS T0: ~ CERTIF.
P K CivlJr, ~~~; i
40 BULLOCK CI~ REGISTER OF WILLS
CARLISLE ~, PA 17015-7616 1 COURTHOUSE SQUARE
CARLISLE PA 17013
i
CITIZENS BANK OF PENNSYLVANIA
provided the department with the information below, which wa:; used in calculating the inheritance tax due.
deceasedna~ndtanyaamou t othe~• thanhezero isareflectedtbelow on the Potential Tax Due line, not
notify the department of
~• you were a joint owner/beneficiary of this account. If you are the Spouse of the
you 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 co
it to the above address. Please all 717-7g7-g327 with questions. a no tax may be due, but you must
COMPLETE PART 1 8 LOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS form and return
Account No. 625043 216
Date 01-09-2008
Established To ensure proper credit to the account, two
Account Balance copies of this notice must accompany
Percent Taxable ~ $ 20,336.4$ payment to the Register of Wills. Make check
~( payable to "Register of Wills, Agent".
Amount Subject to Taxl 50.000
Tax Rate $ 10 ~ 168.24 NOTE: If tax payments are made within three
X months of the decedent's date of death,
Potential Tax DUe ~ • 15 deduct a 5 percent discount on the tax due.
$ 1 , 5 25.24 Anv inheritance tax due will become delinquent
PART
^ nine months after the date of death.
1 TAXPAYER RESPONSE
. , , ~ ~I!'1.;AN flFF~>rI}iL 7 .:ASS EH~
A• ~ 7 e above information and tax due is correct.
Remit payment to the Register of Wills with two co
pies of this notice to obtain
C CHECK I a discount or avoid interest, or return this notice to the Regis er of Wills and
0 N E an official assessment will be issued by the PA Department of Revenue.
BLOCK B ~i
0 N L Y ^ Th above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return
fi~ed by the estate representative.
C• ~ Th above inform~a$ion is incorr1e-ct~ and/or debts and deductions were paid.
Co~iplete PART 121 and/or PART L._J below.
PART If indicating a dif Brent taxi-rate, please state
relationship to dec~edent:~s ~,
TAX RETURN r DFFI IAL ONLY "~ AAF
- CALCULATIpN OF TAX ON JOINT/TRUST ACCOUNTS P'4 DEPARTMENT OF
LINE 1. Date Established D RE YE NUE
1
2. Account Balance 2 $ ~ 1
3. Percent 7axabTe 3 X - 2
4. Amount Subject to Tall q $ __ _
~,
5. Debts and Deductions 5 - ~
6. Amount Taxable 6 ,~`
7. Tax Rate I!i T X 6
8. Tax Due I 8 $ 7
PART ~ 8
DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYI E
DESCRIPTION
AMOUNT PAID
TOTAL CEnter on Line 5 of Tax Computation)
Under penalties of g
perjury, I declare that
complete to the best of m the facts I re orted above are
Y knowledge and belief. p true, correct and
'~,..t.--~ ~~ / 4-~L H O M E C Ji'7 ) :C '`i~5' = S S L 3
/ r
XPAYER SIGNATURE WORK ( ~
l TELEPHONE NUMBER ~~ Zt~ /~
DATE
BUREAU OF :[NDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
a. ^
PENNSYLVANIA INHERITANCE T
INFORMATION NOTICE
AND
~+c~rouE!_~'-' ~ ; '~:-~'r"'~~PAYER RESPONSE
X05-I1)
(', -
;r
BARBARA p K ~?~„i, . ~ _ ,:r,J .~,~ r
40 BULLOCK CI~ `~ "t' ph
CARLISLE ~, PA 17015-7616
TYPE OF
^ SAVINGS
^ CHECKING
^ TRUST
X^ CERTIF.
CITIZENS BANK OF PENNSYL ANIA
provided the department with the information below, which wa.; used in calculating the inheritance tax due.
deceasedna~ndtanyaamou t otheh thaoezero isareflectedtbelow on the Potential Tax Due lin
notify the department of you were a joint owner/beneficiary of this account. If you are the spouse of the
If you believe the information UU ineoraectn please obtain wece~e edorrection from the financial institution, attach a co
it to the above address. Please all 717-787-8327 with questions.
Y checking Box C in PART 1 belowtandowritingY"Spouse" intPART lust
COMPLETE PART 1 B LO{tJ * Py to this form and return
SEE REVERSE SIDE FOR FILING AND PAYMENT 7NCTDrrrrr....~
Account No. 625214 201 n_~_ _
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
PART
CHECK
ONE
BLOCK
ONL Y
-_w~-cuuts
Established
pennsy
DEPARTMENT
REV-1543 EX IFS
$ 21,572.61
X 50.000
$ 10,786.31
X .15
$ 1,617.95
TAXPAYER RESPONSE
RE ,tl!ND 11F~~,.l. itE~tll,T".IN` ilN ~~~
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
months of the decedent's date of death,
deduct a 5 percent discount on the tax due.
Any inheritance tax due will become delinquent
nine months after the date of death.
above information and tax due is correct. - ^4~
Remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or return this notice to the Re
Sister of Wills and
an official assessment will be issued by the PA Department of Revenue.
B• ^ Th above asset has been or will be reported and tax
fi ed by the estate representative, paid with the Pennsylvania inheritance tax return
C• ~Th above infor,m~~a ion is incorrect and/or debts and deductions were paid.
Co plete PART I11 and/or PART 3^ below.
PART If indicat;.,~ ~ ~--~~
ICI
LJ - - -
relationship to dec ~~~
dent: cax te, p e se state
,~~ .rf j
TAX R ETURN
- CALCULATI
ON
O I I OF~ICI~L. UgE ~~.Y
~iAAF
LINE 1. Date Established ' F
1 TAX ON JOINT/TRUST ACCOUNTS f~AD PA DEPARTMENT
OF REVENUE
2.
Account Balance
2
$ R
3. Percent Taxable 3 X 2
4. Amount Subject to Ta y $ ""~ :._...; ~- _ _r
~~.
5. Debts and Deductions ' 5 - fy -
6• Amount Taxable i
6
$
5 i
7. Tax Rate ~ 7 X 6 -
$. Tax Due $ $ 7
A ,
o~nr
~.
DATE PAID
I $ e
~~ DEBTS AND DEDUCTIONS CLAIMED
FILE N0. 21 -) ~ .- ~~ `~~
ACN 11176874
DATE 11-23-2011
EST. OF SI R I'AK
SSN 2:?1-50-1396
DATE OF DEATH o3-27-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
PAYE
Under penalties of
complete to the besteofumy
~ ,
DESCRIPTION
AMOUNT PAID
~_
TOTAL CEnter on Line 5 of Tax Computation)
I declare that ~
the facts I reported above are true, correct and
know. edge and belief.
HOME ( ~/7 ) 2 iLS - `.3 JG.3 \
WORK ( )
TELEPHONE NUMBER j~ Z-~ /
DATE
~ PENNSYLVANIA INHERITANCE
BUREAU of INDIVIDUAL TaxES INFORMATION NOTICE
PO BOX 280601
HARRISBURG PA 17128-0601 Pennsgiv~~~~ ,r ~~~ AND
DEPARTMENT OF REVENUE ~ ~AXpA YE R
REV-1543 EX'gFR (RS •111 RESPONSE
TAX
-,~r
BARBARA pl K
40 BULLOCK CI~
CARLISLE
~~, ~~, .
L ( i. ~ `
C, ' t ,,.
li
Clad. , . H , ~,J~ „~ pH
~~ l r.
PA 17015-7616
FILE N0. 21 _ ~ l - ~ a ~~'
ACN 11176875
DATE 11-23-2011
EST. OF SI R PAK
SSN 2;?1-50-1396
DATE OF DEATH 03-27-2011
COUNTY Cl1MBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
^ SAVINGS
^ CHECKING
^ TRUST
CERTIF.
CITIZENS BANK OF PENNSYL ANIA
provided the department with the information below, which was used in calculating the inheritance tax due.
deceasedna~ndtanyaamou t otheh thanhezero isareflectedtbelow on the Potential Tax Due line n
You were a joint owner/beneficiary of this account. If you are the spouse of the
notify the department of you relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PA
1f you believe the information is incorrect, please obtain written correction from the financial institution, attach a co
it to the above address. Please all 717-787-8327 with questions. Ote no taX may be due, but you must
COMPLETE PART 1 B py to this form andTre urn
LOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 625214 236
Date 09-08-2008
Established 7o ensure proper credit to th
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
PART
iil!!t~
A. ^ T
CHECK
ONE
BLOCK
ONLY a ^ fi~
C. ~ Th~
$
1 ~ $02, 30 copies of this notice oust accompanynt, two
payment to the R
i
~(
50.000 eg
ster of Wills. Make check
payable to "Register of Wills, Agent".
$
~( 9 0 1 . 1 5 NOTE: If tax payments are made within three
wonths of the d
'
$
• 1 5 ecedent
s date of death,
deduct a 5 percent discount
1 35.1 7 on the tax due.
Any inheritance tax due will bec
TAXPev~o ~rnn....~_ ome delinquent
nine months after the date of death.
N D~~dC2J1t,TA)" ASSES, :~#iT
above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
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.
above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return
'd by the estate representative.
above informs ion is incorrffe--ct~~ and/or debts and deductions were .paid.
lete PART 2~ and/or PART la 1
u below.
PART If indicating a dif Brent tax rate,
relationship to dec dent: please state
't.
TAX RETURN I'
- CALCULATIpN OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established
1
2. Account Balance I 2 $
3. Percent Taxable I 3 X
4. Amount Subject to Ta y $
5. Debts and Deductions 5
6. Amount Taxable 6 $
7. Tax Rate ~ 7 X
B. Tax Due ', $ $
PART
DATE PAID
L~si~ AND DEDUCTIONS CLAIMED
DESCRIPTION
complete to the best of m.,
AMOUNT PAID
< <rue, correct and
~~
I
~ ~ PENNSYLVANIA INHERITANCE TAX
BUREAU OF INDIVIDUAL TAXES INFORMATION NOTICE
PO BOX 280601
HARRISBURG PA -17128-0601 pE'~~~~`S~(~Va~7 --'''~ ' ~'' AND
DEPAR~fM^ENT OF REVENUE ~ ~~ ~ ~' ~)r
RE„-is~'ex aFr ~us_,~,,. n TAXPAYER RESPONSE;
BARBARA P K
40 BULLOCK CI~
CARLISLE
~~~: ~ - _
~ ,°: , ~ c
Lei ~, .,:
~^, .,
C; i _` i
PA 17015-7616
FILE
ACN
DATE
N0. 21 -~~~ l0?l9
11176876
11-23-2011
EST. OF SI R p~AK TYPE OF ACCOUNT
SSN 221 -50 -1396 ^ SAVINGS
DATE OF
COUN DEATH 03-27-2011 ^ cNECKING
^ T
TY
REMIT P CUMBERLAND RUSr
~ CER
AYM ENT AND FORMS T0: TIF.
REGISTER
1 OF WILLS
COURTHOUSE SQUARE
CARLISLE
PA 17013
CITIZENS BANK OF PENNSYLV~-
Records indicate that at the deaths of A he above-named decedent,
Drovided the department with ~he information below,
deceased and any amount other) you were a joint owner/beneficiarh~ch was used in calculatin
Y of this account. If 9 the inheritance tax due.
notify the department of your relationship to the deceased by checking Box C in PART 1 below and Writs
If you believe the information is 'ncor~rectr please obtaiCn wdribtenO~orOre thon Pfromnthe financi0ue,nine,
it to the above address. Please c It 717-787-8327 with questions. note no tax mayo be due h but ouse of the
COMPLETE PART 1 B n9 "spouse" in PART lust
LOW
SEE REVERSE SIDE .FOR FILING AND PAYMENTatruernop„ t_ this form and return
Account No. 625214 194 n,*e
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
PART
- u~-1Z-2008
Established
$ 53, 94 ', lg
X 5 000
$ 26,970.59
X .15
$ 4,045.59
,,,.~~e TAXPAYER RESPONc
- -~^~ ~!~° ~ct~>F'o~D,,:Ytil1,.~ESIILT.'IN. --~
A. ~ Th
above information .oF~r~ TAX Ass R
C H E C K
i and tax due is, correct.
aediscounte
e
•
+
w
t
C ONE l or avoid
interest,
or
weturn
an official
this l
tf this na~tice to obtai
BLOCK ~
. . The
assessment will be issued b
v the
b notice
to
he
PA Department n
Register of Wills and
of Revenu
0 N L Y
a
ove asset has been or
i e.
fil w
ll be re orted and
d by the estate representative. p tax
peid with
the Pennsylvani
C• ~ The
abov a inheritance tax return
e informs ion is incorrect and/or debts and deductions were
Com lete PART 2~ and/or PART
below. peiid.
PART If indicating a diff rent tax rate, please state
relationship to dece ent•
TAX RETURN - CALCULATIO
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
B. Tax Due
PART
DATE PAID PAYE
• 4 ~
OF TAX ON JOINT/TRUST ACCOUNTS
1
2 ~`
3 X
4
5 -
6
7 X
8 $
---- . • •••. ~ avn5
To ensure ioroper 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".
N07E: If tax payments are made within three
months of the decedent's date of death,
deduct a 5 percent discount on the tax due.
Any inheritance tax due will become delinquent
nine months after the date of death.
OF~IAL RISE NLY2;r~ ~'~ AAF
PA DEPa1RTtlENT t9F REVENUE
AD
1
2
3-= - tea:
4
5
6
7 ;
8 - ~ ~
`°~~ AnL DEDUCTIONS CL- q D
DESCRIPTION
.,~~uer penalties of perjury,
complete to the best of my
~r~~.x.-~ ~c~:
TOTAL CEnter on Line ~ .,c r_-_ _
AMOUNT PAID
I declare -~ "~"""/zatlon) $
that the facts I reported above are true
now dge and belief. , correct and
HOME ( 7 / 'J ~ ~, f~S'-8~~_3
WDRK ( ~ _
TELEPHONE NUMBER ~! Z8 ~~
DATE
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