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aDREAU OF INDIYIDWL TAXES
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FIARRIStUR6 PA 17128-0601 oEP~
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PENNSYLVANIA`INHERITANCE TAX
INFORMATION _NOTICE FILE No. 21 11-0564
~ ~~. ~ AND ACN _ 1 i 171D07
3 ~`~' TAXPAYER RESPONSE
;, ~~ DATE ~ 11"-30-2n11 "
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TYPE QF AGCQUNT
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4t11;~a~* ~ ;. 1,~.~1NI1C~N REGIST~~R- OF. ,WI1.4S' s ~:- 1~~ x;~~
1'L6; .W ,.HILLCR'EST ~DR , ~_ ~ 1 COURTNUUSE SQUARE . ~ ' - ,
CARLISLE PA 1'7013-.1215 CARLISLE PA 1?Q•13
SOVEREIGN BANK provided the department, with the information below, which was- used 1n ca}culatinSi:the inheritance°taX due.
Records in~ic, to tdat,at the deptb of the above named Aecedent, Xi+u were,a joint owner/beneficiary of this .account. It yoL ar " th,~ !I(1011$e'Ot the
deceasbd an~ any arbdunt olrher thppn`zerqq~ 1s reflaictad below on'the Pottntiat Tax Due line, note no tax say be ~ue ut 'yyaqp iaust
notify 'the d~!ppaartsient'o~f your reiation3`li#n to the deceased by checking Box C 1n PART i~ btlow aiid writing "spouses iii PART 2.
If ou believe the information is incorrect please obtain wrltteo- correction fron the financial institution, attach a copy to this fora and return
.: , tt"..,.a._-~hr! ibex~e add P~al~71I.77.$) ~g7 w4tt~ quebt,#rtA~-... _~ ~~~~ ~•-
~. ~C~~'F~XK~t~~~E~dW,~.~`~"'~~!~E'1~`ER"~`E--.T--__.,~-- _,.,e _ --~,~_ ~- __.t~. ___._". _
~~IDE Fly D`k~~Nb' p#Y1~Mil""T~~:`i"f`~ ~'"~':
Account No. 2895412738` Data 07-07-2000 To ensures proper crodt to thti, accrs~nt, two
Established copies of this notices ^ust pdcowtpdtgr, '
Account Balances 12, 151 .35 paarmant to the Rapis4ar of Wills• Makes check
payable to "Raeister of Wills, Aaant".
Percent Taxable X 50.000
6 ~ 075.68 NOTE: ,If tax pavaaets are aada within throes
AsOUnt Subject to TaX aonths of the daudont's data of death,
Tax .Rate X ;j5. daduct'a`5 percent discount on tho talc-dues.
Any'#nhoritanea tax dwa will baeara delihtlwnt '
Pote»t al TaX Due $ ~ 9.1-Y . 35:', - ninr aonths aftor`th~ daEb' of dratli,'' '
~~ PART ~~ - ~ _ ~F; •> ~~ ~"~ li ~~, ~~
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aba r}Y~a an and tb~c dpli i'+ Ebtttret, . ~ ':. '~ . ~ r
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= q C btE~iC ~ se0un~ g1~ aroid ~nt Iri~~s~4, t:r r. ai:u)Zn, ttr~t no~dew ,ka, tb~t Aayiu~*~, p~f idilly aen~f~~ ,, ~ k `."
}i DNS en offtolsY ass+ssrant w#,1j; ba issued !ry YhYi PA tleparterrlt~sf [t~vanua ~ ~ ,• ~~
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BLCICK a. ~ The abore sssat bas boen or w311 ba roported and tax paid with the Pennsylvania inharitanci 'teat "raturb '
ONLY filed by the estate representative:
C. ~Thq above info~ ion-.is incorr and/or debts and deductions ware paid.
Cwplate.PART ~2 and/or PART ~ below.
PART If indicating a di'fterdnt taasa state
"relstfbnhip ~to~docrdent:
TAX RETURN -CALCULATION OF TAX ON JOINT.//TRUST ACCOUNTS
. LINE 1. Data EslablisAad .1
2. Account Balanco 2 ~ ~-I~`~ ~ + ~ Y
~'~
4. Asount Subject to Tax
5. Debts: and Deductions
6. Asount Taxable
6d...~.
7. Tax RsN _ . 7,~
$. Tax''Di~o d
PART DEBTS AND DEDUCTIONS 'CLAIMED ~ '
3 -
DATE PAID PAYEE. DESCRIPTION AMOUNT PAID
Undoc panaltiea ot.pdr~ury, I declares that tho facts I rapQrtad.abovi ire trui, aorrec>: a»d
'-co~lo~e to thes babt of sy knoxladgo and boli'ot. HOME C' I ) • .. ~
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