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Home My WebLink About01-18-12BUREAU OF INDIVIDUAL TAXES • PO BOX 280601 ~~(!`~~'~VLV HARRISBURG PA 17128-0601 d~~ARTNENT tSi `A~ REr-1563 EJ( AFP PENNSYLVANIA INHERITANCE INFORMATION NOTICE AND ~j~ * ~A~~~~ ~~~~~5~ TAX FILE N0. 21"''~-~~ ACN 11183488 * DATE 01-12-2012 ~~ ~. C~E~f` ~„ Q~~'H~`i~ t ~ ~'Il~ ?f~ r Ct1Aj~~'~ t ,, - f,,': PA SUMI FELEGI 226 STEHMAN RD LANCASTER PA 17603-9678 EST. OF JOHN fELEGI SSN 180-22-0156 DATE OF DEATH 04-26-2011 COUNTY CUMBERLAND REMIT PAYMENT ANl) FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CNECKING - ~ TRUST CERTiF. CITIZENS BANK OF PENNSYLVANIA 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 ere the Spouse of the deceased and'arty 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 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 PILING AND pAYhENT INSTRUCTIONS Account No. 6140167884 PART Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due CHECK. ONE [ BLOCK ONLY Date 10-22-1971 Established ~ 22,563.31 X 50.000 $ 11,281.66 X .00 $ .00 TAXOAVCD .QCf,DAbl A. (~ The-above inforaation and tax due i#-correct. To ensure proper credit to the account, two copies of this notice aust aeeoapany payaent to the Register of Wills. Make check payable to "Register of Wills, Agent". NOTE: If tax payaents are aade within three months of the decedent's date of death, deduct a 5 percent. discount on the ta0c due. Arty inheritance tax dw will beeoae deliheuent nine aonths after the date of death. React Dayaent to the Register.of Wills with two copies of this .notice to obtain a discount or avoid interest, or returnt~iis, notice to the Register of Wills end,. an official assessaent will be issued by the PA Depat~tetent of Revenue. B. ~ The above asset has been nr will be reported and tax paid with the Pennsylvania inheritance tax return filed by the estate representative. C. ~ The above inforaa eon is incorrect and/or debts and deductions were paid. CaapleYe PART ~2 and/or PART ~ below. PART If indicating a different tax rate, please state relationship to decedent: TAX RETURN -CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 2 ~ 3.___Percent ~a~iahla._ _ _ _ . 3 X-- __ - - _- --___ ------ ~,-- _ _ _ _ 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 ~ 7. Tax Rate 7 X 8. Tax Due PART DATE PAID 8 ~ DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID Untler penalties of perjury, 'I declare that the facts I reported above ar• true, correct and complete. to the -best of py knowledge and belief • HOME C `r~ 7 ) 7. - ~ 7r ~ ~", ' WORK C ) ~ ~ /f ~ TAXPAYER SIGNATURE TELEPHONE NUMBER DATE BUREAU OF INDIVIDUAL TAXES f' i Fr\!~~! PO BOX 280601 P~~t`IS;~/kVd1117 HARRISBURG PA 17128-0601 __._ _._ ,_ ,. REV-1543 EX 11iP (\5-I1) PENNSYLVANIA INHERITANCE INFORMATION NOTICE ~~ ~~ AND .,~ ~_~ ~A~E~~~ ~i~tS~t~S~ ~ TAX //~~ /M]/) /~ FILE N0. 21 ~`/ G~-W~ ACN 11183487 * DATE 01-12'-2012 ~~~ ~~~r~~(~ i~ l~J~! Ct_i~~~~ ~ " ~`f ~ a; SUMI EELEGI 226 STEHMAN RD LANCASTER PA 17603-9678 EST. OF JOHN FELEGI SSN 180-22-01,56 .. DATE OF DEATH 04=26-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING "TRUST CERTIF. CITIZENS BANK OF PENNSYLVANIA 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 Point owner/beneficiary of this account. If y04 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 departa~nt of your.relationshlp to the deceased by checking Box C 1n PART 1 below and writing "spouse" 1n PART 2. If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to tfiis form and return it to._thg.Bhpre-.addres~_ viQa~a~Il J17-787-8327 with.questi9ns. - ,.. _ _ _ ~- - - - - - COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 6100701190 Date 07-12-1971 To ensure proper credit to the bccount, two Established copies of this notice must eccorpany Account Balance 11 , 315.11 payment to the Register of Wills. Make check payable to "Register of Wills, Agent^. Percent Taxable X 50.000 NOTE: If tax payments are made Mithin three Amount Sub3eet to Tax 5, 657.56 months of the decedent's date of death, Tax Rate ~( , 0 0 deduct a 5 percent discount on the tax due. . 0 0 Aro inheritance tax due will becoee delinquent Potential Tax Due ~ nine months after .the data of death. P~T ,. TAXPAYER ' RE$RaNSE ..$, . 1 , A. ~-The above information and tax due is corroct. ~ Remit payment to the Repiater of Wills.with,i;wo copies of this notice to obtain r CHECK' a discount or avoid interest. pC;hetitrn.th'is notice tp,the Repister,of.Wills and I ON E ~ an official assessment .will be"i3~.ued by the PA Department. of Revenue. L BLOCK B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return ONLY filed by the estate representative. C. ~ The above infona ion is incorr ct and/or debts and deductions were paid. Complete PART 2~ and/or PART 3~ below. PART If indicatins a different tax rate, please state relationship to decedent: TAX RETURN - CALCULATION LINE 1. Date Established - 2. Account Balance - _ _ _.. S.-teraeTS>t- TS7(7fbYe--- -. 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxabl® 7. Tax Rate 8. Tax Dua OF TAX ON JDINT/TRUST ACCOUNTS 1- 2 ~ -5----~ - - --_ __e_ - . , 4 5 6 ~ 7 X B $ 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~,j correct and complete to the best of my knowledge and belief. HOME C T/7 ) p?Z'V.~yr WORK C ) ~ /,T TAXPAYER SIGNATURE TELEPHONE NUMBER DATE . - :f ., ~~ ~~l E i` ...~ t {~ F ~ ii } .i .3 t~ ~ r...S~ ` ~~~t ~r ` }{ f ~1 ~. f Yr ~t ~' i ~x $~. ~ ~; ~. r., ~ M ~ ' 3 ~' ~ C ~ o ~ y ~ ~ ~ ~~ ~ e.: ,.: .. .: ... -~,; ,c -= ;~ ,« i R .. ~ i ~ ~ ~ ` ~ { c M 7977 a'::' ., '1 ....may $r"~~. `~ ~. °~, . Y ~~~`, ~ A ~ _ ' h N . "tiR •- ~ Y I v - a; - j ~ _. iN. ; fir _. -__ _