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Home My WebLink About01-27-12 (2)~~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE No. ~ ~ ~~-~~ BUREAU OF INDIVIDUAL TAXES Po Box zao6ol ~.G~~~~~rS~f~ AND ACN 12104258 HARRISBURG PA 17128-0601 ~"' ~E2A~TMENTOF TAXPAYER RESPONSE DATE o1-18-2012 ,r;,:~ . ~'~~~ I~~ 27 ~~'s {(~ 34 CI.FR{C ~~ ORPHAN'S COURT CUMBFRLF~ND C;~, ~~ k ~ ~~D NANCY A OLSON ~ ~ 87 SMITH RD GARDNERS PA 17324-9000 TYPE OF ACCOUNT EST. OF EDWARD C OLSON ^ SAVINGS SSN 399-50-8226 ® CHECKING DATE OF DEATH 04-07-2011 ^ TRUST COUNTY ADAMS Lu rn,~jcR~9 "~ ~ ^ CERTIF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 117 BALTIMORE ST RM 102 GETTYSBURG PA 17325 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 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 you believe the information is incorrect. Dlease 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 FILING AND PAYMENT INSTRUCTIONS Account No. 6200175970 Date 05-16 -2003 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance $ 833. 71 payable to "Register of Wills, Agent". Percent Taxable X 50. 000 NOTE: If tax Dayments are made within three Amount Subject to Tax $ 416.86 months of the decedent's date of death, TaX Rate ~( , lrj deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due $ 62.53 nine months after the date of death. PART TAXPAYER RESPONSE I1,1t#t£ ` R£'SPOND.wILt U Iti A}l 'OF T M A. ^ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain C H E C K a discount or avoid interest, or return this notice to the Register of Wills and C 0 N E ~ an official assessment will be issued by the PA Department of Revenue. B L 0 C K 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 were paid. Complete PART ~2 and/or PART 3^ below. PART If indicating a different t~c~ateN pl~ se state relationship to decedent: o J TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due 2 s X 4 5 - 6 $ 7 X 8 PART DEBTS AND DEDUCTIONS CLAIMED ^3 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I reported above are true,~lcrlo/rre~c7t?and complete to the best of my knowledge and belief. HOME C 7/~ ) ~y dIO '" / .,) o~ 6 "Yl,~~- a ~ WORK ( ) j'-~y-ab/1- TAXPAYER SIGNATURE TELEPHONE NUMBER DATE TOTAL CEnter on Line 5 of Tax Computation) S