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Home My WebLink About01-30-12BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 .~ , ~~... Pennsylvania DEPARTMENT OF REVENUE REV-1563 EX AFP (05 -11) PENNSYLVANIA INHERITANCE 'TAX ,INFORMATION NOTICE AND TAXPAYER RESPONSE FILE N0. 21 11-0913 ACN 11182508 DATE 12-19-2011 }~ ~ ~-- ~ ~ ~ Cln ~~ Q ~ ~~USA 1 1 6i: AR ~ ORE u W~ . ~.,A.aEW ~` .. MBE U~ ~ c~.r ~ a r.; S (.~ d1.~SSL PA 17070-1701 EST. OF ZACHARY 0 BOND SSN 167-40-1767 DATE OF DEATH 07-27-2011 COUNTY CUMBERLAND. REMIT PAYMENT AND FORMS T0:`' REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. METRO BANK provided the department with the information below, which was used in calculating the inheritance tax due. Records indicate that at the d nth of the above-named decedent, you were a joint owner/beneficiary of this account. If yoU ere the spouse Of the deceased and any anount o er than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must notify the department of y ur 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- p3aa Q call 717-7.87-@~27_with Questions,. COMPLETE PART I BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 1760 32041 Date 07-2 1-2009 To ensure proper credit to the account, two Established copies of this notice must accofapany Account Balance $ 2,596 .15 payment to the Register of Wills. Make check ^ payable to Register of Wills, Agent". Percent Taxable X 50 .000 Amount Subject to ax ~` 1 , 298 08 NOTE: If tax payments are ^ade within three . months of the decedent's data of death, Tax Rate ~( , lj deduct a 5 percent discount on the tax due. Potential Tax Due g 194 .71 Any inheritance tax due will become delinquent nine wonths after the date of death. P T TAXPAYER RESPONSE ~ 1 A CHECK ONE BLOCK ] B ONLY The 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. The above asset has been or will be reported and tax paid with the Pennrilvania inheritance tax return filed by the estate representative. C. The above informs ion is incorr ct and/or debts and deductions were paid. Complete PART 2~ d/ PART 3~ b an or elow. PART If indicating different tax rate, Please-.state relationship t decedent: TAX RETURN - CALCU ATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Establishe 1 2. Account Balance 2 3: Percent TaM'atr -- _ 3 x, = ... _. _ - - 4. Amount Subject o Tax 4 5. Debts and Deduc ions 5 6. Amount Taxable 6 . 7. Tax Rate 7 X `"'~~' sb;',~ . 8. Tax Due 8 $ 'r~' ~; PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID ~ ~ TOTAL CEnter on Line 5 of Tax Computation) # U-n~P,~ penalties of ~prfury, I declare that the facts I reported above are true, corryct c p etc to the bes of my knowledge and belief. unur .~),~'1 . -"T'9~ ~ , 1~ WORK C'~~~ ) I0~~7 Q~~ TELEPH NE NUMBER DATE i rid .:~~'' ~~v~ ~~. v _ . ~d `~ ~~ AM 9! F ~ . tom( rt~ ~ ~NHAN`~` ~E.F~t ., , ,„; ~~ ~s cif M ~~ 4 ~ ~ --~ ~ ~~ '~U ~J~ ~~ ~~ ___ J ~~