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Home My WebLink About02-15-12~~~ PENNSYLVANIA INHERITANCE TAX' INFORMATION NOTICE FILE BUREAU OF INDIVIDUAL TAXES h'n~ LY ~ ~ ~r AN D PD Box 2ao6o1 ~~ j/t ii++ C, ACN HARRISBURG PA 17128-0601 o~aaTMCwTOFgE E~ E• ~Fk ..~ * * ~A~E~~~~o ~i~1S~'C~NS~ * * DATE REV-1543 EX AFP (05-11) N0. 21 10-0803 12106550 02-08-2012 ~rJ t itjL;~ ~:Z EST. OF ROSALIE S RITZIE ~~~ ~ SSN 198-32-7632 G,- ~ ~ , ~~,~ GQUft~ DATE OF DEATH 0 5 -15 - 2 010 ,~, }- i~~ ~~ D~ COUNTY CUMBERLAND Ct~ REMIT PAYMENT AND FORMS TD: WALTER C RITZIE REGISTER OF WILLS 505 DEUBLER RD 1 COURTHOUSE SQUARE CAMP HILL PA 17011-2017 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 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, 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 FILING AND PAYMENT INSTRUCTIONS Account No. 6140833019 Date 09-15-2001 7o ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance $ 142,392.71 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $ 71,196.36 months of the decedent's date of death> TaX Rate X .00 deduct a 5 Percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due $ .00 nine months after the date of death. PART TAXPAYER RESPONSE B U T ILIA T ~ SE'~NENT I S~'OND LL A. ~! The above information and tax due is correct. I~J Renit 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 antl CHECK an official assessment will be issued by the PA Department of Revenue. C ONE BLOC K B. ~ The above asset has been or will be reported and tax Daid with the Pennsylvania inheritance tax return O 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 tax rate, please state OFFICINAL SSE ONLY ~ AAF,,, relationship to decedent: pA DEPARTMENT OF REVENUE ' TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS AD LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Detluctions 6. Amount Taxable 7. Tax Rate 8. Tax Due 1 2 3 X 4 5 - 6 '~ 7 X 8 $ 1 2 3 _ _ 5 6 r 7 ~~ PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I reported above are~jtrue, ~g,~o'r~/'ec a d complete to the besrrt of my knowledge and belief. HOME C {~ ) ~i.! G~ 4XPAYER SIGNATURE a TELEPHONE NUMBER D TE J~' TOTAL (Enter on Line 5 of Tax Computation) S ~~ `*F~, -'~ "~' '~C ~ t" II r .y`yy ~ !~' ~ ~~ ~' ,~".:.~ ~' l "t i+'t ~ ~ ~~, -a ~ b. t3~s ;3~ r i f~ ./~ ~~ f 's r `*~ `~% 9 y~y 1 P- USp~~RSS