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Home My WebLink About03-29-12 (10)~,; PENNSYLVANIA INHERITANCE TAX BUREAU OF INDIVIDUAL TAXES INFORMATION NOTICE FILE N0. 21 11-1250 PD eox zaocol .rlr ~(~gy AN D HARRISBURG PA 17126-0601 ~ ~r ~~ 'f '' ~ ACN 12107976 l p~eA~,'~~oPa ~ TAXPAYER RESPONSE F`f'!~,,~Iely i;i'~z'a~ <d~,li~j DATE 02-03-2012 CLERK CF ~yORPHq~'~S CC~Rr SHIRLEY A NICHOLS 423 HILLSIDE RD NEW CUMBERLAND PA 17070-1863 EST. OF ROBERT A NICHOLS SSN DATE OF DEATH 09-15-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. SOVEREIGN BANK 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 I BELOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0775545734 Date 04-28-201D To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 10 ~ 131.08 Payment to the Register of Wills. Make check " payable to Register of Wills, Agent". Percent Taxable X 50.000 Amount Subject to Tax $ 5, 065.54 NOTE: If tax payments are made within three months of the decedent's date of death, Tax Rate X .15 deduct a 5 percent discount on the tax due. Potential Tax Due $ 759.83 Any inheritance tax due will become delinquent nine months after the date of death. PART TAXPAYER RESPONSE AI `; E W~~.£ DL:~`IN;~,AN FiC i. T ~ SE~S#4~NT A. ~ The above information and tax due is correct. Rewit payment to the Register of Wills with two copies of this notice to obtain C H E C K 0 N E 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. BLOC K ~ D N L Y g, ~ The above filed by asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return the estate representative. C. The above Complete informs ion is PART 2~ and/or in~oFrect and/or debts and deductions were paid. PAR[ 3~ below. PART If indicating a differen relationship to decedent TAX RETURN - CALCULATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF TAX DN JO?NT/TRUST ACCOUNTS 1 z $ 3 X 4 +fi 5 6 $ 7 X $ $ OFF If~~AL~ US,E L~NL Y A~ PA DEPARTMENT OF REVENUE 1 2 3 4 5 6 7 $ r , PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION eMniiur perm Under penalties of per"ury, I declare that the facts I reported above a e'`~true e n omple to the b st o y knowledge nd belief. HOME C ~ 1 ) ~~~~'~~3~ r ,~ WORK C ) ~ ,'~ 1 TAXPAYER SIGN RE TELEPHONE NUMBER DA E e PAD •-~^~ ~~~~«~ .~~~ ~..~nr ~ Or lax l.O mpULaLlOn) S