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BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE REV-1548 EX AFP (12-11)
PO BOX 280601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON
HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS
DATE 04-16-2012
ESTATE OF DONIVAN ROYAL S
DATE OF DEATH 05-04-2011
FILE NUMBER 21 11-0564
COUNTY CUMBERLAND
SSN/DC
CATHY S WATERS ACN 11179006
116 W HILLCREST DR APPEAL BY DATE:06-15-2012
CA R L I S L E P A 17 013 - 1215 (See reverse side under Objections)
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
-~~ PENNSYLVANIA INHERITANCE TAX
. ~
Q,1 ~ ; INFORMATION NOTICE FILE N0. 21 11-0564
BUREAU OF INDIVIDUAL TA~; tL,'ti' 'U'~~
- ~ PUlBDX 280601 ,.._ - ,,.nqn nsy~V~~a T~
` HARRISBURG PA 17128-O60I`` Y" ~3 ANL ACN 11179006
.- - DEPARTMENT OF RE NUE TAXPAYER RESPONSE
DATE 11.-30-2011
REV-I'i 43 E% AFP (05 -1])
'111 t~rL { ~
..... ~:E rt I $ ~`i~~ ~ ' 25
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CATHY S WATERS
116 W HILLCREST DR
CARLISLE PA 17013-1215
EST OF ROYAL S DONIVAN
SSN
DATE OF DEATH 05-04-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
SOVEREIG N BANK provided the department with the information below, which was used in calculating the inheritance tax due.
Records indicate that at t11e death of the above-named decedent, you were a joint owner/beneficiary of this account. If y0U art 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 retw n
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. 0591134373 Date 10-21-2008
To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 1 , 176.19 uayment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 16.667
Amount Subject to TaX NOTE: If tax payments are made within three
$ 1 9 6 . 0 4 months of the decedent's date of death,
Tax Rate X . 15 deduct a 5 percent discount on the tax due.
Potential Tax Due $ 29.41 Any inheritance tax due will become delinquent
nine months after the date of death.
PART TAXPAYER RESPONSE
FAILURE TO RESPOND_WILL RESULT IN AN OFFICIAI.TAX`ASSESSMENT ~,1,
A. ^ The above information and tax due is correct. 1~~~
Remit payment to the Register of Wills with two copies of this notice to obtain 11 ~/
C H E C K a discount or avoid interest, or return this notice to the Register of Wills and
0 N E an official assessment will be issued by the PA Department of Revenue.
[ B L O C K ~ B. ~ The above asset has been or will be reported and tax paid with the
O N L Y Pennsylvania inheritance tax return
filed by the estate reuresentative.
C. The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART 3L _I below.
PART If indicating a different tax r te, pie se state
relationship to decedent: ~~" OFFICIAL USE ONLY Cl AAF
TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PA DEPARTMENT OF REVENUE
1/ Q PAD
LINE 1 . Date Established 1 ~~ ~ 4~ * ~O
^] p 1
2. Account Balance 2 $ ' (~ ~~ y i9 z
3. Percent Taxable 3 X l~, (~~"~ 3
4. Amount Subject to Tax 4~ $ ~~ ~,(~ If 4
5. Debts and Deductions 5 - ~ 5
6. Amount Taxable 6 $ ~ { ~, Q~ I 6
7. Tax Rate ~ X ` ~'S5 7
8. Tax Due 8_ $ ~ . ~~ $
PART
^ DEBTS AND DEDUCTIONS CLAIMED
3
DATE PAID PAYEE nGCrororrn.l
Under penalties of perjury, I declare that the facts I reported above are true, correct and
co ~Le a to a best of my knowledge and belief.
~/~ / J HOME C r )
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TAXPAYE ST('NATIIRF -r~i_~oun.,c .,,,...~r-~
- -- ~--~ - -~ vi ia~c ~.ompUiailOnJ $
Page 1 of 1
Front:
CATHY S. WATERS //4 1n-. l~r/1G'i^l~~rTrr a~~~ i l 9 4
4 Pti.717~97-8736 ~~ ~~
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https://mlonline.memberslst.org/OnlineBanking/AccountSummary/AccountDetail.px 4/14/2012
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