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Home My WebLink About04-18-12 (2)a,~~ PENNSYLVANIA INHERITANCE TAX BUREAU of IN ~gaAt, TAx~$~, ~ ; INFORMATION NOTICE L ~a r~ FILE N0. 21 - ~ PD eox zaocots ~ '.i ~p~isylvania AND ACN 12125004 HARRISBURG PA ~~;-7,1~QB•-7BbB•J ~ ~ ~~p TMENT OF REVENUE TAXPAYE R RE S P 0 N S E `, _ -~~ DATE 04-12-2012 REY -1543 Ex AFP (05-11) ~~ ~~~ i $ ~,~~ ~: 47 TYPE OF ACCOUNT EST. OF RICHARD L KANN ® SAVINGS $SN ~ CHECKING r ~ /\r C~'-~'~ `v` r ~ DATE OF DEATH 03-29-2012 ~ TRUST r ORP}-SAN,. ~`~L•''_'i'' ` COUNTY CUMBERLAND ~ CERTIF. -. C3' ~~.n C~ n' '~~ ~~ ` ~ ^~ r , . REMIT PAYMENT AND FORMS T0: KAY F KANN REGISTER OF WILLS 1836 WALNUT BOTTOM RD 1 COURTHOUSE SQUARE NEWVILLE PA 17241-9510 CARLISLE PA 17013 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. 6140271967 Date 04-02-1999 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance 1 439.51 payment to the Register of Wills. Make check ~ payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $ 719.76 months of the decedent's date of death, lax Rate ~( , 16j deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due ~` 107.96 nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT 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 an official assessment will be issued by the PA Department of Revenue. ONE 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 ~ below. PART If indicating a different tax ate, pl a state ~ ~ '~ OFFICIAL USE ONLY ~ AAF relationship to decedent: f ~u-s PA DEPARTMENT OF REVENUE TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1. Date Established 1 1 2. Account Balance 2 ~ 2 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ 4 5. Debts and Deductions 5 S 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X 7 8. Tax Due 8 $ g 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, correct andp complete to the best of my knowledge and belief. HOME C 7~7 ) ~ ~7~ - 3 0 p 9 y~~,l ~ . C~rt/GC/ WORK C ) ~ TAXPAxER SIGNATURE TELEPHONE NUMBER AT TOTAL CEnter on Line 5 of Tax Computation) S ~., ~ . ~~ -r~x ~,. a` ~ .... ~' ., o ~ ~~ ~. ~~ a ;~ x al ~ ~, c+ 1 t..~. i' i a•~• iii (1's pit ~ •` itii ~- O ~) ~ ~r ~; -i i„' ;~ ;~:, Y~ '~' ~= ~: :~', t.~ -~;- ,~; ice: _ ,~ ~ c ~ ~ x ~ ~'° ~- ~' r 1 ~: ~ ~ 5 R E~ USAF~S '