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Home My WebLink About05-09-12 (2)-~ PENNSYLVANIA INHERITANCE TAX I,~ BUREAU of INDIVIDUALI. ~ INFORMATION NOTICE FILE N0.,6~f al-la -~W ~9 Po Box 2BO6o1 ,.~ _,p~~~~~nia AND HARRISBURG PA 17128 ~[l.~ ACN 12128606 ~.~ -^DE~?ART4+I~N~7pF~?EVENUE TAXPAYER RESPONSE - ~ RE,-~sGi En.aFp X05-„~ DATE 04-30-2012 ., ~f"ir'rirt ! ~; 1, vl~ i.. C~~~I~FF~~ ~~~rl ~.(;.. ~i~i HELEN P GARVIN 121 RATHTON RD YORK PA 17403-3743 EST. OF ERNEST E GARVIN SSN DATE OF DEATH 03-04-2012 COUNTY YORK REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 45 NORTH GEORGE STREET YORK PA 17401-1240 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 deatYi 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. 6221233457 Date 06-04-2008 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $` 22, 423.04 payment to the Register of Wills. Make check Percent Taxable X payable to "Register of Wills, Agent". 50.000 Amount Subject to Tax $ 11 , 211 .52 NOTE: If tax payments are made within three Tax Rate months of the decedent's date of death, X 1 5 deduct a 5 percent discount on the tax due. Potential Tax Due ~` 1,681.73 Any inheritance tax due will become delinquent nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO RESPOND WILL RESULT IN At'! 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 obtai C H E C K a discount or avoid interest, or return this notice to the n Register of Will C 0 N E ~ an official assessment will be issued by the PA Department s and of Revenue. B L 0 C K 0 N L Y B. ~ The above asset has been or will b e reported and tax paid with the Penns l i file d by the estate representative . y van a inheritance tax return C. ~he above informs ion is incorrect and/or debts and deductions Complete PART ~ and/or PART ~ below. were paid. PART If indicatin g a different tax e, please tate relationship to decedent:_ ~ ~~ TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS LINE I. 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 1 2 +fi 3 X 4 $ 5 - 6 $ 7 X 8 PART DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) ~ Under penalties of perjury, I declare that the facts I reported above are true, correct and complete to the best of my knowledge and belief. ~ ~_, HOME ( ~ ~ WORK (`~) ) - 99s .5'7-1a TAXPAYER IGNATURE TELEPHONE NUMBER DATE DEBTS AND DEDUCTIONS CLAIMED OFFICIAL USE ONLY [~ AAF PA DEPARTMENT OF REVENUE PAD 1 2 3 4 5 6 7 8