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Home My WebLink About05-16-12 (3)PENNSYLVANIA INHERITANCE TAX ~~ INFORMATION NOTICE FILE No. 21 - ~' ~ ~ C BUREAU OF INDIVIDUAL T XES ~ - (_~q~(~ Po BOX 280601 ~ (" ~~"~ n18 AND I/~ p ACN 12128052 HARRISBURG PA 17128` 68'1 _/` ,DEenRThtENYDFry VENUE TAXPAYER RESPONSE DATE C~ 04-26-2012 ' RAY-15Gj~X~KS (05-111 LORETTA S HELMAN 402 GALE ST MECHANICSBURG PA 17055-3968 EST. OF HAROLD W HELMAN SSN DATE OF DEATH 04-07-2012 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 y0U are the Sp0U5e 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. 0471703702 Account Balance Percent Taxable Date 02-26-1981 Established $ 59,988.96 X 16.667 To ensure proper credit to the account, two copies of this notice must accompany payment to the Register of Wills. Make check payable to "Register of Wills, Agent". NOTE: If tax payments are made within three Amount Subject to Tax $` 9,998.36 months of the decedent's date of death. Tax Rate X 00 deduct a 5 percent discount on the tax due. . O O Any inheritance tax due will become delinquent Potential Tax Due $` 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 0 N E an official assessment will be issued by the PA Department of Revenue. BLOC 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 z~ and/or PART IJ below. PART If indicating a different tax rate, please state OFFICIAL USE ONLY ~ AAF relationship to decedent: PA DEPARTMENT OF REVENUE TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS ppD 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 - ~j 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X 7 8. Tax Due g $ 8 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 and complete to the best of my knowledge and belief. HOME C ~ ~C~ J ~(p 9 •-5//~ . ~ - AXPAYER~ IGNATUR~ ~ ° \_7~~e~~-WORK C 6 ~Ci ~ L~ /~- ~js' ~/ TELEPHONE NUMBER DATE iuis~~ ctnter on a ne 5 of lax Computation) S