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Home My WebLink About06-01-12~/ _ __ - ~ .~ BUREAU OF INDIVIDUAL TAXES ~;••~~ ~'r PO BOX 280601 [] `d' HARRISBURG PA 17126-0601 pEan ~ ,o~~~"~~. flEV-1543 EX AFP (05-11) PENNSYLVANIA INHERITANCE TAX ~, INFORMATION NOTICE FILE N0. 21 - I ~ -tJ~ ~Cl ~~~ ~ AND ACN 12131596 ~'~~ j TAXPAYER RESPONSE DATE 05-16-2012 ?~i2 JUN - ! Pty 3~ 23 r^.{ !-n. / ~ s ~~ i ~. [~yyQ~~R~~~fjj'H~i~IAA~ASA~~~~f.:l~U~ rpp~~ V~1MD~riWJ ~.. R'1 YVONNE WHISENANT 1521 INVERNESS DR MECHANICSBURG PA 17050-8329 TYPE OF ACCOUNT EST. OF CATHERINE B BUNJEV'AC ~ SAVINGS SSN 182-16-1084 ~ CHECKING DATE OF DEATH o4-28-2012 ~ TRUST COUNTY CUMBERLAND ~ CERTIF. REMIT PAYM ENT AND FORMS T0: REGISTER OF WILLS 1 COURTH OUSE SQUARE CARLISLE PA 17013 FU LT ON BANK NA 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 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 s 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. 3626-84078 Date 03-29-2005 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance 979.87 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 $` 489.94 months of the decedent's date of death, Tax Rate X .045 deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due $ 22.05 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. 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 an def omplete PART ~ and/or PART ~ below. i ections were paid ~~ ~a q,~\ ~/~~ i~, i/.;lie ~(k IT PART If indicating a different tax rate, please state OFFICIAL USE ONLY ~ AAF 2 relationship to decedent: PA DEPARTMENT OF REVENUE TAX RETURN - CALCULATION OF TAX ON ,~OI NT TRUST ACCOUNTS pAD LINE 1. Date Established 1 / ~ 1i L l 2. Account Balance 2 _ $ ~a ~ 2 3. Percent Taxable 3 X J • Gl:l'. 3 4. Amount Subject to Tax 4 +~ S ~ t 4 5. Debts and Deductions 5 G 5~: -i c7 rj 6. Amount Taxable 6 $ ~i 7. Tax Rate 7 X 7 8. Tax Due 8 $ ~ $ PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION MOUNT PAID ti '.ae ~ ~. L~C ~ WIAL Ctnte rl.iUn Line 5 of rax)COmputEft ion) $ ~(~, S!1 ~~ Under penalties of perjury, I declare that the facts I reported above are true, correct and c plete to the best of my knowledge and belief. /~ ~ / ~~ ~~ ~ ~ H 0 M E C I I ~ ) ~ ~) ~l ~~ °~,'S 5 _ ~+~'2'I ~~ ~, ''.~ ;/~ WORK ( ~ T PAYER S GNATURE TELEPHONE NUMBER DAT