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Home My WebLink About08-21-12~ PENNSYLVANIA INHERITANCE INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES ,^~,, PD Box znobBl ~~y~~ ~ AND HARRISBURG PA 17128-0601 ~, 4Fi n TAXPAYE R RE SPO N S E FOE, BbyEN FILE N0. 21 ~°~- ~~ ACN 12144740 DATE 08-13-2012 ~t~i2 AUG Z I AM 9~ 47 ORPhil~d'~ CJUR;. CUMBERLAND CO., PA JAV E SMITH 436 GOODYEAR RD GARDNERS PA 17324-9309 EST. OF EDWARD S SMITH SSN 18E~-10-3037 DATE OF DEATH 07-12-2012 COUNTY CUMBERLAND REMIT PAYMENT AND 1=0RMS TD: REGISTER OF WILLS 1 COURTHOUSE SUUARE CARLISLE PA ].7013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. PNC BANK NA provitletl the deDa rtment with the information below, which was used in calculating the inheritance tax due. Recortls intli cote that at the death of the above-named tlecetlen t, you were a joint owner/beneficiary of th's account. If you are Lhe Spouse Of the deceased and any amount other than zero is reflected below on the Potential Taz Due line, note no tax may be due. but you must notify the deDa rtment of your relationship to the deceased by checking Box C 1n PART 1 below and writing "spouse" to 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-]8]-8327 with questions. COMPLETE PART 1 BELOW ^ SEE REVERSE SIDE FOR FILING AND PAYNENT INSTRUCTIONS Account No. 5005251768 Date 03-24-2010 Estahlishetl account Balance $ 7.529.00 P er<ent Taxable X 50.000 Amount Subject to Tax $ 3.764.50 Tax Rate X .045 Potential Tax Due g 169.40 TAYDAVCD DCCDAAI~ To ensure proper cretlik to the accquntr two copies of this notice oust accgnpanv pavnent ko the Register of Wills. Make check oayabla to "Register of Wills, Agen k•'. NOTE: If tax paynenks are node wikhin kh ree nonths of khe decedent's tlake of death. detluck a 5 percent tli scounk on the tax due. Am inheritance tax due will becone delinquent nine nonths after the tlata of tleath. A. ~ The above information and kax due is correct. Renit paynent ko the Register of Wills with 4wo copies of thi!: notice to obtain CH EC K a discount or avoid interest, or return this notice fo the Register of Wills antl ONE an official assessment will be issued by khe PA Oepa rtnenk of Revenue. BLOC K B. ~ The above asset has been or will be reported and tax paid with they Pennsylvania inheritance tax return ONL Y filed by 4he estate representative. C. ~ The above info rna ion is ineor reck and/or debts and tleductions were paid. Complete PART 2~ and/or PART ~ below. PART If indicating a different tax rake, please skate relationship to decedent: TAX RETURN - CALCULATION LINE 1. Date Established 2. Account Balance 3. Peregni Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rake 8. Tax Due PART DATE PAID PAYEE OF TAX ON JOINT/TRUST ACCOUNTS 1 2 $ a X 4 5 6 8 DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID TAJCP A7CFR SIGNATURE TELEPHONE NUMBER DATE Under penalties/of per3ury, I declare khak the facts I reported above ~afre ~~ue, < rre ct antl //^7 < etc to kA,{ bes m~ledge and belief. HOME C /~~) ~~~ ~T /~~ ~y1/Jy WORK ( )