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REV-1543 EX AFP (8-94)
C NoNWEALTH OF PENNSYLVANIA INFORMATION NOT I C E
r ~dEPARTMENT OF REVENUE A N D
BUREAU OF INDIVIDUAL. TAXES TAXPAYER R ES P O N S E
DEPT. 280601
HARRISBURG, PA 17128-0601
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FILE N0. 21 -'"~1.3-/~b
ACN 95101156
DATE 01-17-95
TYPE OF ACCOUNT
ESTATE OF NELLIE M LOGAN ®SAVINGS
S.S. N0. 204-01-3332 ^ CHECKING
DATE OF DEATH 06-28-94 ^ TRUST
COUNTY CUMBERLAND ^ CERTIFICATE
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
17025 CARLISLE, PA 17013
FARMERS TRUST COMPANY has Provided the Department with the information listed below which has boon used in calculating the
potential tax due. The1r records indicate that at the death of the above decadent, you ware a joint owner/beneficiary of this account.
If you foal this inforaation fs incorrect, please obtain written correction frog the financial institution, attach a copy to this fora
And return it to the ahnv, address. This account is taxahLe in accordance with thm Inheritance Tex Laws of the Commonwealth of Pennsylvania.
Questions may be answered by calling C717) 787-8327.
COMPLETE PART 1 SELOW ~ * ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 222-010400 Data 12-07-93 To insure proper credit to your account, two
Established (2) copies of this notice must accompany your
• 0 0 payment to the Register of Wills. Make cheek
ACCOUnt Balance payable to: ^Ragistar of Wills, Agent^.
Percent Taxable X 100' 00 NOTE: If tax payments are Wade within three
Anount Subject to TaX • 00 C3) months of the decedent's date of death,
Tax Rata X • 1 Cj you may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
Potential Tax Due • 00 Wino (9) months after the data of death.
PART TAXPAYER RESPONSE
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A. }The above information and tax due is correct.
'~-l~ 1. You may choose to remit payment to the Ragistar of Wills with two copies of this notice to obtain
CHECK a discount or avoid interest, or you may chock box ^A^ and return this notice to the Registrar of
C 0 N E ~ Wills and an official assessment will be issued by the PA Dapartmant of Revenue.
BLOCK B. ~ The above asset has bean or will ba reported and tax paid with the Pennsylvania Inheritance Tax return
0 N L Y to be filed by the decedent's representative.
C. ~ The above inforaation is incorrect and/or debts and deductions warm paid by you.
Vou must complete PART ~ and/or PART ~ below.
PART eta a different tax rata, plaasa state your ;i;i;~•
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PART DEBTS AND DEDUCTIONS CLAIMED
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DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I deelere that the facts I have repartee soave era true, cvrr c env
complete to the best of m knowledge and belief. HOME (~~~ ) ~ ~~
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