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HomeMy WebLinkAbout10-29-12COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: BALMER ELDA J 517 HALDEMAN BLVD NEW CUMBERLAND, PA -------- fold ESTATE INFORMATION: FILE NUMBER: 2112-1 148 DECEDENT NAME: WATTERS SALLIE M DATE OF PAYMENT: 10/ 29/ 201 2 POSTMARK DATE: 10/24/2012 COUNTY: CUMBERLAND DATE OF DEATH: 09/ 14/2012 ACN ASSESSMENT CONTROL NUMBER AMOUNT 12153610 ~ $175.22 12153611 ( $45.49 12153612 ~ $44.12 12153613 ~ $43.11 12153614 ~ 543.07 12153615 ~ 5200.33 12153616 ~ 5170.27 TOTAL AMOUNT PAID: REMARKS: CHECK# 1482 SEAL PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT 17070 INITIALS: HMW 5721.61 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REV-1162 EX(11-96) NO. CD 016708 REGISTER OF WILLS B UREA' PO BCC OF INDIVIDUAL TAXES HARRIX 280601 SBURG PA 17128-0601 -~., PENNSYLVANIA INHERITANCE TAX r ., ,;;;_,, _ INFORMATION NOTICE FILE N0. 21~"/p~' ~/ ~~ «~~ ~ r '~~ ~f' ~`` ' ~~ ~~" ~~" AND ACN 12153b 10 1'~~~(~VT~1d ~,a~r~~.a;r~oFR~vEtvci~.~C TAXPAYER RESPONSE DATE o9-2G-2o12 REV-1543 EX AFP C05-11) ~1~~Y~ri~d ~~ ~.,~~ I }-~ r ELDA J BALMER 517 HALDEMAN BLVD NEW CUMBERLND PA 17070-1235 EST. OF SALLIE M WATTERS DATE OF DEATH 09-14-2012 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. FIRST KEYSTONE NATIONAL 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 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 he 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. 612012506 Date 08-09-1994 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance ~` 20 , 867 • 49 Payable to "Register of Wills, Agent". Percent Taxable )( 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $` 10 , 433.75 months of the decedent's date of death, X . 0 4 5 deduct a 5 percent discount on the tax due. Tax Rate Any inheritance tax due will become delinquent Potential Tax Due $ 469.52 nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO RESPOND Wilt 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 ` ' .f' f; E `;`~ ~ L~ ~f~' ~ a discount or avoid interest, or return this notice to the Register of Wills and , ,~.( - C H E C K an official assessment will be issued by the PA Department of Revenue. ONE 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. ~he above information is incorrect and/or debts and deductions were paid. C . Complete PART 2~ and/or PART ~ below. If indicating a different tax rate, please state OFFICIAL USE ONLY ~ AAF PART relationship to decedent: PA DEPARTMENT OF REVENUE TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS .PAD LINE 1. Date Established 1 2 ~ $ ~m 817° _/ •--- _ 2. Account Balance 2 X I~~ S 3 U 3. Percent Taxable 3 $ 'U C..~ K~ t~ / ' 1 ~ 4 c ' { 4. Amount Subject to Tax 4 - ~ ~ ~ D~- ~ 5. Debts and Deductions 5 $ ~ ~~ ~ ~ ~~ 6 6. Amount Taxable 6 y~ 7 7. Tax Rate 7 X ~ ~ N~ 8 $ ~ ~~ ' 8. Tax Due 8 DEBTS AND DEDUCTIONS CLAIMED PART _ _ _ __ ~,,..~~ _..,-~'` DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I reported above are true, correct and mplete to the best of my knowledge and belief . HOME C ~ ~ r ~ ~ "F~. ~ ~~ woRK c ~ '~ <~ ° '~ -~ •~ ~~ ~ D TE TAXPAYER ~IGNATURE TELEPHONE NUMBER '~ T J _ 1 ~ L./ 70 ~ Ld r. _~t j y ~r+~ `~ n 5 `~ N ~ ~r ~~~~ i~6~ / z}dd~ F ~ r p x fdjl CCC ...~L L ~ 4 , ~- °- :- ttt '( f' a' f.. f ~ t . } y" . ~ p <: L.. i ~' ~il ~. k. a.:.: t _~ ,. . n~ l:. ~ ! <...~ JJ) l j~Ij~ r' ~! ~ ~ t~" ~ S{J. 4 ~1 ~ ,~ d +~ .V ~, y~ r ,f _''.~'~f it 1' ~ ' ,....X.. J g j i, ! J f ` 4' l' . ' [t ;.. i ) -, '- - - . ~ n r ~ ~ / / (;ter ~ - ~a_ _ j~ ~ f _ ## j ~ ~, ~ ~t~k t v; ar - - , ' L. ~,.,~c.: C _ ~ - , ~ f ~ F' ~y= fff Ar ' ~ ~~ ; {~ J +d / ~ J. ~-~ PENNSYLVANIA INHERITANCE TAX J INFORMATION NOTICE FILE NO. 21`~ l ~~~ ~~~ BUREAU OF INDIVIDUAL TAXES PO BOX 280601 e n n ~-; HARRISBURG PA 17128-0601 ~ ~'~~~~, ,'``~t ~ A ACN 12153611 DEPARTMEN f3E1(Ef~UE;; T,.~ C~I'AXPAYER RESPONSE DATE 09-26-2012 REV-1543 ~ ~iAFpI CQ,5 -11) i ~~ -~J~' EST. OF SALLIE M WATTERS DATE OF DEATH 09-14-2012 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. ~~=.. , ~t~~2 ~~~' 26 ~', 3~ ~ eu~~~~~~,~o ~~., Pq ELDA J BALMER 517 HALDEMAN BLVD NEW CUMBERLND PA 17070-1235 FIRST KEYSTONE NATIONAL 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 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 de artment of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2. If you believe ~he 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. 612250030 Date 10-03-1994 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance 2 ~ 127.96 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 ~` 1 ~ 063.9$ months of the decedent's date of death, Tax Rate )( . 045 deduct a 5 percent discount vn the tax due. Any inheritance tax due will become delinquent Potential Tax Due $ 47 . $$ nine months after the date of death. P 1RT TAXPAYER RESPONSE ~~ FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT '~~ ,,' ~- ~~ , r, A. The above information and tax due is correct. ,~,. ~~ Remit payment to the Register of Wills with two copies of this notice to obtain `~ I:, i.~ /~,~~ C H E C K a discount or avoid interest, or return this notice to the Register of wills and 1 `. an official assessment will be issued by the PA Department of Revenue. ONE 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 information is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3~ 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 PAD 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 - 5 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X 7 8. Tax Due 8 $ $ PART DEBTS AND DEDUCTIONS CLAIMED 0 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 wj ~ ) ~ `t~~~~l~ ~ ~ TAX AYER SI ATURE TELEPHONE NUMBER ATE TOTAL (Enter on Line 5 of Tax Computation) $ BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 ~. ~s~lni P~T~l~JV7,,6F REVEf~'1JE RE X43 FX AEP C,05•`117 PENNSYLVANIA INHERITANCE TAX r INFORMATION NOTICE FILE N0. 21" f ~'~'1 AND ACN 12153612 4f~ ~!" TAXPAYER RESPONSE DATE 09-2b-2012 ', f•; ! C ~~~? t1~~ ~~ i ~~ ~~ ~.~ CI~M~SEPL~~~D CQ., PA ELDA J BALMER 517 HALDEMAN BLVD NEW CUMBERLND PA 17070-1235 EST. OF SALLIE M WATTERS DATE OF DEATH 09-14-2012 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. FIRST KEYSTONE NATIONAL 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 yoU are the 5poU5e 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 de artment of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2. If you believe ~he 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. 612250031 Date O 1 - 11 - 1995 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance $ 2, Obi. 94 payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $ 1 , 031.97 months of the decedent's date of death, Tax Rate )( . 045 deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due $ 46.44 nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX .ASSESSMENT ~~ A. I~/( The above information and tax due is correct. , ~`y,,, LJ Remit payment to the Register of Wills with two copies of this notice to obtain / I;~!(i C H E C K a discount or avoid interest, or return this notice to the Register of Wills and l'--/" ~~ an official assessment will be issued by the PA Department of Revenue. ~ ~... ONE 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 information is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART ~ 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 PAD 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 - 5 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X 7 8. Tax Due 8 $ $ PART DEBTS AND DEDUCTIONS CLAIMED 0 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 t ~ / ; ~r,~.- /.~~ "~' ) ~ -~ ~ ..~~_,.1~ ._., ~ ~ ,~ ~ ~ WORK C ~ /~i /, ~ • t, ~~ . , TAXPAYER SI NA URE TELEPHONE NUMBER D TE TOTAL tEnter on Line 5 of Tax Computation) S ~, PENNSYLVANIA INHERITANCE TAX ,~ INFORMATION NOTICE FILE NO. 21`~j~'!/~~ BUREAU OF INDIVIDUAL TAXES PD Box 2BO6o1 {' A N D HARRISBURG PA 17128-0601 ~ ~~ '~~/dt'~~ t' ACN 1.2153613 pTM~r~~dr'REv~rru~'~ U, TAXPAYER RESPONSE ~., ~,;, ,,. ;, DATE 09-26-2012 +"~EY"~6Ldl~% AFP~(p5-1'7t),~~ i. i i `4=~~~~ ~~~ 2b ~ ~~ 3~ 5~ U~~ ~~,~ ~ ~ ~; f C~1R~~ER~,~~~~ GO., PA ELDA J BALMER 517 HALDEMAN BLVD NEW CUMBERLND PA 17070-1235 Date 02-21 - 1995 Established $ 2,017.09 X 50.000 $ 1,008.55 X .045 $ 45.38 EST. OF SALLIE M WATTERS SSN 206-26-4617 DATE OF DEATH 09-14-2012 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 FIRST KEYSTONE NATIONAL 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 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 he 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. 612250032 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART CHECK ONE BLOCK ONLY To ensure proper credit to the account, two copies of this notice must accompanv payment to the Register of Wills. Make check payable to "Register of Wills, Agent". NOTE: If tax payments are made within three months of the decedent's date of death, deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent nine months after the date of death. AXPAYER RESPONSE TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAI_TAX ASSESSMENT ~'~ ~` .~ A. The above information and tax due is correct. ~ ~ ' r- Remit payment to the Register of Wills with two copies of this notice to obtain,` / ~...~ ~~ a discount or avoid interest, or return this notice to the Register of Wills and `r`-~ an official assessment will be issued by the PA Department of Revenue. - -/ B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return filed by the estate representative. C. ~ The above information is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART ~ 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 PAD 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 - 5 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X 8. Tax Due 8 $ 8 PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I reported above are true, correct and comple~tle to the best of my knowledge and belief. HOME C ) ~~ ~ -~~~~~-.~ ~~~~ ~~. ,~~ W0 R K C ) ~G ,~. ,XPAYER GNATURE TELEPHONE NUMBER ATE TOTAL (Enter on Line 5 of Tax Computation) 5 ~~, PENNSYLVANIA INHERITANCE TAX r INFORMATION NOTICE FILE N0. 21'~,dr"I/~ BUREAU OF INDIVIDUAL TAXES Po Box zao6ol pennsylvap~~`va; ~ ' ~:~'~~ L^~ AND ACN 12153b 14 HARRISBURG PA 17128-0601 DEPARTMENT OFREVENDE,'r - ~ TAiX P`AY E R R E S P O N S E ~ a,~~ f C DATE 09-26-2012 REV-1543 EX AFP (OS Yl ~;) ~ !~ _,l..~J TYPE OF ACCOUNT j '~~~~~~~'F ~~ ~~,~ ~~ ~4E$T. OF SALLIE M WATTERS ^ SAVINGS ` DATE OF DEATH 09-14-2012 ^ TRUST ~~ ~ ~ ~' ~'~'~ ,•~;~-~. Q~f~ Nu~~ , ~ ;J~~iT ~ COUNTY CUMBERLAND CERTIF. X^ , . ~ .. CUMBFR~.A~v~') ~~~„ P~ REMIT PAYMENT AND FORMS T0: ELDA J BALMER REGISTER OF WILLS 517 HALDEMAN BLVD 1 COURTHOUSE SQUARE NEW CUMBERLND PA 17070-1235 CARLISLE PA 17013 FIRST KEYSTONE NATIONAL 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 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 de artment of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2. If you believe ~he 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. 0612250033 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due Date 03-23- 1995 Established $ 2,015.25 X 50.000 $ 1,007.63 X .045 $ 45.34 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 months of the decedent's date of death, deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent 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. r~. t 'J ~ ~~ \\~~ 1 '~~ @~ ~ ` Remit payment to the Register of Wills with two copies of this notice to obtain ` ~ a discount or avoid interest, or return this notice to the Register of Wills and C H E C K ~ ~ ~~,~1 i r~ w an official assessment will be issued by the PA Department of Revenue. ONE ~ BLOC K B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania inher itance tax return 0 N L Y filed by the estate representative. C. ^ The above information is incorrect and/or debts and deductions were paid. Complete PART Z^ and/or PART 3^ 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 PAD 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 - 5 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X 7 8. Tax Due 8 $ $ PART DEBTS AND DEDUCTIONS CLAIMED 0 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 ~ ! ~ ~ '~~ J 1 -~~ AXPAYER IGNATURE TELEPHONE NUMBER DATE TOTAL (Enter on Line 5 of Tax Computation) $ -• PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE N0. 21 I~(UX• BUREAU OF INDIVIDUAL TAXES ,~ "'~_,~ Po Box zso6ol en V~dt'Ila.;`_~;~~t~= ~ AND ACN 12153615 HARRISBURG PA 1~IZS-o6ol p ~' _r '~- ~~ TAXPAYER RESPONSE DEPART~N"~p~REYENUE ., ,~~ ~; . _ ~ ,., t ` DATE 09-26-2012 REV-1543 EX AfP COS-11) ~~~. `,J F. ~w. ~j~f l~~~ ~~ ~~~ 3: 54 Qhrf~~l `~~ ,; , , ,. ~t114~,q~~v~GJ/~~j;~ r ~,J, v 1 ELDA J BALMER 517 HALDEMAN BLVD NEW CUMBERLND PA 17070-1235 EST. OF SALLIE M WATTERS SSN 206-26-4617 DATE OF DEATH 09-14-2012 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. FIRST KEYSTONE NATIONAL 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 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 de artment of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2. If you believe ~he 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. 612250034 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART CHECK ONE BLOCK ONLY Date Established $ 03-04-1996 9,372.00 X 50.000 $ 4,686.00 X .045 $ 210.87 TAXPAYER RESPONSE =AILURE TO RESPOND WILL RE5U1_T IN AN OFFICIAL T11X ASSESSMENT n )~~ - A. The above information and tax due is correct. ~(/ , r1~ Remit payment to the Register of wills with two copies of this notice to obtain ~~ a discount or avoid interest, or return this notice to the Register of Wills and --- an official assessment will be issued by the PA Department of Revenue. B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return filed by the estate representative. C. ~ The above information is incorrect and/or debts and deductions were paid. Complete PART ~ and/or PART ~ below. ~. 1~~~~ i PART If indicating a different tax rate, please state OFFICIAL USE ONLY [~ AAF relationship to deceden t: PA DEPARTMENT OF REVENUE TAX RE TURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS pAll_ 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 - 5 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X 7 8. Tax Due 8 $ 8 PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I reported above are true, correct and est of my knowledge and belief. b complete to the HOME ('J/ ~ ~' ~f' -'~~ ~~~ ~ ~~ ~c~~-G~ '~.%fi W O R K ( ~ TAXPAYER IGNATURE TELEPHONE NUMBER ATE' 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 months of the decedent's date of death, deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent nine months after the date of death. TOTAL (Enter on Line 5 of Tax Computation) S BUREAU OF INDIVIDUAL TAXES PO BOX 28D601 HARRISBURG PA 17128-0601 -~~ PENNSYLVANIA INHERITANCE ~~~ INFORMATION NOTICE ~~~ns~ l~a,~ia; ,,_ ANn '~R,~EN~~:R~vpniii~"+ .~ ~)~= TAXPAY E R R E S P O N S E ~1'-1543~EX:AFP C05-11) ~. ~ i ~ ;_ i.~ ~'~'~ C~i~~ ~~ Pig ~: ~~ r l: 'J a l~ ~~~~ c~~~~~R~;c~ co., -Pa ELDA J BALMER 517 HALDEMAN BLVD NEW CUMBERLND PA 17070-1235 EST. OF SALLIE M WATTERS DATE OF DEATH 09-14-2012 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. FIRST KEYSTONE NATIONAL 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 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. 612250037 Date 11-27-2001 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 7, 965.70 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable )( 50.000 NOTE: If tax payments are made within three Amount Subject to Tax $` 3, 982.85 months of the decedent's date of death, Tax Rate )( .045 deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due $ 179.23 nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT ~ ~ ~ ~ r ~ j.,~ .~. A. The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain r+~~ v C H E C K a discount or avoid interest, or return this notice to the Register of Wills and ` an official assessment will be issued by the PA Department of Revenue. ONE 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 information is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3~ 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 PAI3- 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 - 5 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X 7 8. Tax Due 8 $ $ PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I reported above are true, correct and com lete to the b st of my knowledge and belief. HOME C' /~~ ~ r~~ ~~`)~i~mJ '~~ ~ 1~/'~~~~ WORK ( ) ~ ~~ ,~:~ TAXPAYER S GNATURE TELEPHONE NUMBER AT TAX ~ FILE N0. 21 ' I °` f 'T'~ ACN 12153616 DATE 09-26-2012 TOTAL CEnter on Line 5 of Tax Computation) $ w n`. o Q C] N O~- F- C: -- CD VI a.o• ~ ~.i /M Of~_JI~ •Z ~N ~~-+Q'OQ'O t!7 <=uJf~NO ~•o (n~~y~F-Q ~o _] U O U O uJ ~_ ~~ M ~~~ o ~~~ h V `i ~ a o ~a o h ~ O W e ..-. zlh ~a .,~'. t~ U"~ ~ ~ ~~ ~ ~ Q C.3 .. ~- t;.i_. "~ U ~.. t,.~. t ~.~ CL ' ~ ~ CQi ~` t ~ t..~ _ ~ ~ ~ ~ ` ~. r C'~.~1 y~ ~'~ d ~~ D C~ .~. "J r_ ~~ ~ ~ v~ -~C v ~ ~ ~ ~~ ~ .~ ~~~ r