HomeMy WebLinkAbout07-09-07 (5)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
*'
FILE
ACN
DATE
NO. 21 b\ OtD'\3
07121704
06-20-2007
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
REV~lS43 EX AFP (09-00>
TYPE OF ACCOUNT
EST. OF FLORENCE S MONTIJO 0 SAVINGS
S.S. NO. 183-16-9805 0 CHECKING
DATE OF DEATH 05-03-2007 0 TRUST
COUNTY CUMBERLAND [i] CERTIF.
REMIT P~NT AND ~MS TO:
REGISTER 0 LLS ~ _d
CUMBERLAND ~ OURTc:.I:IOUSE\,
CARLISLE, P~;E~013? ~:,-:
:_,J J>'- ----
.-- Z ~ I r~'_'i
_",::0 \.0 ';J
,_V-'A
..--.... {-'~
.-=' \. J 0 -0 i "-1
~ -) t2 ,1 :J: ,_' , ~:~.,'
PSECU has pl'ovided the Departllent with the information listed below which"haDbeen usoi'C)in ,:::' :'c;__~
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were-'l!J5"oint ownerTbenefiFia'1l'..Qf
this account. If you feel this information is incorrect, please obtain written correction from the financia~nstitution~tach a cOpy
to this fo... and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of ~ Commonwe~ith
of Pennsylvania. Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
LINDA C BEATY
205 W MAIN ST
SHIREMANSTOWN
PA 17011
Account No. 0183169805
Date
Established
09-22-1999
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to. "Register of Wills. Agent".
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
x
28,410.96
50.000
NOTE: If tax payments are made within three
14 , 205 . 48 (3) months of the decedent's date of deeth.
.045 you may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
639. 25-~ 1u -"67.J1nine (9) months after the date of deeth.
x
PART
[!]
TAXPAYER RESPONSE
[CHECK ]
ONE
BLOCK
ONLY
A. ~ The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest. or you may check box "A" and 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
to be filed by the decedent's representative.
C. [] The above information is incorrect andlor debts and deductions were paid by you.
You must complete PART ~ andlor PART ~ below.
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3 X
4
5
6
7 X
8
PART
[!]
TAX RETURN - COMPUTATION
If you indicate a different tax rate. please state your
relationship to decedent:
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
PART
[!J
DATE PAID PAYEE
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
.
TOTAL (Enter on Line 5 of Tax Computation)
perjury, I declare that the facts I
knowledge and belief.
have rep~ed above a~ue, correct and
17 -}, 7-<'7 7~
HOME ( ),. - -
w~~~ "'D~n"'''' "'~'''D'''D ......,.. l'rJ