HomeMy WebLinkAbout07-11-07 (3)
COMMONWEAL TH OF PENNSYLVANIA _
DEPART"ENT OF REVENUE
BUREAU OF INDIVIDUAL. . ~ _
DEPT. 280m r~t)qf'lEi , (\r::\.I('\= i .
HARRISBURG PA 1712B-'~t I ,r.- _'..l v l II.- _ '~,
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INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 07-0371
07123145
05-31-2007
CLERK OF
ORPHAN'S COURT
C' '/ ,V)--,.." ,',', "', r-,,--, n,\
l)I\'i-',>:-.-"i . \,i ',~~I\"Il rJ;
EST. OF ETHEL PETERSON
5.5. NO. 554-32-9206
DATE OF DEATH 04-14-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
[i] CHECKING
o TRUST
o CERTIF.
2001 JUL II AM II: 59
KAREN MARCH
1520 SELTZER CT
MECHANICSBURG PA 17050
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MEMBERS 1ST FCU hes provided the Depart.ent with the infoNlation lishd below which hes been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent. you Were a joint owner/beneficiary of
this account. If YOU feel this infor.ation is incorrect. please obtain written correction fro. the financial institution. attach a COpy
to thisfoNl and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co..oftWealth
of Pennsylvania. Questions.ay be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW. . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 290021-11 Date 07-31-2006
Established
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
x
30,443.69
50.000
15,221. 85
.045
684.98
TAXPAYER RESPONSE
To insure proper credit to your account. two
(2) copies of this notice .ust acco.panY your
pay.ent to the Register of Wills. "ake check
payable to I "Register of Wills. Agent".
x
NOTE: If tax pay.ents are .ade within three
(3) .onths of the decedent's date of death.
you aay deduct a 5X discount of the tax due.
Any inheritance tax due will becoae delinquent
nine (9) aonths after the date of death.
PART
[!]
[CHECK ]
ONE
BLOCK
ONLY
A. 0 The above infoNlation and tax due is correct.
1. You.ay choose to re.it pay.ent to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest. or you .ay check box "A" and return this notice to the Register of
Wills and an official assess.ent will be issued by the PA Depart.ent 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. D The above infor.ation is incorrect and/or debts and deductions were paid by you.
You .ust co.plete PART ~ and/or PART [!] below.
PART
I!I
TAX RETURN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
IS. Amount Taxable
7. Tax Rate
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3
4
5
6
7
8
x
If you indicate a different tax rate, please state your
relationship to decedent:
x
PART
[!]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
TOTAL <Enter on Line 5 of Tax Computation>
.
Under penalties of
J.<Tl!!!'pleJ:,~t9 the bJJst of
~rGt't' O{ c;. fA6I j. ((lft'f
facts I
have reported above are ~rl~' correct
HOME ( 7/ 7 ) ~A. "t"fl/~-
WORK ( )
TELEPHONE NUMBER
and
TAXPAYER SIGNATURE
7 J} .0 7
DATE
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