HomeMy WebLinkAbout07-16-07
COMMDI61/EAL TH OF PENNSYLVANIA _
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES """'('./i
DEPT. 280&01 '~!I:I,' {~nr: (\
HARRISBURG, PA 17128-01501_,;_~"'A_O uF 1.1 .
(t:.~f ;("F:.,:-~ ('\ . , "L...
, - ,,, '..J ; L 1 ,;I ~il~4S:EX AFP 109- 0Dl
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 07 -l1.16
07127698
06-20-2007
20U7 JUL 16 PH 2: 06
CLERK OF
~~~J~'S COUFn
CUt,,/ ,.., "', /r' (,,....
. ".,'..' . Ii p~
GREG L SERVIS - .,' ,h
808 FISHING CREEK RD
NEW CUMBERLAND PA 17070
EST. OF JULIA M SERVIS
5.5. NO. 159-26-2434
DATE OF DEAtH 02-18-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAYINGS
Iil CHECKING
D TRUST
D CERTIF.
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
COMMERCE BANK has provided the Depart.ent with the inforntion li!!tad below which has 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 this fo,.. and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co..onwealth
of Pennsylvania. Question..~ be answered ~ calling (717) 787-8!27.
COMPLETE PART 1 BELOW
Account No. 32083222
Date
Established
05-16-1998
. SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
. .
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
982.39
50.000
491.20
.15
73.68
TAXPAYER RESPONSE
x
x
PART
[!]
To insure proper credit to your account, two
(2) copies of this notice .ust acc~pany your
pay.ent to the Register of Wills. Make check
payable to. "Register of Wills, Agent".
NOTE. If tax pay.ents are .ade within three
(3) .onths of the decedent's date of death,
you .ay deduct a 5X discount of the tax due.
Any inheritance tax due will bec._e delinquent
nine (9) .onths after the date of death.
A. 0 fe above infor.ation and tax due is correct.
. 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.
[CHECK ]
ONE
BLOCK
ONLY
B. D 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. C8l The above info,..ation is incorrect and/or debts and deductions were paid by you.
You .ust co.plete PART ~ and/or PART ~ below.
PART
[!]
TAX RETURN - COMPUTATION
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
If you indicate a different tax rate, please state your
relationship to decedent:
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3
4
5
6
7
8
x
x
PART
[!]
DATE PAID
;:2 -~.. 01
AMOUNT PAID
DESCRIPTION
A.PPITlOtV"tL- FVrJfflAL
PAYEE
I :r. 1\ II ~ '" If""f, n
~~:~':'; L I
TOTAL (Enter on Line
Under penalties of perjury, I declare that the facts I
complete to the best of my knOWledge and belief.
~ ..,; Yt~~:~..d..L---
T~~~R SIGNATURE
f Xt"E iV,SU
5 of Tax Computation)
.
have reported above are true, correct
HOME ( 7' 7 ) 93 8' - 0 ~ 0 if
WORK ( )
TELEPHONE NUMBER
and
7-1~-()7 ..\L_
DATE d,lY""l