HomeMy WebLinkAbout10-15-07
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0'01
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REV-1S43 EX AFP (09-QU)
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
* REVISED NOTICE * * *
FILE NO. 21 07 - 0305
ACN 07120180
DATE 10-11-2007
Z0010CT 15 AH 9= 35
TYPE OF ACCOUNT
IiJ SAVINGS
o CHECKING
D TRUST
o CERTIF.
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EST. OF GLENROY G HELLER
5.5. NO. 202-03-0029
DATE OF DEATH 03-19-2007
COUNTY CUMBERLAND
ROGER G HELLER
685 N MIDDLESEX RD
CARLISLE PA 17015
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PNC BANK has provided the DepartMent with the inforMation listed 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 inforMation is incorrect, please obtain written correction fru. 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 COMMonwealth
of Pennsylvania. Questions May be answ.~.d by callihY (717) 787-8327.
COMPLETE PART 1 BELOW
Account No. 5140185652
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
PART
[!]
. .
. SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Da te 02- 07 - 2000
Establ1shed
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: "Registe~ of Wills, Agent".
x
13,401.75
50.000
6,700.88
.045
301.54
TAXPAYER RESPONSE
NOTE: If tax paYMents are Made within three
(!) Months of the decedent's date of death,
YOU May deduct a SX discount of the tax due.
Any inheritance tax due will beCOMe delinquent
nine (9) Months after the date of death.
x
[CHECK ]
ONE
BLOCK
ONLY
A. 0 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 retu~n this notice to the Register of
Wills and an official assessMent will be issued by the PA DepartMent of Revenue.
B. c=J The above asset has been or will be ~eported and tax paid with the PennSYlvania Inhe~itance Tax return
to be filed by the decedent's representative.
C. c=J The above inforMation is incorrect and/or debts and deductions were paid by you.
You Must cOllplete PART 0 and/or PART ~ below.
1
2
3 X
4
5
6
7 X
8
If you indicate a different tax rate, please state your
relationShip to decedent:
PART
@]
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE l. 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
[!]
DATE PAID PAYEE
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Computation)
.
Under penalties of perjury, I declare that the
complete to A best' Oflr~ knowledge and belief.
1Z~. rl~
'TAXPA ER SIGNATURE
facts I have reported above are true, correct and
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