HomeMy WebLinkAbout01-0195
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
hARRISBURG, PA 17128-0601
'*
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21-01- /qQ~
00500212
08-09-2000
REY-1545A AFP 17-99>
: i
U
EST. OF EUGENIA KAPRO
S.S. NO. 086-22-4147
DATE OF DEATH 05-24-2000
COUN~Y CUMBERLAND
TYPE OF ACCOUNT
o SECURITY
[X] SEC ACCT
o STOCK
o BONDS
l..
JOANNE E SHENKEL \ .d
143 OAK FLAT ROAD L\'
NEWVILLE PA 17241
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
AG ESWARDS & SONS has provided the Depert.ent with the infor.ation listed below which has been used in
calculating the potentiel tax due. Their records indicate that at the death of the above decedent, you were a beneficiary of this asset.
If you feel this infor.ation is incorrect, please obtain written correction fro. the transfer agent, attach a COpy to this for. and
return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co..onwealth of Pennsylvania.
Qua$tio~3 aa~ be answ&.ed by calling (717) 737~3327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 684019643
x
29,849.06
100.00
29,849.06
.15
4,477 .36
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. Make check
payable to: "Register of Wills, Agent".
DOD Valuation
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
NOTE: If tax pay.ents are .ade within three
(3) .onths of the decedent.s date of death,
you .ay deduct a 57. discount of the tax due.
Any inheritance tax due will beco.e delinquent
nine (9) .onths after the date of death.
Tax
PART
ill
The above infor.ation 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.
[CHECK ]
ONE
BLOCK
ONLY
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 infor.ation is incorrect and/or debts and deductions were paid by you.
You .ust co.plete PART ~ and/or PART ~ below.
x
If you indicate a different tax rate, please state your
relationship to decedent:
PART
~
TAX RETURN - COMPUTAT!~N
LINE 1. DOD Valuation
2. Percent Taxable
3. Amount Subject to Tax
4. Debts and Deductions
5. Amount Taxable
6,. Tax Rate
7.. Tax Due
TAX ON ABOVE ASSETCS)
OF
1
2
3
4
.5
6
7
x
PART
l!]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line .5 of Tax Computation)
$
Under penalties of perju~y, I declare that the
complete to the best of. my~wl~ a belief.
I ;;: .,'"., ./., .
.//t"-'~ ~.. //L.-. . ~
facts I have reported above are true, correct and
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DECEDENT
tNfOMIAnoN
CORPORATION,
fIINANCW..
INS11TUTION
OR
BROKER
INFORMATION
ACCOUNT
INfORMATION
IlTTAtH IIfYIHTORY
Of' IIC\lIlITT
aCeOuIiIT LlSllNG au.
....,. AflO 01.1'1 Of'
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BENEFICIARY
_ORMATION
REQUEST FOR WAIVER
0"
NOTICE OF TRANSFER
(FOR STOCKS, BONDS. SECUAmES OR
SECURITY ACCOUNTS Hl;LO IN IlENEFlCfARY FORM)
IF YOU Aftl PIEOU9TlNG A W~
PLEASE CHECK THIS BLOCK ~
(~'~ST)
<.. R. 0 Fu ~tJlA
SOCIAl SECURITY NUMBER OF DECEDEIIIT DATE OF DEATH OF DECeDENT (MM-OO'YYYYI
~~~m~~ru~~ ~0rnffi~~~~
ADDRESS OF OEceOENT CITY STATE ZIP coo~ COUNTY
Olt"- lA-1 &€'b kJ~Wll" I f.. A I f ~4- eJAI1~ll.lANtJ
NAME OF CORPORATI N, ANANCIAL INSTITUTION, BROK A OR SIMILAR ENTITY
t tS {. Q l!- J~ ~Sf rl16,N 1'5
ADO E Of A M ST"TE ZIP CODe
tta.-f 00 1> ~ut P ~ R.l> l~ A1U{ sPA , 111 0
TeLEPHONE NUMBER
[1J - [Zl (3] 00. []] ~ [iJ ~
CAPITAL STOCK
SUI 1[
lOQ
EXTENSION ( IF ANY )
.no
o
REGISTEREO BONO
A SECURITY ASSET
ACCRUED INTEREST UNTIL DATE OF DEA1"I-t) IOENTIFYING NUMBER OF ASSFT
2- ~ c!)~ DBEJ~-
ACCOUNT TITLE AS IT APP:Eu GE~ASECUkA-~;,~ACCOUNT, DD~Do~EDDob
NAME. (Last) (FIrl.t)
5 E,L TO~tJ AJ t
(Middle Inlllel)
E.
0fIPII0AL ...-...
ADDRESS
_.J:;.~Jr"~'
lA-\" Q.b
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RELATIONSHIP TO O€CEDENT
C IfRL(f-\KE(c. t oL
~RY NAME (Last)
INFORMATION
TAX ....
STATE
ZIP CODE
CJOIt1C'W. ,..."
ADDRESS
CITY
STATE
ZIP CODE
TAX RAft
RElATIONSHIP TO DECEDENT
(MlOOle Initial)
6ENEFICIARY'S SOCIAL SECURITY NUMBER
ODD-DO-DODD
8~~FtClAftY NAME (L.a~tl
INFOfIIIAOON
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" DAYTIME TELEPHONE NuM8EA
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