HomeMy WebLinkAbout01-31-08
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG. PA 1712B-0601
*-
INFORMATION NOTICE
y ".-, AND
~AXPAYER RESPONSE
FILE
ACN
DATE
NO. 21-0~-/l5
08100975
01-03-2008
REV-1S43 EX~-P,_ '09'.OD)
TYPE OF
ACCOUNT
o SAVINGS
[i] CHECKING
o TRUST
o CERTIF.
Z008 JAN 3 I
.., 12:ElST. OF C E BRYTZ
S.S. NO. 186-28-1319
CLERK OF DATE OF DEATH 11-05-2007
ORPHAt,J'S COURTCOUNTY CUMBERLAND
CUI"H-G! ('J' ,r~() PA,
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MARY L ZINN
1290 S MTN RD
DILLSBURG
PA 17019
PSECU 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 from the financial institution, attach a copy
to this fO!"DI and .ctu;-n i~ to th~ O1bCi.va :;,ddres"4 This account l50 tCli<alJl" in accordant.d wilh lh~ Inhei itance Tax Laws of tile COllmom.;ealth
of Pennsylvania. Questions may be answered by calling (717) 787-B327.
COMPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0200168925
Date 10-15-1974
Established
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
7,496.71
X 8.333
624.70
X .045
28.11
TAXPAYER RESPONSE
NOTE: If tax payments are made within three
(3) months of the decedent's date of death,
you may deduct a 5Y. discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
PART
[!]
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 lIay check box "An and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department 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 information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
If yoU indicate a different tax rate, please state your
relationship to decedent:
PART
~
TAX
LINE
PART
[!]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
RETURN - COMPUTATION
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
OF TAX ON JOINT/TRUST ^CC~UnTS
1
2
3 X
4
5
6
7 X
8
TOTAL (Enter on Line 5 of Tax Computation)
$
i..J "3 q r.;,/JO
Under penalties of perjury, I declare that the facts
complete to the best of m~knowledge and belief.
have reported above are true, correct and
HOME (717 ) L/ 0;). - 341 K'
WORK (71 ) to;1.- NOd-.. Ct /1
TELEPHONE NUMBER
q