HomeMy WebLinkAbout06-04-08
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF IINDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG, PA 11128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO.21 b<b OloO<l
08124063
05-27-2008
REV-1543 EX AFP (09.00) I
EST. OF EVA M DOUGHERTY
S.S. NO. 200-28-4365
DATE OF DEATH 05-12-2008
COUNTY CUMBERLAND
TYPE OF ACCOUNT
[i] SAVINGS
o CHECKING
o TRUST
o CERTIF.
REMIT PAYMENT AND F~S TO:
REGISTER OF('fJILLS c::::>>_,"
CUMBERLAND GC:>OURT@USEr'.C."
CARLISLE, P~;W013 ~ f"'~
I ii;f. 2 :.::1
~Zm ' '-~.;
;;;.. -::P .. . .
~Z(j)/, (~'""'l f~
GOl') -0 ,..' ~ll
OQ 1'l ::it :.....: .-,
MEMBERS 1ST FCU has provided the Department with the information listed below which ~Wn used ~ ;C.,''' ~'T1
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a ~oi~ owner/boli;l1ficiafiFloji--)
this account. If you feel this information is incorrect, please obtain written correction from the financial i!!pitution, at(::fh a COpy",.,
to this fori. and return it to the above address. This account is taxable in accordance with the Inheritance T~Laws of the~mmonwealth~'
of Pennsylvania. Questions may be answered by calling (111) 181-8321.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
**
SHARON E DELANEY
45i11 JACK ROAD
CHAMBERSBURG
PA 17202
Account No. 313430-00
Date
Established
09-07-2007
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".
x
.00
100.00
.00
.12
.00
TAXPAYER RESPONSE
NOTE: If tax payments are made within three
(3) months of the decedent's date of death.
you may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
potential Tax Due
x
PART
[!]
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 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
8. 0 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. 0 The above information is incorrect and/or debts and deductions were paid bY you.
You must complete PART ~ and/or PART ~ below.
x
PART
[!1
TAX
If you indicate a different tax rate, please state your
relationship to decedent:
RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established 1
2. Account Balance 2
3. Percent Taxable 3
4. Amount Subject to Tax 4
5. Debts and Deductions 5
6. Amount Taxable 6
1. Tax Rate 7
8. Tax Due 8
x
DEBTS AND DEDUCTIONS CLAIMED
PART
@]
DATE PAID
g=\
PAYEE
DESCR I PTI ON
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
$
Under penalties of perjury, I declare that the facts I
complete to the best of my knowledge and belief.
~~~ t .~~
have reported above are true, correct
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