HomeMy WebLinkAbout10-06-08B~ U OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
REV-1543 EX AFP COB-09Y
PENNSYLVANIA INHERITANCE
INFORMATION NOTICE
AND
TAXPAYrER RESPONSE
I
TAX
FILE INO. 21- v~`U ~~~
ACN 08144820
DATE 09-29-2008
TYPE OF
~`~~~ I~,~ -p S.' ~ `i; i;~~ST. OF JACQUELIN L CARBAUGH
SSN 191-62-0017
ANNA M BINLAW
112 SHIPPENSBURG MBL
SHIPPENSBURG PA 17257
DATE OF DEATH 09-24-2007
C~F,,1~, ,, ,,-,.~. COUNTY CUMBERLAND
~'~'~ REMIT PAYMENT AND FORMS T0:
/~~.tr ~ A c,,,r '.. ~. ,
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
ORRSTOWN BANK Provided the Department with the information below, which has been used in calculating the
potential tax due. Records indicate that at the death of the above-named decedent, You were a Joint owner/benefic:iary of this account.
If you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form
and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of
Pennsylvania. Please call (717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 103006912 Date 01-26-2007 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance • 00 payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 100.00
NOTE: If tax payments are made within three
Amount Subject to Tax $ 00 months of the decedent's date of death,
TaX Rate ~( • 15 deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax Due $ • 00 nine months after the date of death.
PART TAXPAYER RESPONSE
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX A55E55MENT'
A. ® The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
C H E C K a discount or avoid interest, ar 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.
C ONE
B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsvlvania Inheritance Tax return
0 N L Y to be filed by the estate representative.
C. ~ The above informs
Complete PART 2~ ion is incorrect and/or
and/or PART ~ below. debts and deductions were paid.
If indicating a different tax rate, please state OFFICIAL U5E ONLY ~ AAF
., ..relationship to decedent:
PA
DEPARTMENT OF REVENUE
~r FN~~!- - COMPUTATION OF TAX ON JOINT!TRUST ACCOUNTS °An _ ~ _ .~_~_- _.___._
. Date Established 1 1
2. Account Balance 2 $ 2
3. Percent Taxable 3 X 3
4. Amount Subject to Tax 4 $ 4
5. Debts and Deductions 5 5
6. Amount Taxable 6 $ 6
7. Tax Rate 7 X 7
8. Tax Due 8 $ 8
PART DEBTS AND DEDUCTIONS CLAIMED
3^
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I have reported ab~'o7ve are true, correct and
complete to the best of my knowledge and belief. HOME C /~ ~) ~ 3 c~ - ~ ~ y
~o.nn o / / 1 w ,~
~XPAYER SIGNAT RE TELEPHONE NUMBER DATE
TOTAL CEnter on Line 5 of Tax Computation) ;i
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