HomeMy WebLinkAbout10-07-08COMMONWEALTH OF PENNSYLVANIA I N F O R M A AND N O T I C E
DEPARTMENT OF REVENUE •
BUREAU OF INDIVIDUAL TAXES ,_;._~AXF AY E R RESPONSE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-154 EX. AFP (09-0021 ~` " '
FILE N0. 21-~~- ~~
ACN 08133801
DATE 07-24-2008
'~~~~'_+~? ~t1•~ --J N'i I I • ~ (EST. OF JOSEPH G SEMANCIK
S.S. N0. 188-38-9627
- -- DATE OF DEATH o7-12-2008
(,'.l
~~ ~Jr ? !f`? COUNTY CUMBERLAND
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
r~~~ '~'~ REMIT PAYMENT AND FORMS T0:
- - REGISTER OF WILL'S
LINDA K SEMANCIK CUMBERLAND CO COURT HOUSE
100 TOUCHSTONE DRPA 17015 CARLISLE, PA 17013
CARLISLE
HARLEYSVILLE NB 8, TC 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 ioint 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 form 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 answered by calling 1717) 7B7-8327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 20013005 Date 03-04-1992 To insure proper credit to your account, two
(2) copies of this notice rtiust accompany your
Established payment to the Register of Wills. Make check
Account Balance 2,753.95 payable to: "Register of Wills, Agent".
X 1 6. 6 6 7 NOTE: If tax payments are made within three
Percent Taxable
Amount Subject to TaX 459.00 (3) months of the decedent's date of death,
. 1 5 You may deduct a 5% discounnt of the tax due.
Tax Rate X Any inheritance tax due will become delinquent
6 $ , $ 5 nine C9) months after the date of death.
Potential Tax Due
TAXPAYER RESPONSE
T `
CHECK
ONE
[ BLOCK
ONLY
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 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.
g• ~ The above asset has been or will be reported and tax Daid 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.
~•~~~ p~se state your
PART If you indicate a different to to )
relationship to decedent: -~ -
TAX RETURN - COMPUTATION OF TAX~~4J0~~TRUST ACCOUNTS
LINE 1. Date Established 1 ~ ll~ LL~..~..~~~ U.~
2. Account Balance 2
3. Percent Taxable 3 r ' ~~y-~
4. Amount SubJect to Tax 4 `-i ` lJ(l
~~--
5. Debts and Deductions 5 - l;
6. Amount Taxable 6 'T O ~~--
7. Tax Rate T X ~ ,~-~O
8. Tax Due 8 LLB
PART
DATE PAID PAYEE
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
s
TOTAL CEnter on Line 5 of Tax Computation)
Under penalties of per]ury, I declare that the facts I have repor-t7ed abov/e-yare trueQ correct and
co lete to the best of my knowledge and belief. HOME C~ /~ ) ` O ~ v ~ ~~`
Q~ WORK C ~ 1...
TELEPHONE NUMBER D TE
TAX AYER SIGNATU E