HomeMy WebLinkAbout10-07-08 (2)COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES __ FILE NO. 21~-U~ ~~-~-<~
DEPT. zaocol `-`, `tAXPAYER~aESPONSE ACN 08133799
HARRISBURG, PA 17128-0601
- ~ DATE 07-24-2008
REV-1543 EX AFP (09-00) ~' ~" -
TYPE OF ACCOUNT
~ :.~ ~ ,J ~l , f _
~£S~'`. ~F JbSEPH G SEMANCIK ^ savlNCs
_ S.S. N0. 188-38-9627 ®CHECKING
~~ -"- ,~A1'£ OF DEATH 07-12-2008 ^ TRUST
1~ ~~`~ COUN, CUMBERLAND ^ CERTIF.
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~~ REMIT PAYMENT AND FORMS T0:
LINDA K SEMANCIK REGISTER OF WILLS
100 TOUCHSTONE DR CUMBERLAND CO COURT HOUSE
CARLISLE PA 17015 CARLISLE, PA 17013
HARLEYSVILLE NB $ 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 point 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. puestions may be answered by calling (717) 787-8327.
COMPLETE PART I BELOW * ~ * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 2399 Date 11-29-1991
To insure proper credit to your account, two
Established (2> copies of this notice must accompany your
Account Balance 21 Payment to the Register of Wills. Make check
8, 127
.
payable to: "Register of Wills, Agent".
Percent Taxable X 16.667
Amount Subject to NOTE: If tax payments are made within three
Tax 1 , 354
56
.
(3) months of the decedent's date of death,
Tax Rate X , 15 You may deduct a 5% discount of the tax due.
Potential Tax Due Any inheritance tax due will become delinquent
203
18
.
nine (9) months after the date of death.
PARr TAXPAYER RESPONSE
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......................................:..................................................:.......:..:.::::::::::.:.:.:................................................................................................_::,fi~:::i~.~~.R.S'~N.~N'1',:_,HJ~~:EI~::::#IN:::::T::. ,.:.,. , .............
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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
CHECK a discount or avoid interest, or you may check box "A" and return this notice to the Register of
0 N E
~ Wills and an official assessment will be issued by the PA Department of Revenue.
B L 0 C K
B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
0 N L Y to be filed by the decedent's representative.
C. ~ The above information is incorrect and/or debts and deductions were
aid b
p
y you.
You must complete PART 2^ and/or PART 3^ below.
PART I f o u indicate a €:;:s:s:;ss::~ ::~ s:s::::e~=:::;s:;-= : :::::::::::::::::::::::::::::::::::::::::::::::::::::::: :::::::::::::::::::::::::::- ....,.,.,.,.,.,.,.,.,.,.,
Y different tax r te, p a e state your :.:.: ;:;..,;~ .:.....:::::.:::::::::
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.... ......+~AY~~:
relationship to decedent:
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TAX R E
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O M P U TAT I O N
O F TAX
ON .JOINT/TRUST ACCOUNTS .
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INE
I.
Late Established
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2.
Acco
unt Ba
lance
2
2
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3. Percent
Taxable
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4. Amo
unt S
ub-ect to Ta
x
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sii~i ~;~~ ~ ~ i=iii i~_'-?~ sii€i~i€ss~i~ i':~ i i€si~;i~s:"s ~;i;i i€i€
5. Debts and Deductions 5 - °`
6. Amount Taxable 6__ IT ~~_ ~
7. Ta
x Rate
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8. Tax Due B
--
PART DEBTS AND DEDUCTIONS CLAIMED
3^
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I have reported above `a^^~~re true,~-ycorrect and
complete to t~hje best)~of my knowledge and belief. HOME C ) (,J~ ~- ~ (~~
~(~Cy~ !'1 . ~~ G~i/1 ~'~ WORK C ) e~~ ~~~
~XPAYER SIGNATURE TELEPHONE NUMBER DAT 1~1~f„
IUTAL itnLer on Line 5 of Tax Computation) $