HomeMy WebLinkAbout10-07-08 (2)COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE LN F O R M AT I O N N O T I C E
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601 AN D
HARRISBURG, PA nlza-o6Bl TAX P AY E R R E S P O N S E
REV-1543 E% AFP (09-00)
FILE N0. 21 ' ~~~- ~U">°
ACN 08140088
DATE 09-04-2008
.. ..
~~- TYPE OF
EST. OF ANNE SAMPSON
,.
• ~ S.S. N0.
~rr~, ~ ~O~•.~TE OF DEATH 02-27-2008
- ''~`~'~% L~O~JNTY CUMBERLAND
ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
REMIT PAYMENT AND FORMS TD:
JOYCE A GREGOR REGISTER OF WILLS
1912 FISHER RD CUMBERLAND CO COURT HOUSE
MECHANICSBURG PA 17055 CARLISLE, PA 17013
FULTON BANK ~~
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 form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. :ucstions may he answered by calling C717) 787-8327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PwYMENT INSTRUCTIONS
Account No. 0101-02698 Date 02-27-2001 To insure proper credit to your account, two
Established (2) copies of this notice must accompany your
Account Balance 19,451.14 payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax 9,725.57 (3) months of the decedent's date of death,
TeX Rate X lj You may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
Potential Tax Due 1,458.84 nine C9) months after the date of death.
P~T TAXPAYER RESPONSE
1
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT BASED aH THIS NOTICE
A. ~ The above information and tax due is correct.
1. You nay choose to 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, 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.
S 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 paid by you.
You must complete PART ~ and/or PART ~ below.
PART It you lntlicate a different tax rate, please state your
relationship to decedent:
TAX RETURN - COMPUTATION
LINE 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 ACCOUNTS
1
2
3 X
4
5
6
7 X
8
PAD
OFFICIAL U5E ONLY Q AAF
PA DEPARTMENT OF REVENUE
i
2
3
4
5
b
7
8
PART DEBTS AND DEDUCTIONS CLAIMED
3^
DATE PAID PAYEE DESCRIPTION AMOUNT Parn
_ ~ h ~( r RI
CdC FG o P C A1'-v~
S W
rr wn une ~ or IaX GOmpULatlOn) $ ~!~[ttj' ~,~
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
(/c~mple{.t~e to the best of my knowledge and belief. HOME C ~/7 )~~_f ~ ~ Z ~
i °`'!'P t'Y - .~~~~' n ~ WORK ( ) ~1I
R
fEL
R
DATE