HomeMy WebLinkAbout03-09-09 (4)PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE //~~ ^'~
BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 U~~ Od~~
PD Box 280601 TAXPAYER RESPONSE ACN 09108141
HARRISBURG PA 17128-0601
REV-1543 EX AFP (OB-0e) DATE 02-12-2009
TYPE OF ACCOUNT
EST. OF L C FURRY ^ SAVINGS
S$N 205-30-6310 ® CHECKING
DATE OF DEATH 01-21-2009 ^ TRUST
COUNTY CUMBERLAND ~ ^ CF~TIF.
REMIT PAYMENT AND FORMS T0: '~~~ "°' ~'t
_.J _ -
LEWIS C FURRY REGISTER OF WILLS ti= "~' -'
110 WATSON LANE CUMBERLAND CO COURT HOUSE,? '~ `._~ ~ '~
NEW BLOOMFIELD PA 17068 CARLISLE, PA 17013 '~'~ ~ ~``'
-. ='~
- ; ~ -, .~
MEMBERS 1ST FCU provided the Department with the information below, which has been uYe'd in calcul~'ng the '~~i
potential tax due. Records indicate that at the death of the above-named decedent, you were a .ioint owner/beneficiary of t'IV'3's 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
Fannsvlvania. P'__a~a call !7'-?) 787-832? with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 250943-11 Date 09-13 -2004 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance
$ 5, 512.
15 payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 16. 667
NOTE: If tax payments are made within three
Amount Subject to Tax $ 918.71 months of the decedent's date of death,
Tax Rate ~( .045 deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax Due $ 41 .34 nine months after the date of death.
PART TAXPAYER RESPONSE
~ FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT
A. ^ The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
CHECK a discount or avoid interest, or 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.
ONE
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 estate representative.
C. ^ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART ~ below.
PART If indicating a different tax rate, please state ~ OFFICIAL USE ONLY
^ AAF
relationship to decedent: PA DEPARTMENT OF REVENUE
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD
LIME 1. Date Establis~ed 1
2. Account Balance 2 $ 2
3. Percent Taxable 3 X 3
4. Amount Subject to Tax 4 +~ [~
5. Debts and Deductions 5 ,/y% 5
6. Amount Taxable 6 $ (>
7. Tax Rate 7 X 7
8. Tax Due 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 above are true, correct and
complete to the best of my knowledge and belief. HOME C"7 1 ~i ~ ~ ~'1 -'~{/ ~ 7
rnv~v= ro crr_~.in~o~ WORKroun~r,u,u ~o ~ ~ ~~/9 ~. Y-~~ ~~
TOTAL CEnter on Line 5 of Tax Computation) S