HomeMy WebLinkAbout03-09-09 (5)PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AND FILE NO. 21 ~~~ o2..Z~
Po sox zaocol TAXPAYER RESPONSE ACN 09108142
HARRISBURG PA 17128-0601 DATE 02-12-2009
REV-1543 EX 11FP (88-887
TYPE OF ACCOUNT
EST. OF L C FURRY ® SAVINGS
SSN 205-30-6310 ~ CHECKING
DATE OF DEATH 01-21-2009 ~ TRUST
COUNTY CUMBERLAND ~ CERTIF.
REMIT PAYMENT AND FORMS T0:
LEONA FURRY REGISTER OF WILLS
1925 CHATHAM DRIVE CUMBERLAND CO COURT HOI~
CAMP HILL PA 17011 CARLISLE, PA 17013 ~_~ ..a -'-
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MEMBERS 1ST FCU provided the Department with the information below, which has been use(F i?r.G~lcula~rlg the-.- ~'.~':~
potential tax due. Records indicate that at the death of the above-named decedent, you were a ioint owner/bene# arl~ of Y1j~ account ..~_i
If you feel the information is incorrect, please obtain written correction from the financial institution, attar copy t~is form L•.
and return it to the above address. This account is tau able in accordance with the Inheritance Tax laws of th~EeAmonwealYb;of -
Pennsyivania. Please call (7171 787-8327 with questions. ~~ (,.,) `"~'
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS --
Account No. 250 943-05 Date 01-20-2006 To ensure vroper credit to the account, two
Established copies of this notice must accompany
payment to the Register of Wills. Make check
AcCOUnt Balance $ 2 , 871 58 payable to "Register of Wills, Agent".
Percent Taxable X 16.667
NOTE: If tax payments are made within three
Amount SUbjeCt t0 TaX $ 478 • 61 months of the decedent's date of death,
Tax Rate ~( , 00 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 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
a discount or avoid interest, or check box "A" and return this notice to the Register of
C H E C K 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 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
relationship to decedent:
TAX RETURN - COMPUTATION
LIME 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 ~(AAF
PA DEPARTMENT OF REVENUE
2
3
4
6
7
8
PART DEBTS AND DEDUCTIONS CLAIMED
nw,-r oArn PAYEF DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the bxest of my knowledge and belief . HOME C -7f ~ ~ ~7G3 _ ~0 7 9 ,
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