HomeMy WebLinkAbout03-09-09 (6)PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE i r'~
BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 ~ (~ LZ. 1
Po Box zao6ol TAXPAYER RESPONSE ACN 09108143
HARRISBURG PA 17128-0601
DATE 02-12-2009
REV-1543 E% 11FP (48-OB)
TYPE OF ACCOUNT
EST. OF L C FURRY ® SAVINGs
$$N 205-30-6310 ^ CHECKING
DATE OF DEATH 01-21-2009 ^ TRUST
COUNTY CUMBERLAND rv ^ CERTIF.
REMIT PAYMENT AND FORMS T0: C7 '~=~
LEWIS C FURRY REGISTER OF WILLS r~ _~ ,'_ ''
110 WATSON LANE CUMBERLAND CO COURT HOUSE). '*~~ --
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NEW BLOOMFIELD PA 17068 CARLISLE, PA 17013 ``~ =-'`~ ~ ~ - ~'
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MEMBERS 1ST FCU provided the Department with the information below, which has been used~in calcul~ing the- ~~'''
potential tax due. Records indicate that at the death of the above-named decedent, you were a Joint owner/beh'>;ficiary of Strjis aceauhf,",
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
Pennsylvania. Please call (717) 787-8327 with quastio;ss.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS- '
Account No. 250 943-05 Date 01-20 -2006 To ensure proper 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".
P t Taxable X 16. 667
ercen
NOTE: If tax payments are made within three
Amount Subject to Tax $ 478 • 61 months of the decedent's date of death,
TaX Rate X .045 deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential TaX Due yt` 21 • 54 nine months after the date of death.
PART TAXPAYER RESPONSE
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX AS5E55MENT
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
BLOC 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 3^ below.
PART If indicating a different tax rate, please state OFFICIAL USE ONLY ^ AAF
relationship to decedent: PA DEPARTMENT DF REVENUE
TAX RE TURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS' PAD
LiHE 1. Date Established 1 I
2. Account Balance 2 $ 2
3. Percent Taxable 3 X 3
4. Amount Subject to Tax 4 +fi 4
5. Debts and Deductions 5 5
6. Amount Taxable 6 $ 6
7. Tax Rate 7 X 7
8. Tax Due 8 $
PART
DEBTS AND DEDUCTIONS CLAIMED
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 ~ 17 ) Sb'1' 1111 7
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