HomeMy WebLinkAbout08-25-09 (4)BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
PENNSYLVANIA INHERITANCE TAX
-- ~ - --INFORMATION NOTICE
AND FILE N0. 21~~~~y3
~~ ~~ - -TAXPAYER RESPONSE ACN 09104132
DATE 01-19-2009
REV-1543 EX AFP (OB-00)
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PATRICIA A YOUNG
812 W KELLER ST
MECHANICSBURG PA 17055
EST. OF RUTH M SWARTZ
SSN 222-05-5506
DATE OF DEATH 11-30-2008
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
M 8~ T BANK provided the Department with the information below, which has been used in calculating the
potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this 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
Pennsylvania. Flease tali 1717) 787-832"i with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 31003913914014 Date 01-01-1999 To ensure proper credit to the accoun#, two
Established copies of this notice must accompany
payment to the Register of Wills. Make check
Account Balance $ 10,912.98 payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax g 5,456.49 months of the decedent's date of death,
Tax Rate X .045 deduct a 5 percent discount on the tax due.
2 4 5.5 4 Any Inheritance Tax due will become delinquent
Potential Tax Due $ nine months after the date of death.
PART TAXPAYER RESPONSE
..~iLURE TO WILL UL~' `Abl OF~f' ~IAL< ~ X ASSE55 {f{
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.
C ONE
B L 0 C K
ONLY
B. The above asset has been
to be filed by the
or will be reporro~( a~~ tar .,a;,( u;th the Pennsylvania Inheritance Tax return
Joint Owner
C. ~ The above informs ion is
Complete PART 2~ and/or incorrect and/or debts and deductions were paid.
PART ~ below.
PART If indicating a different tax rate, please state OFFICIAL 135E QNLY ~ AAF
2
^ relationship to decedent:
PA DEPARTMENT OF REVENUE
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD
LiriE 1. Late Estaolished i 1
2. Account Balance 2 $ 2
3. Percent Taxable 3 X 3 _
4. Amount Subject to Tax 4 $ 4
5. Debts and Deductions 5 - 5
6. Amount Taxable 6
7. Tax Rate 7 X 7
8. Tax Due 8
~~
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
co to the best of my knowledge and belief. HOME C 717 ~ 766-1363 _ ~(
~j , WORK ( 1~I ) Z V
TAX YER SIGNATURE TELEPHONE NUMBER DA
PART DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE DESCRIPTION AMOUNT PAID