HomeMy WebLinkAbout08-25-09 (6)~ BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
REV-1543 EX ~AFP (OB-OB)
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
- - AND FILE
TAXPAYER RESPONSE ACN
DATE
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EST. OF RUTH M SWARTZ
SSN 222-20-5550
DATE OF DEATH 11-30-2008
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
PATRICIA YOUNG REGISTER OF WILLS
812 W KELLER ST CUMBERLAND CO COURT HOUSE
MECHANICSBURG PA 17055-4028 CARLISLE, PA 17013
N0. 21 Y I,
081.63 95v~~
12-22-2008
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
PNC BANK NA 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. Please call 0717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 000210001011469 Date 03-12-2004 To ensure proper credit to the account, two
Established copies of this notice must accompany
payment to the Resister of Wills. Make check
Account Balance $ 3, 877 • 23 payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 1,938.62 months of the decedent's date of death,
X .045 deduct a 5 percent discount on the tax due.
Tax Rate Any Inheritance Tax due will become delinquent
Potential Tax Due $ 87 • 24 nine nonths after the date of death.
PART TAXPAYER RESPONSE
FAIL E T~i~~5P~ND ILL R~SUL7 IN AN ~FFiCIAL TAX A~SE55NENT
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.
ONE
C
B L 0 C K B. ® The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
ONLY to be filed by the ~tac~e-,~ea.~~e+*t•~i~• Joint Owner
C. ~ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART IJ below.
PART If indicating a different tax rate, please state OFFII<IAL .USE°Y ~AAF
relationship to decedent: PA DEPARTMENT OF REVENUE
TAX RE TURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD
LINE I. Date Established 1
2. Account Balance 2 $ 2
3. Percent Taxable 3 X 3
4. Amount Subject to Tax 4 $ 4
5. Debts and Deductions 5 S
6. Amount Taxable 6 $ 6
7. Tax Rate 7 X 7
8. Tax Due B $ 8
PART DEBTS AND DEDUCTIONS CLAIMED
0
naTF PAiD PAYEE DESCRIPTION AMOUNT PAID
TOTAL CEnter on Line s or pax ~ompucaci~n,
Under pe~ties of perjury, I declare that the facts I have reported above are true, correct and
comple a ~, best of y knowledge and belief. HOME C )
WORK C -J~ ) Z 1
TAXPAYER SIGNATURE TELEPHONE NUMBER ATE