HomeMy WebLinkAbout07-31-09BUREAU OF INDIVIDUAL TAXES
PD BOX 280601
HARRISBURG PA 17128-D601
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND FILE N0. 21 C~ C`a~xn
TAXPAYER RESPONSE ACN 09124516
DATE 04-15-2009
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CLERK OF
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CHERYL BRUBAKER
18 SOUTH 30TH STREET
CAMP HILL PA 17011
EST. OF MARIAN BRUBAKER
SSN 188-20-8176
DATE OF DEATH 03-24-2009
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
MEMBERS 1ST FCU 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 ]oint 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 (i17) 787-b327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 1 04523- 1 1 Date 12- O 1 - 198$ 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, U85 • 51 payable to "Register of Wills. Agent".
Percent Taxable X 16.667
NOTE: If tax payments are made within three
Amount Subject to Tax $ 347.59 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 $ 15 • 64 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.
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 estate representative.
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C. y /I The above informs ion is
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PART 2~ incorrect and/or debts and deductions were paid.
PART 3~ below
or
an
Complete .
PART If indicating a different tax rate, please state OFFICIAL USE ONL Y U AAF
relationship to decedent: PA DEPARTMENT OF REVENUE
TAX RE TURN - COMPUTATION OF TAX ON INT/TRUSy ACCOUNTS PAD
LINE 1. Date Established 1 1a. - ~~` - L-Q ~~ 1
2 $ ~ n ~!T + ~~ 2
2. Account Balance o
.
3 X T 3
3. Percent Taxable
4. Amount Subject to Tax 4 $ 4
5. Debts and Deductions 5 - ~. ~ 6~ 5 ~ 5
6. Amount Taxable 6 ~ d 6
7. Tax Rate 7 X 7
8. Tax Due B $ ~ 8
PART DEBTS AND DEDUCTIONS CLAIMED
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Under penalties of perjury, I declare that the facts I have reported above are true, correct and
/~co plete to thebelst of my knowledge and belief. HOME C ~~~] ) ~~~~~~~
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E NUMBER DATE
TOTAL CEnter on Line 5 of Tax Computation) s
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