HomeMy WebLinkAbout10-06-09 (2)PENNSYLVANIA INHERITANCE TAX
CITIZENS BANK OF PENNSYLVANIA 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 Commanwealth of
Pennsylvania. Please call (717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 6100595099 Date 09-02-1997
To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 4, 633.17 Payment to the Register of Wills. Make check
Percent Taxable X Payable to "Register of Wills, Agent".
50.000
Amount Subject to Tax $ 2, 316.59 NOTE: If tax payments are made within three
Tax Rate months of the decedent's date of death,
X . 0 4 5 deduct a 5 Percent discount on the tax due.
Potential Tax Due $ 104.25 Any Inheritance Tax due will become delinquent
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
C CHECK a discount or avoid interest, or check box "A" and return this notice to the Register of
0 N E ~ Wills and an official assessment will be issued by the PA Department of Revenue.
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.
r,irt~ •~ inuicaiing a olfferent taX rate, please state
relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established 1
2. Account Balance 2 $
3. Percent Taxable 3 X
4. Amount Subject to Tax 4 $
5. Debts and Deductions 5 -
6. Amount Taxable 6 $
7. Tax Rate ~ X
8. Tax Due g $
PART
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE DESCRIPTION
AMOUNT PAID
TOTAL CEnter on Line 5 of Tax Computation) g
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.
!~ --t, HOME ( ~ ~ ~ ~ if ~" '7
TAXPAYER SIGNA ~j IdORK C ) -~ D .~
TELEPHONE NUMBER DATE
-2
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES
Po Box zaocol ~~ ~' r~ 'A'NpC I-.,- FILE N0. 21- ~q_ U`~39
HARRISBURG PA 17128-0681 TA~PiRYER RESPONSE ACN 09154167
REV-1543 E%AFP (OB-OB) "~-~~ ~"'`- ~ -' DATE 08-26-2009
2Q~~ ~~`~' _6 ~~~ ~. ~~ TYPE OF ACCOUNT
EST. OF ALTA C STITZEL ~ SAVINGS
~,: ,_~ S~lY 179-20-5102 ® CHECKING
~C,"- ~0~~'~„OF DEATH o6-11-2009 ~ TRUST
_ ~ - ! ,,
r,; , COO~T~n CUMBERLAND ~ CERTIF.
L`' REMIT PA~'MENT AND FORMS T0:
PEGGY A QUICK REGISTER OF WILLS
1820 BRANDY AVE CUMBERLAND CO COURT HOUSE
NEW CUMBERLAND PA 17070 CARLISLE, PA 17013
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OFFICIAL USE ONLY ~ AAF
PA DEPARTMENT OF REVENUE