HomeMy WebLinkAbout09-28-09 (2)BUREAU OF [NDIVI DUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-8601
R[Y-1566 E%
PENNSYLVANIA INHERITANCE
INFORMATION NOTICE
- - AND
'' `T,~IXPAYER RESPONSE
T
FILE N0. 21 - O I'C~~'{
ACN 09155712
DATE 09-04-2009
2009 SEP 28 Ake ~~' 24
CLEN'~~ CJUR1
CUM:: _ ,_., ,_ ,,.
DORIS ROBINSON
440 CRANES GAP ROAD
CARLISLE PA 17013
EST. OF RODNEY CAMPBELL
SSN 284-32-3855
DATE OF DEATH 08-22-2009
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OFWILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
® CERTIF.
MEMBERS 1ST FCU provitled the Oapartaent with the inforaation below, which has bean used in calculating the
potential tax due. Reeo rds indicate that at the death of the above •naaad dacetlent, you ware a joint owner/benef iciarv of this account.
If you foal the inforaation is incorrect, please obtain written correction fran the financial institution, ettsch a coot/ to this fora
end return St to the above atltlress. This account is taxable in accordance with the Inheritance Tax laws of the Conaonwealth of
Pennsv lvania. Please call (717) 787-8327 with questions.
COMPLETE PART 1 BELOW ^ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 314392-42
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
Date 09-24-2007
Establlshad
$ 4,357.14
X 50.000
$ 2,178.57
X .15
$ 326.79
To ensure proper eredi4 to the account, two
copies of khis notice oust aeeoapary
pavaent to the Register of Wills. Make chock
payable to ''Ravi star of Wills, Avant".
NOTE, If 4ax payaents are aada within throe
aonths of the tleeedent's date of tleath.
detluet a 5 percent tliseount on the tax due.
AW Inha ritanc• Tax due will beeose delinquenk
nine aonths after the data of death.
C. ~ The above inf or a
6 ion is incorrect and/or tleb is and deductions ware paid.
Coaplete PART
2 and/or PART 3~ bal w.
PART If in tl3 cating a tlifferent tax rate, please state
relationship to tle cadent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Data Established 1
2. Account Balance 2 S
3. Percent Taxable 3 X
4. Amount Subject to Tax 4 +t
5. Debts and Detluct3ons 5
6. Amount Taxahla 5 S
7. Tax Rate 7 X
8. Tax Due e S
PART DEBTS AND DEDUCTIONS CLAIMED
Untler peneltl as of perjury, I tleclare that the facts I have reportgd ah ov are true, corset antl
complete to the ba of my knowled8e antl ba 13 •f. HOME C ) `_
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Q-7.(.0~ ~c~i~iilr~O7'li WORK C ) .. . O
~XPAYER SIGN URE TELEPHONE NUMBER DATE
DATE PAID PAYEE DESCRIPTION AMOUNT PAID