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HomeMy WebLinkAbout10-23-09 (2)PENNSYLVANIA INHERITANCE TAX BUREAU OF INDIVIDUAL TAXES ^j !`' '~~' :,'rt ice?-~ AND FILE NO. 21 0 9 - 0 634 PO BOX 280601 '~' ~;- T/~4~CPAYER RESPONSE ACN o9161oss HARRISBURG PA 17128-0601 it' ~ ~~~..~~,~. _'l.vi~ `• ' '. DATE 09-23-2009 REV-1543 EX AFP (08-OB) ~~ t. ~,~ ,_.r., 1~~~_y; ~ ,..'_ ;;-,T ~~~'r , '''_Wi t,, ~ t , KATHLEEN D ROTH 119 CAMBRIDGE DR MECHANICSBURG PA 17055 EST. OF BETTY W CASEY SSN 201-16-3214 DATE OF DEATH 06-26-2009 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. SOVEREIGN 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 point 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. Plasse call C717) 787-8327 witi~ questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 16$17],200$ Date 05-15-2002 To ensure proper credit to the account, two Established copies of this notice must accompany 2, 741.17 payment to the Register of Wills. Make check Account Balance $ payable to "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax ~ 1,370.59 months of the decedent's date of death, Tax Rate ~( ~ 1 rj deduct a 5 percent discount on the tax due. 2 0 5.5 9 Anv Inheritance Tax due will become delinquent Potential Tax Due $ nine months after the date of death. PART TAXPAYER RESPONSE 1 ...:; , ;,..:: , ~ ::...::..; :....:::.:: !. :' A:i::::'~.. :~~.''':::t~>~:i.:::i'...;n~v';i:::.:.:.:n;i:::. ~:.i:nii::: ~!:.i~ ~~::.~i.~ ,i,. ,yyGG~~ , ::>: ': .~. 1. ::i: ~'+~:' i : :: ~: •' .G., ~1 ~ l:ryrsf:::y ::y: ~: •::T::% .:•f•.v• 1/ '1} ::~ :: / : 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 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 ONLY o 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 3~ below. n d a c a t i n a different t o,~~j// r a t e ~;~` ;~~ ,~ ~'~' ~~" ~'``~ ~°~ ''h~ ~. •~a<>>a<:»>:;: PART ~ 9 , , Please state `+~'`~ ~ •~ ~•• ~ `~ ~ ~ "" 2 relationship to decedent: ~ ~ ;~;t~3;. ~: TAX RETURN COMPUTATION OF TAX ON JO ~:';:::::.:,<.::~f::~:..,..,::.:..:.~;,,>:.;~:,<...:..,,.~..,:....:•:.A:~<,:,<.:::<.:,,.:.: INT/TRUST ACCOUNTS ::<;:.: ;.<;<::::;;;<::: LINE 1. Date Established 1 f.. ~"~ ~ ~• ry .::;:.::. ~::: 2. Account Balance 2 ~ •/ ~ .n~,.~'~`;~'~~}~~:.~~•:r'~«:::::~": 3 . Percent Taxable 3 X ~ • • f` 4 ,:;x:.~..~>~,•~....~:;.,~s. ~~:.:.~ .~°'x~ ~~< 4. Amount Sub ect to Tax 4 $ ~~ ~. ~.• •¢~,.,•` ~:.i''~6 ~ f~'~~`?`"'F~, 5. Debts and Deductions 5 - ;,,,, ~% •~~f:~`: r q~~'~... off : `i~f~•b ^ ii,::~fi'},''~?{~''li G:;f:~~~il:$'yjl'1•:ff,J 6. Amount Taxable 6 $ ~.~ U• ~ ' fs~~• .~'. ~~.%,f~:~~..`~"4„' .,floc ~ :,/•, c %wFfi:. d::':?i . ~ 7 . Tax Rate 7 X ~ ~ r ..r,`. ~:.::~:.:,,~.,,;:'<;:~.<;<::>:~`; €:<<;:>~;;::::::::: 8. Tax $ ~/'/. ~J' .~" x.~~•s~~~.¢~z~~~;<>><><:><:;:; D V @ 8 G d r:.yn,:.~ ..r . :~. ,,` . ~ •~~.:~..~..,,>~i:>:..`5:•`..~:,~.n,a.<:r..>:::w . y::<::;?#s>;':# ... .~.. ..F.. X: :.G.': <Gfr r: Si::' f:/..t:nn: ~ F.~ :.: H.:. ~: PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of m~y^ knowledge and belief. HOME C 7/7 ) ~li °~ 1 TAXPAYER t W~ ~ ~~7 ~ 7GG - ~ /(/ ~ Gf IGNATURE TELEPHONE NUMBER D TE INFORMATION NOTICE IUTAL ctnter on Lane 5 of Tax Computation) $ -PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES A N D r. r^r-"fns- ~°,,_ PD BOX 280601 t ~` ~ t ~ y~~~.!'TAXPAYER RESPONSE HARRISBURG PA 17128-0601 r... t , t . ,,... ~,. '"' 3.•t , ~~ r REV-1543 D( A-GOW~~~i)t •i t ' ~/ t ~ - - EST. OF BETTY W CASEY SSN 201-16-3214 DATE OF DEATH 06-26-2009 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. FILE N0. 21 09-0634 ACN 09161089 DATE 09-23-2009 ZQ~9 4~T 23 ~ 9~ 3~ rr+~ ~ .r'A,r y" { r ..Cis:; KATHLEEN D ROTH 119 CAMBRIDGE DR MECHANICSBURG PA 17055 SOVEREIGN 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. Please call (717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 1684012402 Date 05- 15-2002 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 85 Payment to the Register of Wills. Make check 3 , 0 0 7 • payable to "Register of Wills, Agent". Percent Taxable X 50.000 1, 503.93 NOTE: If tax payments are made within three Amount Subject to Tax $ months of the decedent's date of death, Tax Rate X 15 deduct a 5 percent discount on the tax due. $ 2 2 5 .5 9 Any Inheritance Tax due will become delinquent Potential Tax Due nine months after the date of death. PART TAXPAYER RESPONSE „a. ,. ~. ~;::':9r%.:~r~:<'<:^:;;:.fc;>s:8<:r..;:~:::.:.y:..,~.:.n...;::..,..:::..:.:..;'r.:.<:::.;.r.;;':;::;:;:;.:~::::.~::::::.~::::.~:.~:::::::;:;a.;:::o:;::;:::.~:::: :.:.~ :::::::::: .::: ..:.......... ~'f~t~ ~1t .. ...: :r.n........ i.:... .:.c:..:. 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 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 3L-J below. PART If indicating a different tax rate ~" "'"" ~" ~~ Please state `~%` '~~~~' "f"`• ~'r~ :,:;:: { ~'` l relationship to decedent: ~.~ ,. ..:;~,%„y.,,. ~:~~~%x%%~;~~' ,< :. TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS ~r': ~ ~'_> LINE 1. Date Established 1 2. Account Balance 2 $ ~., ~007~ c~' 3. Percent Taxable 3 X ~ /O 4. Amount Subject to Tax 4 $ /~ /'~~~3 i ~3 ..,. , ;;.i, ,.yh FY ; ¢,. 5. Debts and Deductions 5 - :,,; y~:. r~ .. 6. Amount Taxable 6 $ / ~~©3•y-3 ,, ~~ r~.~ .f 7. Tax Rate 7 X ~ 05~ , , •~ f~ ~,, ,, .~ 8. Tax Due 8 $ G. ~, (p~ ,f `~' _ , <:;::, PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above area true, correct and co late to the best of m knowledge and belief . HOME ~~7 )/~/fi^' c,?f'7i i ~. mac. ~etRK ~ `7~ 7 ~ 7U~ - o~yJi ~~ as TA AYER SIGNATURE TELEPHONE NUMBER DATE iuiw~ Denier on ~lne 5 of Tax Computation) $