HomeMy WebLinkAbout11-09-09 (2)BUREAU OF INDIVIDUAL TAXES -(~
PD B(D( 290601 ~^
HARRISBURG PA 17129-9601
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PENNSYLVANIA INHERITANCE T
INFORMATION NOTICE
~ r :~,~~ AND
,':TAXPAYER RESPONSE
.,.
FILE N0. 21-ZOOq"~DSI
ACN 09168764
DATE 10-23-2009
2009 N04 -9 PM 1104
CLERK OF
ORPKAN'S COURT
GAIL STOUFFER
3609 KOHLER PL APT 9
CAMP HILL PA 17011
EST. OF CARMELIA L PEASE
SSN 179-10-7733
DATE OF DEATH 07-16-2009
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS TD:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
WACHOVIA BK NA provided the Department with the inf oraatign below, which has been used in calculating the
pa tential tax due. Records indieste that ak the death of the above-named tlacetlenk, you were a Taint owns r/benefi ci a,v of this aeeoun4.
It you feel the infonatien is lncorreet, please obtain written correction frog the finanei al institution, aktaeh a copy to this fora
and return it to the above address. This sccount is tsxsble in acco rtlanee with the Inheritance Taz laws of the Coeeornealth of
Pennsyl venia. Please call C717) 797-9527 w14h questions.
COMPLETE PART 1 BELOW ^ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 109001314 1033 Date 12-05-1997
To ensure proper credit to the account, two
Eatab lashed topics of 4his notice oust aeeompary
At<OUnt Balane• g 5,760
20 payment to the Register of W111s. Make check
. payable to "Raaistar of Wills, Apent".
Pere ont Taxable X 50.000
Amount SYbi act tc Tax $ 2
BB0
10 NOTE: If tax pavmants era made within three
,
. months of the decedent's data of tleath.
Tax Rsta X ~ 1 5 tleduct a 5 portent discount on the tax due.
Potential Tax Duo $ 432
02 Ary Inheritance Tax due will become delinquent
. nine months after the date of death.
A. ® The above lnfonatien and tax due is correct.
React paymen4 to the Reg lstar of Wills with two cgpies of this notice Lo obtain
CHECK a discount or avoid interest, or check box "A" and return this notice to the Raaistar of
DNE Wills and an offief al assessment will ba issued by the PA Department of Revenue.
BLOCK B. ~ The sbove ssset has bean or will be repgrtetl and tax paid with the Pennsylvania Inheritance Taz return
ONL Y to be filed by the estate ra0 resentative.
C. ~ The above info a fan is ineo rrect and/or debts and detluctions ware paid.
Cwplet• PART ~ and/or PART ~ below.
PART If iodic at lnB a different tax rata, please state
relationship to da cadent:
TAX RETURN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Parc ant Taxable
4. Amount Subject to Tax
5. Debts end Daductlons
6. Amount Taxable
7. Tax Rate
8. Tax Due
PART
DATE PAID PAYEE
DESCRIPTION
AMOUNT PAID
_ TOTAL (Enter on Line 5 of Tax ComputatloN a
Under penaltl es of perlury, I tle<la re that the facts I have reported a~DTOV+a-sera true, <or tact and
compl et• opt h. of bast o my k o ledge' antl belief. HOME ( I'f ! )
~-f-~-~ WORK C ) I/ b
,XPAYt:K J1l,NAlUKt TELEPHONE NUMBER DATE
OF TAX ON JOINT/TRUST ACCOUNTS
1-
2 $
3 X
4 S
5 -
6 S
7 X
8