Loading...
HomeMy WebLinkAbout11-13-09BUREAU OF INDIVIDUAL TAXES`?.~''`i '~"~''~` '`~ PO BOX 280601 ~'f-'''-;'-,` - HARRISBURG PA 17128-0601 ~' t ~ , ~',_ REV-1543 EX AFP C08-08) PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE AND TAXPAYER RESPONSE FILE N0. 21~ ~~'~~~ ACN 09160496 DATE 09-22-2009 2~~ SOY 13 A~ I ! ~ 51 ~~~~~ `~ f~R©NA~~`S ~fl~!RT CURTIS D BOWERMAN 7100 CHAMBERS HILL RD HBG PA 17111 EST. OF DALLAS H BOWERMAN SSN 257-32-0529 DATE OF DEATH 05-25-2009 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ~nu~o~ TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. SUSQUEHANNA 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 ac;dress. This account is taxably in accor,3~nce ,+ith the Inheritance Tax laws of the Commonwealth of Fennnylvenia. Fitaa~ i.oii i7i73 787-8327 wici~ yue~tion~. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 337163164 Date 09-12-2005 To ensure proper credit to the account, two Established copies of this notice must accompany 2, 896.75 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 , 448.38 _ _ months of the decedent's date of death, Tax Rate X ,,,,,,.~-~~j-- ~pri~ duct a 5 percent discount on the tax due. 217.26 ~~r,,', t iv Inheritance Tax due will become delinquent Potential Tax Due $ 1~ nine months after the date of death. PART TAXPAYER RESPONSE !,~.:> ! % il:~ :! Y .:::n.:..~ni;.;.;.i~ni;:!t'"iiii:.i bi:;:iirif4ir :'i iii i:i ii. viii;. :::::..... .:~.>: 1 • l.:u ;::;;.:+i ii....•r:..n ::r:: ivn: yn}}•N.•::.n.:.::....:~. Jn: i:~'; ~~ %ii:: f~;i::>i::. . .../ >%'%J"!<:::::'s:''%%%:r::::::Y:'t:j;;:;ifi:::i;2::>j;:;:;::::rg:;::i'Yi:"i::i2:i::::::::{::t:'::::::j::::>i<:i:i:t:i::: `: ~w.: .~y~. ~'i IG:TT 1. ~~I gyp f ..............................................:w::::: ~:.:..........:.... :I. p•Fi : : :vf: i::~~.~: }.j fv. : q4 !::n. ..i yn: i}:hi'n::ii'!.i n.. :. ..x ~:: .::: %.S:.i.. ........ ... ~:s. .:.s•!. !p :!: .:........!:...:.!!.•':•H.Y<o..:..: :!.!.. ''f'i.::.::..:.:::.i:::?:::::::.n. ..:. .. '!'/'.. !.. ..:.. :..: .. .. ....... .:..::a:.~ni::.:......:::::::::n~::n~:n...n».~:::. ~:: i;ii;i;a::ai:~ n~. 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 3~ below. If indicatin a different to rat lease state ~~i',?~.%a•! ~~'' `"~ ''>~ f.! .'•>',•: ~`'~~"'Y'~~: PART 9 P ;~3 ~;~<'~;,~;, ~ ' ' r e l a t i o n s h i t o d e ~i LI. 11 ~© :` ;~%~ff`'r'y~.~%:.!~. „f~ ~i ., w.,•::,:.;;':~`":,::•! ~;:s•:. • ;~ .:'...<~:,,•.:.:;••.`? :n '.,;;,.::.~'::.':..:,::.f.,.,...:<.:;/...'~/..r.:Of~.:.;•i':':.,~N.'.f.~~•p~:i?.:": ~{,/~SY::'.`9i,}:;i:.'!::''4: i;:;'.::::~:.,.:: R N fi::.. .:....:.: ..::......:...... ..:. TAX RETU TATION OF TAX ON JOINT/TRUST ACCOUNTS "" ' ' "'"'• ::~ '< .•.".':<:••.<•!..,.<.....•:. LINE 1 . Date Established 1 ~'~fy~Y!n`~y! ~ ~'~`~%~%%' `'`~r,~f;;,u~s~' ~y~^ 2. Account Balance ~: ~ ~~:~•.' :~.d '.r:..:. `" • :.:~ "'i1':'1'•o:,J `.iy.?%hPrrx*~ ,~,`.¢::;:;••' •:,7k:y>f.'ri .;f;.::..';.;k! r: ~•~` ':<>fr:: ~: /'•ty!y>~!, f. r!% ryf l!' y fr:.c ~Y r`.;t 4~ ),yf /rf r•~ fi'riy:~'i;•f.v.; ,:,r:•.?srf X Y f.~'1.°:`}:,'t'f,;k:: ~~+:; £~ ,°'~,k'~~ F.4 ry ~,~.'!F!`'.:~?~, f`~ A~ lv ,f+ .S N ~ /; ~. A!.fr,~ '!'t`~Y~ ~•~'~ vF •. I{,:fif~H' / !u .:<a:6 ;9!,~ 3 . Percent Taxable 3 ;x;,~e~j> .~::,:.!~::.. ~:.! ,~..:.,.:.,,::. •...•....!. :. A:.r!!~ </<:.r~!f<:,:.,:,:.~.~: ~~%, f •::t'! ¢'~~!/,. r !! ! ;.flf F. f {4'•'f;?`: ,~~jC;%. ~:ti`~%:! ~ r/.Yr~ 4 . Amo $ ' fyfFi ~~'~'';;, ~'•r~~;f9.~~: :~.~; ,.::,:,.,~'~ •y~s .,r.y'«si•<>,.~c,~••. u n t Subject t o Tax 4 ~ ~ - ~ ,,,:,,,,; .! .:.;:f,~:~ ..~, :~`~`.~:,... 'i//. !7,1:fi.:: ~?:i: `:.~~•;:~; !. r:. :$' !.!.!: .:3::x•:7".%• ,rl!,~` U frf.•o y•' :F!: '.`.Cf:%'`:•.":':y: ;Y.%r,';%:':G:'':'8:;•:::c•,.:::..: !!!::%:3: 5 . Debts and Deductions 5 - .~~ . ~r+~ /~:..../.,v !.: . ~:~>E. ! s.. ;:: ::.~....,.:::::::;:::::;;~.:<:,«,:,..;::.<.<;.::,.::>< 2!!: ` /f ~ : !:. t, ~/f' :.t.:afci;`: :,ril.:':~4:i•'•>'r r?r's~.~':,'%b".~r; ;;;i 6 . Amount Taxable 6 $ ! : .~,~,~ ~;9:'`:.•,:~!srr':zf:/y~::~•~,'«~,:~.,;`•Y••b:I..::,::'^R:.nR"•i?d~F.:C.'r:.:3yi..'r.:1.::::::•:•`:;':;'}:.:t::fy:~Fl~'I•,I::.. :>~ ,~::'{:yr: ,?+! ./~! ~:'.`~:•'!`"'!.,:p}O:.•.q:.'/+16:!^!''3l•;iY r'y;'~6~~ .: '2k.;~3'+:£ 7 . Tax Rate 7 X e ~ ~ ..:,.;~•r'!.`•:• :;"~' ` ' ./~'~! ~~ :y`~!z~~!,:r%Y.. ~<ssc•,!:'~rs. ,,<f n;~,..,~ ~ ~:::<;~z.:~;:,,: G !"~:~ k:~:f!./~'~F:•f~:r'•~4"'~ ~"+'),''!:$uy~•l:l~~•c'/+.'J'•~l'~~~~h~`i'7'1.i "uF%f2:/,:•:~':`vFI>~'Y:Y:'i':::>:; r f.,~~~ s/if/.•H.<'{c~r!~. ~~/:/+'r:!r'fF~.i/~,C •. o, .9:'•,.? :'4:~"h ~~r!•%w':::0~5"+$"~'::.:' ::`i::+!%. 8. Tax Due 8 +fi l0'J. ~~ :.:.~`,~;;;~•.,r..!. ,r: :::.?:.,!,s:~l,'!.,,~`c',;.:,:./..::,.,r,:.,...:,,,.,;:;:rr•,~~!!,u...:.:,{:<:,:,,,,!:..~<:::,,:;::,,;>:,. :::f:; :.F:. PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID ~ l~ TOTAL CEnter on Line 5 of Tax Computation) ~ der pe alt es f perjury, I declare that the facts I have reported above are true, correct and c m he est of my knowledge and belief. HOME C~~ ~ ~~~' ~ J WORK (~. ( ~ 3~5 ' ~1~~D 1 ~- ° 6 ,XPAYER SI URE TELEPHONE NUMBER DATE