HomeMy WebLinkAbout11-02-09 (2)BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601 f; .,,„,j
REV-154b~X~ ~~ 0~~
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND
' ~~,~~ ~~TAXPAYER RESPONSE
.~
FILE N0. 21
ACN 09161725
DATE 09-28-2009
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MICHAEL GEORGE `.
3001 ST REGENTS DRIVE
APT 274
FAIRFAX VA 22031
EST. OF GREGORY GEORGE
SSN 183-46-8104
DATE OF DEATH 09-17-2009
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
MEMBERS 1ST F CU provided the Department with the information below, which has been used in calculating the
potential tax dua. 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, Dlease 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 C7i7) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 211790-00 Date 12-01-2001 To ensure proper credit to the account, two
Established copies of this notice must accompany
payment to the Register of Wills. Make check
Account Balance $ 4,491.15 payable to "Register of wills, agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to TaX $ 2, 245.58 months of the decedent's date of death,
TeX Rate X .045 deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax Due $ 101 .05 nine months after the date of death.
PART TAXPAYER RESPONSE
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
ONE 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.
PART If indicating a different 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 7 X
8. Tax Due 8 $
PART DEBTS AND DEDUCTIONS CLAIMED
3^
DATE P AID 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 my knowledge and belief. HOME C7/~ ~ Jam/ y-~~y7
G~ WORK CT03 ~ 8 ~/,2. - /s_
-XPAYER SIGNATU TELEPHONE NUMBER DATE
TOTAL CEnter on Line 5 of Tax Computation) S