HomeMy WebLinkAbout12-21-09 (3)BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601 yk~±
REV-1543 ~B( AFP ~UY-;O8
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND
r ~ _~~f k.: I~~AXPAYER RESPONSE
1;~ C'
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FILE N 0. 21' Za%'1- -! 7~'
ACN 09176575
DATE 12-02-2009
~~0~ ~~~ 21 PM I ~ 5Q
ORP~~"~~'~ ~~".1U~T~jj~
NANCY WHITMAN
7 ANDES DRIVE
MECHANICSBURG PA 17055
EST. OF EVA KIMMEL
SSN 168-36-2802
DATE OF DEATH 11-18-2009
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 FCU 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
Penn!sy)vanie• Plarsn call C717) 787-8327 Nith questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 200476- 11 Date 01-02-2001 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 rfi 2, 037 • 56 payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 1 , 018 • 78 months of the decedent's date of death,
Tax Rate X .045 deduct a 5 percent discount on the tax due.
Anv Inheritance Tax due will become delinquent
Potential Tax Due $ 45.85 nine months after the date of death.
PART TAXPAYER RESPONSE
1 r.ft: i:'fi";.u.::f:Y: ':''1" "Ji.¢i, :ry::•'r•Y~f.+:,•U': :.. ~.::.. .•J•:.
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A. ~{XThe above information and tax due is correct.
Ifu 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 PA RT 2~ and/or PART ~ below.
PART If indicating a different tax rate, please state '¢~r:~+i~'~/'~~ ~ •. ,~;} •
ff ..r.,,,
relationship to decedent: .r
TAX RETURN - COMPUTATION OF
TAX ~.
ON JOINT/TRUST ACCOUNTS '~~ ~~~ ~'~%~~•'~" ~ rr '~~"` ~~
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Account Balance 2
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Percent Taxable 3
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Amount Subject t o Tax 4
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Debts and Deductions 5
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Amount Taxable 6 $ ./°r~:~~.'~YJ+f:: ~,:arty n r~~C+'9II`~' d''F r /•f~r` ~,,`~~'•
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7 . Tax Rate 7 r,
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8 . Tax Due 8 rkyGy~•~ ~ : .:~r.:.::r: ,,:.:~. ,r .~. a}:' ::> . i'.. ..~.•:•°a~:.:
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PART DEBTS AND DEDUCTIONS CLAIMED
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DATE PAID PAYEE DESCRIPTION AMOUNT PAID
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IUTAL ~tnter on pine 5 or iax computation) ~ ~f-~; ~ Fj
Under penalties of perjury, I declare that the facts I have reported above are thrue, correct ~a7nd
complete to the best of my knowledge and belief. HOME C /f ~ ) / lprp ' 9a 9 /
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TAXPAYER S NATU TELEPHONE NUMBER DATE