HomeMy WebLinkAbout12-30-09 (2)BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
R[Y-I6t5
PENNSYLVANIA INHERITANCE TAX
INFORMATION NDTICE
AND FILE ND. 21 -ZOB~-IZ13
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^'i~~~ ~KXPAYER RESPONSE ACN 09150616
~~ ''^"' ~ <' DATE 12-22-2009
~T .
1009 DEC 30 PM I ~ 05
CLERK{ CF
ORPHAN'S CCURT
CUh~'PER' A~'ti~~ ~'~^ . PA
PATSY A MARTIN
167 OVERCASH RD
CHAMBERSBURG PA 17201
EST. OF GLEN R HORN
SSN 188-12-5666
DATE OF DEATH 12-06-2009
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS 70:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
FARMERS i MERCHANTS TRUST CO oravided the Deoartsent with the inforwetion below, which has been used in caleulatinp the
potential tax due. Reca rds indicate that at the death of the above -nawad decadent, vpu ware a !oink owner/banef ieiarv of this account.
If you foal the info nation fs incorrect, please obtain written correction trove the financial institution, attach a cppy to thia forty
and return ft to the above address. This account is tnubla in accordance with the Inhe ritanca Tax laws of the Cowwarnealth of
Penn nlrertie. Plpaae call (717) 787-8327 with Questions.
COMPLETE PART 1 BELOW ^ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Aeoount No. 70-64365
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential lax Due
Date 05-23-2000
Established
$ 14,241.68
X So.DOD
$ 7,120.84
To ensure proper eredi4 to the account, two
copies of this notice oust aeeowpalry
paywant to 4he Rapister of Wills. Make check
payable to '•Repistar of Wills. Avant".
NOTE, If tax paynen is era wade within three
months of the dacedanY's date of death.
tleduet a 5 oereent discount an the tax due.
Am Inheritance Tax due will become delinauenk
nine wpnths after the tlat• of death.
A. ~ The above inf ormatlon and tax due is corroct.
Rewit payment 4o the Repistar of Wills with two copies of 4his notice to obtain
r CHECK a discount or ova id interest, or chock box "A" and return this notice to the Rapister of
I ONE ~ Wills and an official assassmank will b• issued by the PA Deoarteant of Revenue.
L BLOCK B. ~ Tna above asset has been or will be reported antl tax paid with the Pannsy lvania Inheritance Tax return
ONLY to be filed by 4he esta to rao resantative.
C. ~TAa above inf orma ion is ineo rrac4 and/or debts and tlaductions were paid.
Complete PART 2~ and/or PART 3^ below.
PART If intl3 eating a dlfterant tax rata, plc as• state
relationship to decetlent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established l 5 - ~-3- ~.Ooo
2. Account Balance 2 $ ~42uN~./_$
3. Pere ant Taxable 3 X {o tr
4. Amount Subleet to lax 4 $ ~~ 1 0. s4
5. Debts antl Deduetlons 5 A
6. Amount Taxable 6 $ "'~ 1 ~ e. 9:4
7. Tax Rate 7 X -tlU C C_rl~.ni4 tiae~
8. Tax Due B $ 316-Uf!
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT vArn
Untler penalties of per3ury. I declare that the facts I have reportetl above are true, correct antl
complete to the best of my knowletlpe and bell ef. HOME ( 717 ) .3^/.~'Z 7
~- ~Q.. WORK (71'1 ) 5_SAO ~SS3~l - 28` -O9
TAXPwrt:K SIGNATURE TELEPHONE NUMBER DATE