HomeMy WebLinkAbout01-07-10 (2)PENNSYLVANIA INHERITANCE
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES j~~;:`; AN D
PO BOX 280601 r ~•~~ ~ ~` ~~
HARRISBURG PA 17128-0601 TA~C~Y E R R E S P O N S E
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REV-1543 Ex AFP (00-00)x.: •.~ ...I - ~ ~ ilj.,lV
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FILE N0. 21'2 {- loa'~
ACN 09006175
DATE 10-08-2009
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C(CF,'PN is 'COURT
MICHAEL S PATRICK
440 WALNUT ST ~k202
KNOXVILLE TN 37902
EST. OF JAMES R PATRICK
SSN 174-20-6742
DATE OF DEATH 08-11-2009
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
PSECU provided the Department with the information below, which has bean used in calculating the
potential tax duo. Records indicate that at the death of the above-named decedent, you were a ioint 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. TAis account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of
Fenasy l:rac~:a. ?1~aM. evil C717i 787-8327 with gUHit i,lna..
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 1174 206742-051 Date 04-28-2004 To ensure proper credit to the account, two
Established copies of this notice must accomparor
payment to the Register of Wills. Nake check
Account Balance ~ 80,694.21 payable to "Register of Wills, Agent".
Percent Taxable X 33.333
NOTES If tax payments era ^ade within three
Amount Subject to Tax ~ 26,897.80 months of the decedent's date of death,
Tax Rate X .045 deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax Due ~ 1,210.40 nine months after the date of death.
P
T 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
C 0 N E ~ Wills and an official assesseent will ba issued by the PA Department of Revenue.
BLOCK B. ~ Tha 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 ware paid.
Complete PART 2~ and/or PART 3~ below.
PART If indicating a different tax rate, please state
relationship to decedent:
TAX RETURN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3 X
4 ~
5
6
7 X
8 $
PART DEBTS AND DEDUCTIONS CLAIMED
3^
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I have reported a~jb~gve are ~t~ryu,~, correct and
complete to t e best `of my knowledge and belief. HOME C O`''ff ) lX~~~ U3~(,
TOTAL CEnter on Line 5 of Tax Computation) 6