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HomeMy WebLinkAbout02-02-10COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 ~~~~ ..~ ,_ 1,:,,., .,:. ~ , ,"1 , `7~~-ti-off? ; ~ INFORMATION NOTICE AND TAXPAYER RESPONSE FILE N0. 21 09-1122 ACN 09505075 DATE 12-17-2009 ~~tt1~'E~ -~ PM ~' ~~ ~~ ~~~ JEANNE LUDT ~~~~'~~~~ 3 SCHOOL STREET AMHERST NH 03031 TYPE OF ACCOUNT EST. OF BURTRAM P GOODMAN ^ SECURITY S . S . NO . 178 - 22 - 2212 Q sEC AccT DATE OF DEATH 12-01-2009 ^ sTOCK COUNTY CUMBERLAND ^ BONDS REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MERRILL LYNCH has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a beneficiary of this asset. If you feel this information is incorrect, please obtain written correction from the transfer agent, 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. Qu~sticas may bs an~r;;:reG Gy ca3lin„ C;I7) ?S7-S3i7. COMPLETE PART 1 BELOW ~ ~ * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 000 To insure proper credit to your account, two (2) copies of this notice must accompany your DOD Valuation 239, 918.58 payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". Percent Taxable X 50.000 Amount Subject to Tax 119, 959.29 NOTE: If tax payments are made within three C3) months of the decedent's date of death, Tax Rate X .045 you may deduct a 5~ discount of the tax due. Potential Tax Due 5, 398.17 Any inheritance tax due will become delinquent nine C9) months after the date of death. PART TAXPAYER RESPONSE A. ^ The above information and tax due is correct. ........... ..... ....,-:r. :r. ,~.... r,;.,~~:.v:.r::rv: •r:~ r':. _..r::»°¢:Y;^.;;:. 7f...~<tr 1. You may choose to remit payment to the Registe r of Wills with two copies of this noti t a CHECK a discount or avoid interest, or you may check ce o obt in 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 d t an 0 N L Y to be filed by the decedent's representative. ax paid with the Pennsylvania Inheritance Tax return C. ^ The above information is incorrect and/or d bt e s an You must complete PART a and/or PART ~ below. d deductions were paid by you. PART If You indicate a different tax rate, please state your relationshi t `'~•`•~~%~`• ~~'• '~ ' .,,,rk-0:~ ~ „`s<..~ ~ ' ~ +~ ~, ~, © p o decedent: , f ~;: ~' . • TAX RETURN - COMPUTATION OF TAX ON ABOVE ASSET(S) ~ °~~•:~.s~~+ ,f.% '~' Mfr ~' LINE 1. DOD Valuation 1 _ ~'x~'r• •"" `""' Vf .~ • ~ ~ ' f F •'' ' ' f~5 ~`~~ ` • 2. Percent Taxable 2 X 9`'+-0. f J 5 i~ ~ /: ''~ $~f'~~'J%A~Fr : i ,::rr~y;.. ~~!i~s~`!~ ~~r'~• /.. ,' . ,~ 3 k • " ~%l~• ~"+ ! . Amount Sub ect to 3 Tax 3 ~<,, >.r' ~„s, ,~~,,r. + ;',• :. ~ rt%" ~~~~ ~ •~.:~.4.fx~~~ •'v~' r. ;f.'ri.'. i .::`rf FF~f'F,~~9i,`,"y'',ro~ .+1.5;ib J{::>r` ^;;r°'`''+r' '"° S'' y~ , fl,'y~::.r,,`.;',. / fir :: ~~ ~•o•' 9 • '~'%~ 4 . Debts and Deductions `# - ~ : r. ~ . r ~ ~.. ISF,, fY~...hfi~3:4• ~Sr.'i%:f.'S ~~ j''<f%./G~''~r ~~~:r: Q~ %~!.h:+o',,lf+',`•j!M:s'"crr.`.~ ?'<: E:,r'~.~r1'49'".~.:3:fil ':e":.s•~% 'or.%w ••"`#~ rr'<'6'~,;.if;'t`o~%`~»~>~`;°rr ~i ~~e;% /'.;rf. ~ • ` fn:~'•:~f~:.'ff ~+ '`~y ' ~"~~•:~f +" mount T a x a b 1 e rj , , . . , , ., , . , 2;? •.. ,•~~ • j~~ ... ~. ,~:..: • ; •F'•.~¢. ::rr-0`. , F:lx~;~3;'"~r~ ' y r.~, . 'N:;<;r % `"~ yr~'~Y''~'&''`r~'.F a y'ri ;,r ~ ',':~' '„i ~' ~+~„ y~•s•,-0~,. 6 . Tax Rate 6 X ~:~ ~:r~:,r'.; :,.,~~ i-0~':.~ •,~:.~ .:;:,., • .. : •r . . ' ; •~~(: ~:{ ~~rY ~ • / F df~: ~ '-0 : , '` f4..:. ~ , :, , •~~; f ;~', ~`/,yf'},. ~ "%~~ ' :;~:Y . :/~r. ~/.i~r.f ~~f, r::! /l~ . ~ 4 ~ ~ 7 . Tax Due T ,.,~W ~;•-0' ,fr;<.: ,,..~lr :; ,. :. :. :z.,.•;Y.~ ,;,,•„ ~:: .;; .... . .........r.:.r..~..-.>r'.' -v+/':Y}:(Y'::g~rrylo:5-0:`/.:.'/r'A7J.;c;>,.:~.1iS..fll'~k:{F%.i':'s?l44,.1L°i°r.~m°. e'er PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) ~ 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 C ~~ ) C ,.~ ~ ... ~° 2 WORK C ) ~ 1 ~ PAYER SIGNATUR TELEPHONE NUMBER ATE