HomeMy WebLinkAbout03-25-10 (2)PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES r' ~ '_ ~ ~,- AND FILE N0. 21'^~D--b3~)
HARRISBURG6PA nlza-gaol V ~ ~','~AYER RESPONSE ACN 10112272
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~~`;`~`-~`~ L' ',: DATE 03-05-2010
REV-1543 IX AFP COB-Oel
~Qf~ ~4AR ZS PM I ~ ~Q TYPE OF ACCOUNT
EST. OF CHARLES HILMER ~ SAVINGS
~~E~ri ~~- SSN 194-28-9332 ® CHECKING
~~~~-i.~;~,~v ~~Ur~?' DATE OF DEATH 12-12-2009 ~ TRUST
C~~A~a ~:,~ ~,F~ i~~ ~A COUNTY CUMBERLAND CERTIF.
REMIT PAYMENT AND FORMS T0:
JOANN HILMER
25 N 2ND ST
WORMLEYSBURG PA 17043
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
FULTON BANK NA 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 joint 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
Pennsylvania. Please call (717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 3622-45738 Date 12-17-2004
To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 10,541.83 payment to the Register of Wills. Make check
Percent Taxable payable to "Register of Wills, Agent".
X 16.667
Amount Subject to Tax $ 1,757.01 NOTE: If tax payments are made within three
Tax Rate months of the decedent's date of death,
X ~ 00 deduct a 5 percent discount on the tax due.
Potential Tax Due $ ~ 00 Any Inheritance Tax due will become delinquent
nine months after the date of death.
PaT
1 TAXPAYER RESPONSE
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
0 N E
~ Wills and an official assessment will be issued by the PA Department of Revenue.
BLOCK B. ~ The above asset has bean or will be reported and tax paid with th
P
0 N L Y e
ennsylvania Inheritance Tax return
to be filed by the estate representative.
C. ~ The above informs ion is incorrect and/or debts and deductions ware paid.
Complete PART ~Z and/or PART 3~ 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 B $
PART DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE DESCRIPTION wr~n~~ur morn
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.
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XPAYER SIGNATURE TELEPHONE NUMBER DATE
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