HomeMy WebLinkAbout04-14-10 (2)PENNSYLVANIA INHERITANCE T
' INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AN D
Po Box zao6ol TAXPAYER RESPONSE
HARRISBURG PA 17126-0601
REY-1543 IX.gF~,~(,Q8 0~). -
FILE N0. 21 09-1011
ACN 10118863
DATE 03-31-2010
:.
2DIQ APR 14 PM 12~ 48
CARL BOHNER
102 CEMTER
CLERK OF
ORPHAi~ S COURT
CHATHAM NJ 07928
EST. OF CLAYTON E BOHNER
SSN 182-28-6558
DATE OF DEATH 10-16-20D9
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
MID PENN BANK vrovided 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
Pennsylvania. Please call C717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 309002531 Date 05-19-2009 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 $ 19 ~ 593.25 payable to "Register of Wills, Agent".
Percent Taxable )( 100.00
NOTE: If tax payments are made within three
Amount Subject to TaX $ 19,593.25 months of the decedent's date of death,
Tax Rate X .045 deduct a 5 Dercent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax Due $ 881.70 nine months after the date of death.
PART TAXPAYER RESPONSE
^ ..
CHECK
ONE
[ BLOCK
ONLY
The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
B. ~ The above asset has been ar will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the estate representative.
C. ~ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART ~ below.
PART If indicating a different tax rate, please state
Q 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
PART
DATE PAID PAYEE
DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I have reported above are truer, correct and
complete toethe best of my knowledge and belief. unMr ~ 7~i ~~ h X1119
WORK ( ) ~~/IG ~ ~I ~ Q G
TELEPHONE NUMBER DATE
TOTAL CEnter on Line 5 of Tax Computation) S