HomeMy WebLinkAbout04-14-10 (3)PENNSYLVANIA INHERITANCE TAX
~'' INFORMATION NOTICE
'BUREAU OF INDIYIDUAL TAXES AND FILE N0. 21 09-1011
PD Box zao6gl ~.; ;~ ,`?~ TAXPAYER RESPONSE ACN 10118862
HARRISBURG PA 17128-0601 ~-
r-~..-~ --.~,~ ~ ~,~: , ~~ DATE 03-31-2010
RE1f-Y6.~d~7CJ~Fe.k~ekpeY ey~tL ~...J
210 APR I ~+ PM 12~ 49
CLERK Cr
ORPHAN'S Ct~~JRT
CURT C~P`"1'.~~ t ~.. PA
CARL BOHNER
102 CENTER AVE
CHATHAM NJ 07928
EST. OF CLAYTON E BOHNER
SSN 182-28-6558
DATE OF DEATH 10-16-2009
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 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 C717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 901-675-9 Date 11-0 9-2004 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 $ 5 ~ 116 • 85 payable to "Register of Wills, Agent".
Percent Taxable X 16 .667
NOTE: If tax payments are made within three
Amount Subject to TaX $ 852 • 83 months of the decedent's date of death,
X 045 deduct a 5 percent discount on the tax due.
TaX Rate . Any Inheritance Tax due will become delinquent
Potential TaX Due $ 38 • 38 nine months after the date of death.
PART TAXPAYER RESPONSE
~ T~ "";
CHECK
ONE
[ BLOCK
ONLY
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 or 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
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
" PA
AD
_~
2
3 ..,..
4
j
7
~ ~ ~~
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE ~ DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I have reported above are/true, correct d
complete to t e best of my knowledge and belief. HOME C ) Fj ~ /,
WORK C ) ~ O~~(,JQ
-XPAYER SIGNATURE TELEPHONE NU BER ATE c~`A,
TOTAL CEnter On L1ne 5 07 iax ~ompucacaan~ s