HomeMy WebLinkAbout04-16-10 (2)BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
mcv-1543
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND FILE N0. 21 09-1172
'''rv~lG~ ~bXPAYER RESPONSE ACN io114360
{ `"" "'`•~' ~ ~ DATE 03-11-2010
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CIRPHA~!'S C{~URT
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E A HAAS
1000 W SOUTH ST
CARLISLE PA 17013
EST. OF GLADYS L. HAAS
SSN 174-20-6ooa
DATE OF DEATH 10-02-2009
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SgUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
METRO 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. 513072181 Date 06-26-1999
To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 7,424.71 payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 50.000
Amount Subject to Tax $ 3, 712.36 NOTE: If tax payments are made within three
months of the decedent's date of death,
Tax Rate ~( , lrj deduct a 5 percent discount on the tax due.
Potential Tax Due $ 556.85 Any Inheritance Tax duo will become delinquent
nine months after the date of death.
PART TAXPAYER RESPONSE
1 K
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 obtafn
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.
8. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance lax 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
PART
3^
DEBTS AND DEDUCTIONS CLAIMED
- - ° ..e ~ wr :ax LomPULa[ion) g
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to he best of my knowledge and belief. HOME C ) ~ ~ ~)
WORK C ) 1S ~D
TAXPAYER SIGNATURE TELEPHONE NUMBER DAT
OF TAX ON JOINT/TRUST ACCOUNTS
1
2 +~
3 X
4 +~
5
6
7 X
8 +~
DATE PAID PAYEE DESCRTPTTf1N ...,,,,.,r .,. ~.,