HomeMy WebLinkAbout05-10-10 (2)BUREAU OF INDIVIDUAL TAXES
PD BOX 280601 ,'
HARRISBURG PA 17128-0601
1. ~. .,.
REV-1543 E% AFP (OB-OB)
r",^C ~,~
~' ~,~~1(LVANIA INHERITANCE T
_~' ~.
-~-PNFORMATION NOTICE
AND
~~{{ TAXPAYER RESPONSE
FILE N0. 21-jiJ~G`'~~~
ACN 10122543
DATE 04-23-2010
_cRK ,;r
^ EST. OF AGNES S ANCHEFF
SSN 211-22-6918
DATE OF DEATH Oi3-23-2010
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
MARY L SNYDER REGISTER OF WILLS
106 S ENOLA DR 1 COURTHOUSE SQUARE
ENOLA PA 17025 CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
SUSQUEHANNA 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 (717) 787-8327 with ^~astions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 10005628457 Date 08-29-2008
To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 2 ~ 039.86 payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 50.000
Amount Subject to Tax $ 1 ~ 019.93 NOTE: If tax payments are made within three
months of the decedent's date of death,
TaX Rate X .15 deduct a 5 percent discount on the tax due.
Potential Tax Due $ 152.99 Any Inheritance Tax due will become delinquent
nine months after the date of death.
PART TAXPAYER RESPONSE
1
FAILURE TO RESPOND WILL RESULT IN AN DFFICIAL TAX ASSE55MENT
A.\IYI The above information and tax due is correct.
~J Remit payment to the Register of Wills with two copies of this notice to obtain
C H E C K 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.
B L 0 C K ~ B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inher'
0 N L Y to be filed by the estate representative. stance Tax return
C. ~ The above information is incorr1e-~ct and/or debts and deductions were [paid.
Complete PART 2~ and/or PART ~a ~ below.
rAeci ~~ inuicating a alrterent 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
z S
3 X
4
5
6
7 X
s $
PART
OFFICIAL U5E ONLY ~ AAF
PA DEPARTMENT OF REVENUE
P A D --------
1
2
3
4
5
6
7
8
DEBTS AND DEDUCTIONS CLAIMED
------~ _ __.._ ~ ~ vmNU~acion.i g
Under penal
complete to ties of perjury,
the pest
f I declare that the facts I have reported above are true, correct and
~~ Co
my k
, nowledge and belief.
~ ~ ~ -~
H O M E C ~ I 1 ) :,~ '~ 15~
CL1v y
`~
~~l/i
'L-- ._
W O R K C )
iAxPAYER ~T rnlarnaF ~
1 TELEPHONE NUMBER DATE
DATE PAID PAYEE nFCrRrpTrnu ..._...._ _ _ __