HomeMy WebLinkAbout06-04-10PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES _ AN D
Po Box zaocol ~ ~"~ ~';~i~~~'-,,~'R_ RESPONSE
HARRISBURG PA 17128-0601 ,1
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REV-1543 EX RiP (OB-OB) ~ .. .: ~~-a ~ ~.'~ +-
FILE N0. 21 10-0160
ACN 10127693
DATE 05-19-2010
2~~d J~~ '~~ ~~ (~' E~T. OF EVA R GIRONDI
SSN 195-07-8891
~+~((~ DATE OF DEATH O 1-15 - 2 010
Q~~`J ~~ COUNTY CUMBERLAND
~~~ ~~ F1~EMIT PAYMENT AND FORMS T0:
ALFRED J GIRONDI REGISTER OF WILLS
1440 AMHERST CT 1 COURTHOUSE SQUARE
MECHANICSBURG PA 17050 CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
WACHOVIA BK 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 ]oint 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 tau able 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. 1010092595664 Date 03-24-2004 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 $ 16,658.16 payable to "Register of Wills, Agent".
Percent Taxable X 16.667
NOTE: If tax payments are made within three
Amount Subject to Tax $ 2 ~ 776 • 42 ~~ months of the decedent's date of death,
TaX Rate ~( , 1Fj x' deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential TaX Due $ 416.46 X nine months after the date of death.
PART TAXPAYER RESPONSE
,~`
LT ~1 AN F~FICTAI_ TAX A55E55 NT
A. ~ 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
CHECK Wills and an official assessment will be issued by the PA Department of Revenue.
C ONE
B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
O N L Y to a 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 3~ below.
PART If indicating a different tax rate, please state OFFICIAL USE O NL Y ~ AA F
relationship to decedent: y PA DEPARTMENT OF REVENUE
TAX RETURN - COMPUTATION OF TAX ON JOI~N/T/TRUST ACCOUNTS PAD
LINE 1. Date Established 1~-a7 1Oti ~/ 1 - --- -
2. Account Balance 2 $ ` 6 SO • ~6 2
3. Percent Taxable 3 X ~~i . 6G ~ ~ ° 3
4. Amount Subject to Tax 4 $ ~a-: 4
5. Debts and Deductions 5- ~S7 5 S• 7 fl 5
6. Amount Taxable 6 $ b
7. Tax Rate 7 X y S ~o G t I/4_L 7
8. Tax Due 8 $ 0 $
PART DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
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IUTAL tenter vn amine ~ ui vmr~~a ~+~~~•
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`. HOME C
~/1i°'~ ) WORK C ~ l7 1 ~~ ~ Zg~ 0 G ~~
r...e. ro crr_u i~o~ TELEPHONE NUMBER A
ADDITIONAL DEDUCTIONS:
Dr. Edward Camargue Physician services in January 2010 $435.00
Register of Wills Carlisle Courthouse $ 75.50
Spirit Physician Services Second opinion offered by
Dr. Dukkapatti -Holy Spirit Hospital $270.00
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