HomeMy WebLinkAbout06-09-10
BUREAU OF INDIVIDUAL TAXES ~I
PO BOX 280601 ..,..,-,.c[~
HARRISBURG PA 17128-0601 '~;';°;
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PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND FILE
~~~ TAXPAYER RESPONSE ACN
~' DATE
~~
N0. 21 10-0160
10127692
05-19-2010
Z01fl ,SUN -9 PM ~~ 4~
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RITA A GIRO DI
2305 CLARIDGE CT
ENOLA PA 17025
EST. OF EVA R GIRONDI
SSN 195-07-8891
DATE OF DEATH 01-15-2010
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SgUARE
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 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. 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 , 658.1 6 payable to "Register of Wills, Agent".
Percent Taxable )( 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 ~( 15 deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax Due $ 416.46 u nine months after the date of death.
PART TAXPAYER RESP NSE
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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.
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
0 N L Y 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.
If indicating a different tax rate, please state ,,,,
PART ~~~~~~:~~~~ •M1~,+ ••a
relationship to decedent: ~~~~~.'" v
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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
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{~P,,,fAs-~ea
OF TAX ON JOINT/TRUST ACCOUNTS
1 c~ 3 -~ ~ ~ -- 2 Oa ~
z $ 16 ~S R'~ !b
s X ti
5 ~S' 7's~": 7 a
6 $ D
8 $ a
PART
noTF P4TD PAYEE
DESCRIPTION AMOUNT PAID
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Under penalties of perjury, I declare that the facts I have reported above are true, correct and
mplete to the be t of my knowledge and belief. H 0 M E C ~ ~ 3c~ ` ~~
.. ~ WORK ( `1 /7 ~ ~7 ~ ~ ~ 5 ~ ~ fp 7 l1,~
XP YER SIGNATURE TELEPHONE NUMBER D T
DEBTS AND DEDUCTIONS CLAIMED
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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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