HomeMy WebLinkAbout07-28-10PENNSYLVANIA INHERITANCE TAX
f • INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AN D
PO BOX 280601 -"~ _'~ ~ +_,r~`
~~ TAXPAYER RESPONSE
HARRISBURG PA 17128-0601 ~. - -- ~ ~~~-
REV-1543 F~.'^fP~(Q8~-08~ -
FILE N0. 21 °°-~CJ_Q~(~
ACN 10129324
DATE 05-20-2010
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JANICE E BURKHOLDER
319 GLENDALE DR
SHIREMANSTOWN PA 17011
EST. OF JOHN A SHUGHART
SSN 195-38-8090
DATE OF DEATH 01-26-2010
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
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. Fiease call C717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 536883549 Date 12-23-2004 To ensure proper credit to the account, two
Established copies of this notice must accompany
payment to the Register of {dills. Make check
Account Balance $ 2 ~ 121 • 79 payable to "Register of Wi1:Is, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 1 t 060 • 90 months of the decedent's date of death,
Tax Rate ~( ~ l,~j deduct a 5 percent discount on the tax due.
Anv Inheritance Tax due wi1:L become delinquent
Potential Tax Due $ 159.14 nine months after the date of death.
PART TAXPAYER RESPONSE
1
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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
ONE 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 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.
and/or PART ~ below.
Complete PART 2
If
PART d"c t"
in i s in
9 a d'ffer n a rate a se state
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o decedent.
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TAX RETURN - COMPUTATION OF TAX 0
LINE 1. Date Established 1 ~'~1
2. Account Balance 2
3. Percent Taxable 3 X
4. Amount Subject to Tax 4
5. Debts and Deductions 5 -
b. Amount Taxable 6
7. Tax Rate 7 X ~
8. Tax Due 8 +~
JOINT/TRUST ACCOUNTS
PART DEBTS AND DEDUCTIONS CLAIMED
0
DAT~ P~4ID PAYEE DESCRIPTION AMOUNT PAID
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f" /~.(C G F 7C
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TOTAL CEnter on Line 5 of Tax Computation) S
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. ~''~ C''
HOME C7/~ ~ %~7-~ ~~ 7_ J
WORK C`~~ ~ ~~J ~(p~~' l fir")
T PAYER SIGN TURE TELEPHONE NUMBER DATE
'~ETRO
BANK
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JOlNI A SHUGNART, JII. ~ gpVtRl7uN
JANICE ^11RIWOLOEII i p il~il
an r.~11o71E~ ona1E ~ FEB 162069 ~' p / •
51WBW13SdWN P~ 17011
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OlUER Of ~. .._ ~_ D
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1:03130 a,8ti61: 53 688354 0998
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$998 20100217 $2,100.00
0536883549 v»,nA ~ of ~ METRO-ROLL
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