HomeMy WebLinkAbout07-08-10 (2)BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
H1IRRISBUR6 PA 17128-0601
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND
~? , ~~ ; YER~ RESPONSE
REV-1543 EX FFP
FILE NO. 21 10-0344
ACN 10132195
DATE 06-09-2010
ZD~8,1~. -8 PM ~: QQ EST. OF GILBERT K SHIRK
SSN 179-09-9036
t
DATE OF DEATH 01-08-2010
`~~' ~A'fC+ COUNTY CUMBERLAND
(`(~, p~ REMIT PAYMENT AND FORMS T0:
NANCY CRAMPTON `~/ f~! REGISTER OF WILLS
PO BOX 218 1 COURTHOUSE SQUARE
FUNKSTOWN MD 21734-0218 CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
® CERTIF.
FIRST NH OF PENNSYLVANIA provided the Devartwent with the inforaation below, which has boon used fn calculating the
potential tax duo. Records indicate that at the death of the above-naaed decedent, you wer• a joint owner/beneficiary of this account.
If you feel the inforaation is incorrect, please obtain written correction frog the financial institution, attach a Dopy to this fora
and return it to the above .address. This account is taxable in accordance with the Inheritance Tax laws of the Coaaom+ealth of
Pennsylvania. Please call 1717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 101090816 Date 07-22-2008 To ensure proper credit to the account, two
Estsblished copies of this notice oust aeeoaparo
pavaent to the Register of Wills. Make check
Account $alanca 10 313.55
~ payable to "Register of Wills, Apent".
Percent Taxable )( 16.667
NOTE, If tax vsyaents era ^ade within three
Amount Subject to Tax ~ 1 , 718.96 wonths of the decedent's dat• of death,
TaX Rate ~( , 04rj deduct a 5 percent discount on the tax duo.
Arai Inheritance Tax duo will becoae delinquent
Potential Tax Due ~ 77.35 nine eonths after the data of death.
P
T TAXPAYER RESPONSE
~
1
~. ,~
A. ~ The above inforaation and tax due is correct.
Rsmit payaent to the Register of Wills with two copies of this notice to obtain
CHECK a discount or avoid interest, or check box "A" and return this notice to th• Register of
C ONE ~ Wills and an official assessaent will ba issued by the PA Departaent of Revenue.
BLOCK B. ~ Tha above asset has been or will ba reported and tax void with the Pennsylvania Inharitanca Tax return
0 N L Y to be filed by the estate representative.
C. ~ The above inforaa ion is incorrect and/or debts and deductions ware paid.
CoaDlete PART ~2 and/or PART 3~ below.
PART If indicating a different tax rate, plaasa state
a relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established 1
2. Account Balance 2 $
3. Percent Taxable 3 X
4. Amount Subject to Tax 4
5. Debts and Deductions 5 -
6. Amount Taxable 6
7. Tax Rate 7 X
8. Tax Due 8
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION
AMOUNT PAID
Under penalties of perjury, I declare that the facts I have reported above aro true, oorractp~and J
complete yto t//h~~® bast of my knowledge and belief. HOME C.38) ) ~~3^~~~0 (0 ' 3~ ~a
~"'~`~_ ~ - CJ~-Li~'V WORK
TAXPAY SIGNATURE TELEPHONE UMBER DATE