HomeMy WebLinkAbout07-08-10 (5)BUREAU OF INDIVIDUAL TAXES
PO BOX 2BD6D1
FMRRISBURG PA 17128-0601 _
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REV-1543 E~AFP (Ca- D)
PENNSYLVANIA INHERITANCE
INFORMATION NOTICE
AND
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TAXI
FILE ND. 21 10-0344
ACN 10132200
DATE 06-09-2010
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LEONA FICKEL
124 OLD FORD DR
CAMP HILL PA 17011-8352
EST. OF GILBERT K SHIRK
SSN 179-09-9D36
DATE OF DEATH 01-08-2010
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS,
CHECKING
TRUST
CERTIF.
FIRST NB OF PENNSYLVANIA provided th• Departwent with the inforwation below, which has been used in calculating the
potential tax due. Records indicate that at the death of the above-pawed decedent, you ware a point owner/beneficiary of this account.
If you feel the inforwation is incorrect. please obtain written correction frog the financial institution, attach a copy to this fore
and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Cowwonwealth of
Pennsylvania. Please call C717) 767-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
account No. 701702862
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
Date 01-01-1970
Established
$ 16,566.96
X 16.667
$ 2,761.22
X .045
$ 124.25
To ensure proper credit to the account, two
copies of this notice oust accowpany
paywent to the Register of Wills. Make check
payable to "Register of Wills, Agent".
NOTE: If tax paywants are wade within three
wonths of the decedent's date of death,
deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will becowe delinquent
nine wonths after the date of death.
A. I I The above inforwation and tax due is correct.
LJ Raait payrant to the Rogister 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 the Register of
ONE Wi11s and an official assesswent will be issued by the PA Departwent of Revenue.
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BLOCK B. Tha above asset has been or will be reported and tax paid with the
~ Pennsylvania Inheritance Tax return
ONL Y to be filed by the estate representative.
IIIIII
C. ^ Tha above inforwa ion is incorrect and/or debts and deductions were Daid.
Cowplete PART 2~ and/or PART 3~ below.
PART If indicating a different tax rate, please state ~
relationship
to decedent:
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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 ~
1 3,.
r ''
5. Debts and Deductions 5 - " t=
6. Amount Taxable 6 $ y'~' ~
7. Tax Rate 7 X ;~ t ""' ~,
8. Tax Due B $ ;~
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
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 (~//'7 ) 7~~-p~ p7
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TAXPAYER SIGNATURE TELEPHONE NUMBER DATE °~