HomeMy WebLinkAbout10-20-10 (2)BUREAU OF INDIVIDUAL TAXES ~',
PO BOX 280601 -
HARRISBURG PA 17128-0601 ~;~
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PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
F I L E N O. 21 - I ~ -- < ~\;,~ ~~,f
ACN 10145028
DATE 08-12-2010
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BARBARA J LACAVA
1101 MIDLAND AVE
APT 119
BRONXVILLE NY 10708
EST. OF WILFRED J MARTEL
SSN 003-09-9580
DATE OF DEATH 07-31-2010
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS TD:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
MEMBERS 1ST FCU 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. Please call clli) 78i-83Zi with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 194797-05 Date 06-06-2000 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 ~` 35 ~ 440.24 payable to "Register of Wills, Agent".
Percent Taxable )( 5.000
NOTE: If tax payments are made within three
Amount Subject to Tax ~` 1 ~ 772.01 months of the decedent's date of death,
Tax Rate )( . 045 deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax Due $ 79.74 nine months after the date of death.
PART TAXPAYER RESPONSE
FAI~.URE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT
A. ~ The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
C H E C K a discount or avoid interest, or check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenuc).
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 ~ and/or PART ~ below.
PART If indicating a different tax rate, please state OFFICIAL USE ONLY ~ AAF
relationship to decedent:
PA DEPARTMENT OF REi/ENUE
TAX RE TURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD
LINE 1. Date Established 1 1
2. Account Balance 2 $ 2
3. Percent Taxable 3 X 3
4. Amount Subject to Tax 4 $ 4
5. Debts and Deductions 5 - _5
6. Amount Taxable 6 $ 5
7. Tax Rate 7 X 7
8. Tax Due 8 $ 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 are true, correct and
complete to the best of my- no sedge and belief. HOME C `~ /`7r ~ ~
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TAXPAYER SIGNATURE TELEPHONE NUMBER DATE
TOTAL (Enter on Line 5 of Tax Computation) ~~