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Home My WebLink About12-17-10 (4)BUREAU OF INDIVIDUAL~'7A~'~S'~~'~ ~~`;;-;-1 PO BOX 280601 . - ~ •• • '' } ` .• HARRISBURG PA 171:28.0.4.01 = ~ ~ •+,; ..:,.i ~ i ... ~i ~ i ~.....'j REV-1543 EX AFP (08-08) PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE AND TAXPAYER RESPONSE FILE N0. 21 10-1001 ACN 10162463 DATE 11-02-2010 Z~r~ G~~, I7 F~f~ ~~ 24 CLEnK rr JOSEPH C PHILLIPS 328 DEERFIELD RD CAMPHILL PA 17011 EST. OF JOHN W PHILLIPS SSN 184-24-5141 DATE OF DEATH 09-23-2010 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT © SAVINGS CHECKING TRUST CERTIF. FNB BNAK 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 ]oint owner/benefiiciary 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 I:ommonwealth of Pennsylvania. Please call C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FDR FILING AND PAYMENT INSTRUCTIONS Account No. 30 0 0-25486 Date 06-05-2006 To ensure proper credit t:o the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance $ 106 , 988.91 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to Tax $ 17, 831.84 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 $ 802.43 nine months after the date of death. PART TAXPAYER RESPONSE FAILU{2E~'ll~£SPOi~+~D~~iWILL~~tESUL~'IN~,A~i il~\FTCIAL ,T'AX i~SSESSMEN~C 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 Revenue. ONE BLOC 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 3~ below. PART If indicating a different tax rate, please state „~ ~ OFFICIAL-USE ONLY •~ ~ AAF ~ relationship to decedent: ., PA ~~ DEPART ENT t)F REVENUE ~~~~~~" TAX RE TURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD .. ~ ~ :~ . LTNt i. 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 $ 6 7. Tax Rate 7 X 7 8. Tax Due 8 $ $ PART DEBTS AND DEDUCTIONS CLAIMED DATE P AID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are/true, correct and c m lete t b{e of my knowledge and belief. HOME ( ~~~ ) !7d ~Ti~i~Z. WORK C X12 ) 23g ~~J''..~j~ IZ~/ ~» .X R SIGNAT RE TELEPHONE NUMBER DATE TOTAL CEnter on Line 5 of Tax Computation) $