HomeMy WebLinkAbout12-17-10 (5)BUREAU OF INDIVIDUAL TAXES
PO BOX 280601 - ~ -r. r .~,-
HARRISBURG PA 17128-060:I' ~. - ~ ~''
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MICHAEL J PHILLIPS
328 DEERFIELD RD
CAMP HILL PA 17011
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE N0. 21 10-1001
ACN 10162464
DATE 11-02-2010
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.
F NB B AN K 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/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 C717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 5701-00453 Date 06-05-2006 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 $ 27 ~ 220.06 payable to "Register of Wills, Agent".
Percent Taxable X 16.667
NOTE: If tax payments are made within three
Amount Subject to Tax $ 4,536.77 months of the decedent's date of death,
Tax Rate X .045 deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax Due $` 204.15 nine months after the date of death.
PART TAXPAYER RESPONSE
1
FAILURE"~,TO~~ SpOND WILL RESULT`~~IN, AN_°~FFIC~AL 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
a discount or avoid interest, or check box "A" and return this notice to the Register of
C H E C K
Wills and an official assessment will be issued by the PA Department of Revenue.
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 information 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
a relationship to decedent: "
;~~~ PA DEPARTMENT OF REVENUE
TAX RETURN - 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 b $ 6
7. Tax Rate 7 X 7
8. Tax Due 8 $ $
PART DEBTS AND DEDUCTIONS CLAIMED
0
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 C ?~~ ) ~7~7 -'9C'~~~'
G ~ /~ WORK C 7/ 7) 9 ~`~ ~ 2779 L~ / ~i~
.XP YER SIGNATU E TELEPHONE NUMBER DA E
TOTAL tEnter on Line 5 of Tax Computation) $