HomeMy WebLinkAbout01-11-11BUREAU OF INDIVIDUAL TAXES
Po Box 260601
HARRISBURG PA 17128-0601
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
REY-15f3 EX
AND FILE N0. 21- f ~-QDJ a
'~, ~~~ ;;j=rIRAYER RESPONSE ACN 10147079
• ~,~ r''dlll`; DATE 08-25-2010
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TRUDY CAPAZO
187 ASHFORD DR
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C',~MBERL~' ~ !'.+ ~ . P~~
ENOLA PA 17025
EST. OF RUTH M CAPAZO
SSN 300-38-403
DATE OF DEATH 07-08-2 10
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER DF WILLS it
1 COURTHOUSE SQUARE
CARLISLE PA 17013
ORRSTOWN BANK provided the Department with the information below, which has been i
potential tax due. Records indicate that at the death of the above-named decedent, you ware a joint owner/be
If you feel the information is incorrect, please obtain written correction from the financial institution, at
and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of t
Pennsylvania. Please Dail C717) 767-8327 with questions.
COMPLETE PART 1 BELOW ^ SEE REVERSE SIDE FOR FILING AND PeYMFwr ruc,
Account No. 103003372
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
PART
CHECK
ONE
BLOCK
ONLY
Date 04-09-2002
Established
S 4,787.74
X 16.667
$ 797.97
X .15
$ 119.70
To ensure proper cred
copies of this notice
payment to the Regist
payable to "Register
NOTEi If tax payment:
months of the deceden~
deduct a 5 percent di:
Any Inheritance Tax di
nine aonths after the
A. ~ The above information and tax due is corset.
Resit payment to the Register of Wills with two copies of this notice to
a discount or avoid interest, or cheek box "A" and return this notice to
Wills and an official assessment will be issued by the PA Department of I
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
ed in calculatino the
~f ciary of this account.
Rc a copy to this form
, ommonwealth of
'U~1'IONS
to the account, two
lust acCOmpany
off Wills. Make check
Wills, Agent".
ar made within three
s ate of death,
ou t on the tax due.
w 11 become delinquent
at of death.
,lister of
B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inhheritance Tax return
to be filed by the estate representative.
C. ~ Tha above inform ion is incorr ct and/or debts and deductions were paid. III
Complete PART 2 and/or PART b below.
PART lr indicating a different tax rate, please state
relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established 1
2. Account Balance 2 $
3. Percent Taxable g 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
0 ~
DATE PAID PAYEE DESCRIPTION II AMOUNT PAID
TOTAL CEnter on Line 5 of Tax Computation) Oi
Under penalties of perjury, I declare that the facts I have reported above are true, co rget and
complete to the best of my knowledge and belief.
~ .HOME (7(~ ) S`(d -'~ y
WORK C ) 1 g 11
TAXPAYER S GNATU E TELEPHONE NUMB R D T
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