HomeMy WebLinkAbout02-16-11 (2)PENNSYLVANIA INHERITANCE TAXI
INFORMATION NOTICE f
BUREAU OF INDIVIDUAL TAXES AND ,FILE NO ° 21 "' ~ 4 °° ~~ '~' ~ _.~~
Po Box 2BO6ol `c~CXPAYER RESPONSE 'ACN 11103290
HARRISBURG PA 17128-06D1 ~~'~• ,
'~-- - Yt, ;i ~ (~ DATE O 1 - 18 - 2O 1 1
.,
REV-1543 EX AFP COB-08) ~ -,y,-~j '~,
r ,, TYPE OF ACCOUNT
..
1 '" ~~~ ~~ -. EST. OF O S ESTES ~ SAVINGS
SSN 161-64-9279 ~ CHECKING
~--~~ ~~'~{ Q~ DATE OF DEATH 01-07-2011 ~ TRUST
~~~_~' ~ .~~~ ~~+' COUNTY CUMBERLAND ~ CERTIF.
~! }',~' --~~~~~I~ r ~'. REMIT PAYMENT AND FORMS T0:
WAYNE ESTES REGISTER OF WILLS
51 CREEK BANK DRIVE 1 COURTHOUSE SQUARE
MECHANICSBURG PA 17050 CARLISLE PA 17013
MEMBERS 1ST F CU 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 C717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 319265-11 Date 12-10-2007 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 $ 2, 340.34 payable to "Resister of Wi11s, Agent".
Percent Taxable X 16.667
NOTE: If tax payments are made within three
Amount Subject to Tax $ 390.06 months of the decedent's date of death,
Tax Rate ~( ~ ~ deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax DUe $ DO nine months after the date of death.
PART TAXPAYER RESPONSE
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A. I/I The above information and tax due is correct.
LJ Remit payment to the Register 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
0 N E Wills and an official assessment will be issued by the PA Department of Revenue.
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 2~ and/or PART 3~ below.
PART If indicating a different tax rate, please state ~'
OFFIC USE IlN 'o~~~~~ A
~
relationship to decedent:
2 ~~. ~\ ~ o
~~ PA DfP
~T ~~
OF REVENUE
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS ,
PAD
LINE 1. Date Establisheu 1
~~~~~ .. ~
2. Account Balance 2 $ 2 ~~~~~~~~~~~ ~'~~~\~ \
3. Percent Taxable 3 3 ~~. \
~~~~~
\~~~~~
4. Amount Subject to Tax 4 $ {1 \ '~~ ~ ~~ ~~~ ~~~ ~ '
5. Debts and Deductions 5 - ~j °` ~~~~~~ '~~~~~~~~ '
6. Amount Taxable 6 $ 6 ~ \~\\~~~ ~ ~\
7. Tax Rate 7 X 7 ~~~~~~ ~~`
8. Tax Due 8 $ g
PART DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I
comp e
~ to t best of my knowledge and belief have reported a are true,
~ correct and
. HOME C V ) ~~~ ~U ~Iy
+ ,
~ I ~ ~~ WORK C ) ~~Q~
,XPAYER SIGNATURE TELEPHONE NUMBER DATE
TOTAL CEnter on Line 5 of Tax Computations S
USA FIRST-CLASS FOR~,YER
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