HomeMy WebLinkAbout03-08-11BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
REV-1543 EX AFP (OB-OB)
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND FILE NO. 21 11-0119
TAXPAYER RESPONSE acN 11111920
DATE 02-23-2011
CAROL A NELSON
6 AVONDALE DRIVE
NEWTOWN PA 18940
EST. OF EDWARD L OCONNOR
SSN 072-14-0825
DATE OF DEATH 01-21-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
WACHOVIA BK NA 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 (717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 1010180466430 Date 12- 17-2007 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 $ 20
191
54
,
.
payable to "Register of Wills, Agent".
Percent Taxable X 16 . b67
NOTE: If tax payments are made within three
Amount Subject to Tax $ 3
365
32
,
.
months of the decedent's date of death,
Tax Rate X , 15 deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax Due $ 504.80
nine months after the date of death.
PART TAXPAYER RESPONSE
1^
A. ~ The above information and tax due is correct.
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 \\\\ ~ ~~
~\ ,
relationship to decedent: \\ ~ ~~ \~
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
~
~
~,
LINE 1. Date Established 1 ~. \\\ ` ` ~\ \\
Z. Account Balance 2 $ ~\\~ ~~ \\
~~~o
3. Percent Taxable 3 X\\' ~~ s ~~ ~ ~
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
3^
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under enalties of per' ry, I declare that the facts I have reported above are true, correct and
com to to the s of my knowledge and belief. HOME CaZ~~~ ~~'~ g " o2G ~ d
. WORK c ~~ ~ A '~ - a4
TAX AYER SIGNATURE TELEPHONE NUMBER D E
IUTAL ctnter on Line 5 of Tax Computation) $