HomeMy WebLinkAbout03-09-11 (2)BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17126-0601
PENNSYLVANIA INHERITANCE
INFORMATION NOTICE
AND
F?!^~_ TAXPAYER RESPONSE
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PAULINE ANDRIUTSA
4905 E TRINDLE RD OFC C
MECHANICSBURG PA 17050-3643
EST. OF DIMITRI ANDRIUTSA
SSN 058-30-7400
DATE OF DEATH 0:3-05-2010
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILL'S
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
CITIZENS BANK OF PENNSYLVANIA 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) 787~327_..Kiah questions.
COMPLETE PART 1 BELOW *=`SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 6221033903 Date 04-17-2008 ~ To ensure groper credit to the account, two
Established copies of this notice must accompany
payment to the Register of Wills. Make check
Account Balance ~` 12,371.94 payable to "Register of Wills, Agent".
PART
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
CHECK
ONE
[ BLOCK
ONLY
X 50.000
$ 6,185.97
X '~ . 15
$ 927.90
'~S~cXPi~YER RESPONSE
NOTE: If t:ax payments are made within three
months of t:he decedent's date of death,
deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
nine month: after the date of death.
AT~i , .<`. >-~~~..t sRE.1L IN ~M1 -t1F~Z~IAt: T,A~ `ASSE55MENT I
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
Wills and an official assessment will be issued by the PA Department of Revenue.
B. ~ The above asset has been or will be reported and tax Paid with the Pennsylvania Inheritance Tax return
o be filed by the estate representative.
C. he 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 to the ase state ~~r-.'...-
relationship to decedent: ` ~I ~ ~~~ &~~4`~~1
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TAX RETURN - COMPUTATION OF T /XJ O/N nJOInNT/ RUST ACCOUNTS {~~ ;.,
LINE 1 Date Established I ~/ f~/ Si /~~ ~A£..
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$ ' ~ =t'~ ~ '~ ' ~ ~c
2. Account Balance 2 Z
3.
Percent Taxable
3 ~~
X ~~
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4.
Amount Subject to Tax
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$
5.
Debts and Deductions
5
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6. Amount Taxable 6 '~ ~ ~
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7. Tax Rate ~ X .~
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T
D
8 ._+
$'r0
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8. ax
ue
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalt" s of perju I declare that the facts I
f have reported abov~ef,are true", corre t and
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qo le e .
e es my knowledge and belie HOME C~/ / ) ~/ J
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WORK C ) ~~........~~~~~~~~
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~ PAYER _ TELEPHONE NUMBER HATE
TAX
FILE N0. 21 10-0345
ACN 11114917
DATE 03-04-2011
TOTAL CEnter on Line 5 of Tax Computation) S
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