HomeMy WebLinkAbout03-07-11BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 171~~i~i 1 i p ~
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REV-1543 EX AFP (OB-OB)
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 10-1123
ACN 11105450
DATE 02-01-2011
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** VERNA H GROFF
325 WESLEY DR
MECHANICSBURG PA 17055-3511
EST. OF KENNETH R GROFF
SSN 207-34-7041
DATE OF DEATH 10-30-2010
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
PNC B ANK 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 point 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. 5005799555 Date 12-10-2009 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 .0 0
payable to "Register of Wills, Agent".
Percent Taxable X 50.000
Amount Subject to Tax
$
• 00 NOTE: If tax payments are made within three
months of the decedent's date of death,
Tax Rate )( . 045 deduct a 5 percent discount on the tax due.
Potential Tax Due
$
• 00 Anv Inheritance Tax due will become delinquent
nine months after the date of death.
P
RT TAXPAYER RESPONSE
A
1
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
omplete t t bes of my knowledge and belief . HOME C 7/ 7) ~~~-,~'>'~,j
WORK C ) .,~"3~ %~
AX YER S G A URE TELEPHONE NUMBER DATE
TOTAL CEnter on Line 5 of Tax Computation) ~
D 5 +.
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