HomeMy WebLinkAbout03-22-11 (9)PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 - ((- dL~
Po BDx zeo6ol T~-X~;a1YER RESPONSE ACN 11115848
HARRISBURG PA 17128-0601 -~
~, DATE 03-08-2011
REV-1543 EX ~FP (OB-OB)
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SUSAN CARACCIOLO
6632 PELHAMS TRACE
CENTREVILLE VA 20120
~' EST. OF AMBER M LEIBIG
SSN 187-44-9172
DATE OF DEATH 02-25-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
BANK OF LANDISBURG 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. 0709115 Date 04-01-1999
Established
Account Balance $ 37,533.43
Percent Taxable X 16.667
Amount SubSect to Tax $ 6,255.70
Tax Rate )( • 12
To ensure proper credit to the account, two
copies of this notice must accompany
pavment to the Register of Wills. Make check
payable to "Register of Wills, Agent'•.
NOTE: If tax payments are made within three
months of the decedent's date of death,
deduct a 5 percent discount on the tax due.
_- Anv Inheritance Tax due will become delinquent
Potential Tax Due $ 750 • 68 nine months after the date of death.
P
CHECK
ONE
[ BLOCK
ONLY
TAXPAYER RESPONSE
URE TO RESP D W ~L ~ ESU IN o OFF iALTAX,SSfSSI~NT
A. ~ The above information and tax due is correct.
Remit pavment 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
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 a below.
PART If indicating a different tax rate, please state QEFICIAL IkSE C)~1L'~~ o AAF
relationship to decedent: PA DEPARTMENT OE REVENUE \
TAX RE TURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD
LINE 1. Date Established 1 1
2. Account Balance 2 $ 2
3. Percent Taxable 3 X 3
4. Amount Subject to Tax 4 $ 4
5. Debts and Deductions 5 - 5
6. Amount Taxable 6 $ 6
7. Tax Rate 7 X 7
8. Tax Due 8 $ 8 \
PART
DEBTS AND DEDUCTIONS CLAIMED
TDTAL (Enter on Line 5 of Tax Computat:ion~ s
Under penaltie of 'ur I d late that the facts I have reported above are true, correct and
complete to th be t of k 1 dge and belief. HOME C )
WORK c 71 7 ) 774-7435 3 ~ 7~i
TAXPAYER SIGNATURE one, sq. TELEPHONE NUMBER DATE
DATE PAID PAYEE DESCRIPTION AMOUNT PAID