HomeMy WebLinkAbout03-22-11 (10)BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
PENNSYLVANIA INHERITANCE
INFORMATION NOTICE
AND
1~ ' TAXP-Ai1~f~R RESPONSE
REV-1543 EX BFP (08 -OB1 ~ -~.~J
TAXI
FILE N0. 21-t (-c7C'`~
ACN 11115849
DATE 03-08-2011
- ~ ~ -g'ST. OF AMBER M LEIBIG
SSN 187-44-9172
(;~_=;';-~; ~;;= DATE OF DEATH 02-25-2011
Crir'i ~ ~~,,`iT COUNTY CUMBERLAND
~~,';`',,' ~ REMIT PAYMENT AND FORMS T0:
FRANCES EWING REGISTER OF WILLS
201 E MAIN STREET 1 COURTHOUSE SQUARE
LANDISBURG PA 17040 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. 068473184 Date 04- 11 - 1994 To ensure proper credit to the account, two
Established copies of this notice ^ust accompany
payment to the Register of Wills. Make check
Account Balance ~` 826.24 payable to "Register of Wills, Agent".
Percent Taxable X 16.667
NOTE: If tax payments are made within three
Amount Subject to Tax ~` 137.71 months of the decedent's date of death,
Tax Rate X .045 deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax Due $ 6 • 20 nine months after the date of death.
PART TAXPAYER RESPONSE
FAT ~ UL'T~~~~~.~ AN FIfiI L TAX ASSESSIfiENTe
RE ~iIIL
~ \~
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
CHECK Wills and an official assessment will be issued by the PA Department of Revenue.
C ONE
BLOCK 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 revresentative.
C. ~ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART 3~ below.
PART Lf indicating a different tax rate, please state OFaFI~IAL USES ONLY ~AAF
relationship to decedent: PA DEPARTMENT OF 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
0
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjur cl a that the facts I have reported above are true, correct and
complete to the be t of y kno 1 g and belief. HOME ( )
WORK c717 ~ 774-7435 *y~!
~XPAYER SIGNATURE David H. St e, Esq. TELEPHONE NUMBER DATE
TOTAL CEnter on L1ne 5 or iax Gomputa a one a