HomeMy WebLinkAbout04-12-11 (9)BUREAU OF INDIVIDUAL TAX!'" '-' `~ ~.•
PO BOX 280601 i'_, "` _' t~
HARRISBURG PA 17128-0601 ;'.~`,; ! ~
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REV-1543 EX AFP (08-OB)
PENNSYLVANIA INHERITANCE
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
~ * ~ .REVISED NOTICE
TAXI
FILE N0. 21 ~ ~ 1 ~,'l.~,~~,?~
ACN 11117638
* DATE 03-24-2011
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JENNIFER A HUDSON
748 CHESTERBROOK DR
YORK PA 17406
EST. OF JANET K WEIGEL
SSN 182-28-0558
DATE OF DEATH 04-30-2010
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
SOVEREIG N BANK
potential tax due. Records indicate tha
If you feel the information is i provided the Department with the informati
t at the death of the above-named decedent, on below, which has been used in calculating the
you were a
p
i
t
ncorrect
and return it to the above address. Thi , please obtain written correction from the
s account is tax
bl o
n
owner/beneficiary of this account.
financial institution, attach a
a
e in accordance with the
Pennsylvania. Please call (717) 787-8327 with quastinns. copy to this form
Inheritance Tax laws of the Commonwealth of
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT
Account No. 2471709532 INSTRUCTIONS
Date
08 - 05 -1996
Established To ensure proper credit toy the account, two
Account Balance
$ copies of this notice must accompany
Payment t
th
Percent Taxable 19 ~ 702.20
X o
e Register of Wills. Make check
payable to "Register of Wills
A
"
5.000 ,
gent
.
Amount Subject to Tax $ 985.11 NOTE: If tax payments are made within three
T a x R ate X
0 4 5 months of the decedent's date of death,
d
d
Potential Tax Due .
$ e
uct a 5 percent discount on the tax due.
Any Inh
i
4 4 . 3 3 er
tance Tax due will become delinquent
PA
R T nine months after the date of death
^
~
TAXPAYER RESPONSE .
FAIL~tE ~~. R~ES~#~~~ILL R~S~LT. IN AN UFFICIAL TAX ASSESS~lEN~"
A• ^ The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
C H E C K 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 T
0 N L Y to be filed by the estate representative. ax return
C• ~ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART 3~ below.
PADT Tf ...~:__i___
-~ -••--~o~~~~y d a~rrerent tax rate, please state
relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established 1
2. Account Balance 2 $
3. Percent Taxable 3 X
4. Amount Subject to Tax 4 $
5. Debts and Deductions 5 -
6. Amount Taxable 6 $
7. Tax Rate ~ ~(
8. Tax Due 8 $
r~rR ~
DATE PAID
PAYEE
DESCRIPTION
AMOUNT PAID
TOTAL CEnter on Line 5 of Tax Computation)
Under $
penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best of my knowledge and belief.
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TAXP YER SI' MATURE ~* ~'` c-. ~ ~~ -- WORK ( ~ -~,
` TELEPHONE NUMBER ~~ Z 4,
~~ DATE
DEBTS AND DEDUCTIONS CLAIMED
OFFICIAL USE DNLY ~ AAF
PA DEPARTMENT DP REVENUE
PAD
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