HomeMy WebLinkAbout04-21-11' - PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES ~ # .f ~ '~ ., r ~"' ''AND FILE NO. 21 --''
PO BOX 280601 ~ ~~ "~ ~y "'•~ r ~ '~~//
r ~ TAX 1R RESPONSE ACN 11123010
_ ..
HARRISBURG PA 17128-0601 , ;' L,~ DATE 04 - 06 - 2011
REV-1543 EX AFP (08-08)
f j t' k R
~i~ ~ ~~~i~ ~' f". ~~~ ~ TYPE OF ACCOUNT
EST. OF CARMELA R KAVASANSKY ® SAVINGS
C~E~~C (~{~ SSN 129 •• 18 - 4974 ~ CHECKING
0~~~~~`'f~ ~~r'1, DATE OF DEATH 0 3 - 24 - 2 011 ~ TRUST
F '' ` (~`'~~JRT COUNTY CUMBERLAND ~ CERTIF.
~~~t ~~j~r ~3 r,~R t~' Gr ~S, 1 n
" P~'REMIT PAYMENT AND FORMS T0:
CAMILLE K HYDER REGISTER OF WILLS
1711 LOCUST STREET 1 COURTHOUSE SQl1ARE
NEW CUMBERLAND PA 17070 CARLISLE PA 1~~013
MEMBERS 1ST F CU 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. 235209-00 Date 09-09-2003 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance 29 Payment to the Register of Wills. Make check
11
191
,
.
payable to Register of Wills, Agent .
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 5
595
65
,
.
months of the decedent's date of death,
Tax Rate X .045 deduct a 5 percent discount on the tax due.
Potential Tax Due Any Inheritance Tax due will become delinquent
$ 251
80
.
nine months after the date of death.
P
RT TAXPAYER RESPONSE
A
1
~.
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
ONE 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 Tax return
O N L Y t "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 3~ below.
PART If indicating a different tax rate, please state
relationship to decedent: ,,,u, ~~
TAX RETURN - COMPUTATION OF TAX ON_JOINT/TRUST ACCOUNTS
LINE 1. Late Established 1 tJ ""~ °"
2. Account Balance 2 $ ~ f
3. Percent Taxable 3 X ~ L~+
4. Amount Subject to Tax 4 $ ~~
5. Debts and Deductions 5 - ~ ~ ,
6. Amount Taxable 6
7. Tax Rate 7 X r
8. Tax Due 8 $
PART DEBTS AND DEDUCTIONS CLAIMED
3^
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
~s 'ate ' ~ T 1 'P U{Y1 ti" V~ (a.
a / C' c'.
1 U I NL ~r.nter on Line 5 or i ax GOmpuiaLlDn) S ~ ~ ~ (~ ~ ~ ~'
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
co lete to the best of my knowledge and belief . HOME C~' 7 ;~ ~ 7(J ~~~9
,~,~ W O R K C // 7 a 3 yO C -l
T PAYER SIGNATURE TELEPHONE Nl1MBER DATE
10437
CLAREMONT
NURSING & REHABILITATION CEN~.E~R~r
DATE ~ 20_.~
NAME
. AMO UNT
TYPE OF
CHECK
OAT6~ ~ CHECK NO. ~ (~ ---~
TYPE OF CHECK
GATE CHECK NO.
TYPE OF CHECK
DATE CHECK NO.
TYPE OF CHECK
DATE CHECK NO.
TOTAL
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