HomeMy WebLinkAbout04-21-11 (2)!~ * 3
BUREAU OF INDIVIDUAL TAXES ~j- ~'
PO BOX 280601 '
HARRISBURG PA 17128-0601 ~'~
. .. _,
REV-1543 EX AFP (08-OB)
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
r~r ,. AND FILE NO. 21 `"/ ~" ~~~r
'~~• d~ TAXPAYER RESPONSE ACN 11123011
;' l-.~ ~ DATE 04-Ob-2011
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CL.E~~C G~F
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CAMILLE K HYDER
1711 LOCUST STREET
NEW CUMBERLAND PA 17070
TYPE OF ACCOUNT
EST. OF CARMELA R KAVASANSKY ^ SAVINGS
SSN 129-18-4974 ® CHECKING
DATE OF DEATH 03-24-2011 ^ TRUST
COUNTY CUMBERLAND ^ CERTIF.
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
MEMBERS 1ST FCU 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 Tai: lrws 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. 235209-11
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
Date 09-09-2003
Established
$ 628.82
X 50.000
$ 314.41
X .045
$ 14.15
To ensure F~roper credit to the account, two
copies of this notice must accompany
payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
NOTE: If t:ax payments are made within three
months of t:he decedent's date of death,
deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
nine month<c after the date of death.
PART TAXPAYER RESPONSE
1
A. ^ The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this inotice 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 I~ennsylvania 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:
TAX RETURN - COMPUTATION OF TAX,~N JOI T/TRUST ACCOUNTS
LINE 1. Date Established 1 V ~~` ~~'~
2. Account Balance 2 $
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
PART
DATE PAID PAYEE
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
n .~ ~ d
TOTAL (Enter on Line 5 of Tax Computation) S lD~ ~~~ ~.
Under penalties of perjury, I declare that the facts I have reported abo/ve are-7true, correct and
complete to the best of my knowledge and belief . HOME C ~! 7 ~~ / 74//gg
WORK C ` ~ ~' S ~ d ~ ~..,~~
AXPAYER SIGNATUR TELEPHONE NIIMBER DATE
10437
C~.AREMONT
NURSING & REHABILITATION CEN~~
DATE ~ 20`„~
j RESld~nt~S ,
NAME a~ky~
AMO UNT
TYPE OF CHECK ~
DATf~ ~ CHECK NO. '
/ ~ ---~-.
s
TYPE OF CHECK
DATE CHECK NO.
TYPE OF CHKK
DATE CHECK NO.
TYPE OF CHECK
GATE CHKK NO.
TOTAL
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