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HomeMy WebLinkAbout05-05-11s r BUREAU OF INDIVIDUAL TAXES PO BOX 280601 WIRRISBURG PA 17128-0601 PENNSYLVANIA INHERITANCE TAX ~~ t,, ~.. ~ -F ~~~~~~ ~AY _5 ~~~'` ~y CLERK C` ORPH.~N'S COURT *^ STANLEY SETLOCKMaE~1~ ~~~ C'~ PA 1304 WEST LIME AVENUE LOMPOC CA 93436-6418 EST. OF EVELYN SETLOCK SSN 174-05-2852 DATE OF DEATH 04-14-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SgUARE CARLISLE PA 17013 TYPE OF ACCOUNT ^ SAVINGS ^ CHECKING ^ TRUST i© CERTIF. MEMBERS 1ST FCU providetl the Departaent with the inforaation belor, which has been used in calculating the potential tax due. Records indicate that at the death of the above-nsaed decedent, you were a ioint owner/beneficiary of this account. If you feel the inforaation is incorrect, please obtain written correction frog the financial institution, atteeh a copy to this forty and return it to the above address. This account is taxable in accordance with the Inheritance Tax lays of the Cwaore,ealth of Pennsylvania. Please call t717) 787-8327 with questions. COMPLETE PART 1 BELOW ~ SEE REVERSE SIDE FOR FILING AHD PAYMENT INSTRUCTIONS Account No. 233896-44 Date 01-03-2011 To ensure proper credit to the account, two Established copies of this notice wust accoapanir Account Balance $ 10,994.61 vaveent to the RaBister of Wills. Make cheek Percent TeXable X Payable to "Register of Wills, ASent". 50.000 Amount Subject to Tax $ 5,497.31 NOTE: If tax payaents are aade within three Tax Rate X months of the decedent's date of death, . 0 4 5 detluct a 5 percent discount on the tax due. Potential TaX Due $ 247.38 Anv Inheritance Tax due will becoae delinq}~ent nine aonths after the tlate of death. PART ~ TAXPAYER RESPONSE A. ~ The above inforaation and tax tlue is correct. Resit Dayaent to the Regi star of Wills with two copies of this notice to obtain C CHECK ~ a discount or avoitl iota rest, or check box "A" and return this notice to the Re ONE Wills and an official assessment will be issued 0ister of by the PA Departaent of Revenue. BLOCK B. ~ TA• above asset has been or will be reported and tax paid with th• Pennsylvania Inheritance Tax rat4rn 0 NL Y to be filed by the estet• representative. C. . The above ihforma ion is incorrect and/or debts antl deductions were Daid. Complete PART ~2 and/or PART O below. PART If indicating a different tax rate, please state relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Uate Established 1 2. Account Balance 2 $ 3. Percent Taxable 3 X 4. Amount Sub~act to Tax 4 $ 5. Debts antl Deductions 5 - 6. Amount Taxable 6 $ 7. Tax Rate 7 X 8. Tax Due B $ PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT P/UID TOTAL CEnter on Line 5 of Tax Computation) a Under penalties of perjury, I dada ro that the facts I have reported above are true, correct and complete to the bast of my knowledge and belief. HOME ~ q XPAYER SIGNATURE ~~ WORK C I `\J TELEPHONE NUMBER D INFORMATION NOTICE n (~Q C ~ AND FILE N0. 21 -~pf~~~-~/ /'~ ._ .;'. ~ ~ '~ ~' TAXPAYER RESPONSE ACN 11129324 "~~- '':~ ~~ i Q ~atFV~~~~een-.-~-'~ DATE 05-D2-2011 Y James M. Bach ~~ i ^ >, ~'~E ~..,~ b- ~~~ ~' N ~~ ;,~ Y r c0 > ~ Q M Os Q oJU ~~ ~o E fA ~ J ~~~ ~. :, ~Y~ ,~.. ~ ;l ~ra R~ +ri