HomeMy WebLinkAbout04-27-11CUMMUNWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU DF INDIVIDUAL TaxES INFORM TION NOTICE FILE N0. 21 11-0203
Po Box zsosol ~~" AND
HARRISBURG PA 171za-ocoi ;S(' - - TAXPA ER RESPONSE ACN 11500862
r~~ )~`~ ~ O DATE 04-21-2011
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"'' E T. OF CARRIE R STEVENS ^ SECURITY
C! ERK C~' S. S. N0. 208-38-5500 ~ sEC ACCT
D TE OF DEATH o1-26-2011 ^ STOCK
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ERIC T STEVENS REMIT PAYMENT AND FORMS T0:
426 RIDGE AVE REGISTER OF WILLS
ENOLA PA 17025 1 COURTHOUSE SQUARE
CARLISLE PA 17013
FIDELITY has provided the Department with th
calculating the potential tax due. Their records indicate that at th
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th information listed below which has been used in
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ea
If you feel this information is incorrect, please obtain written corre
ti f the above decedent, you were a beneficiary of this asset.
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on
return it to the above address. This account is taxable in accordance with t rom the transfer agent, attach a copy to this form and
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Questions may be answered by calling (717) 787-8327. e
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eritance Tax Laws of the Commonwealth of Pennsylvania.
COMPLETE PART 1 BELOW ~ * * SEE REVERSE SIDE FO R FILING AND PAYMENT INSTRUCTIONS
Account No. 73116
To insure proper credit to your account, two
(2) copies of this notice must accompany your
DOD Valuation 106,413.96 payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Percent Taxable X 100.00
Amount Subject to Tax 106,413.96 NDTE: If tax payments are made within three
(3) months of the decedent's date of death,
Tax Rate X . 00 you may deduct a 5% discount of the tax due.
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Potential Tax Due Any inheritance tax due will become delinquent
nine (9) months after the date of death.
PART TAXPAYER RESP
1^ NSE
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT BASED ON THIS NOTIGE
A. ® The above informationand tax due is correct.
1. You may choose to remit payment to the Reg ster of Wills with two copies of this notice to obtain
C H E C K a discount or avoid interest, or you may c eck box "A" and return this notice to the Register of
0 N E Wills and an official assessment will be i
~ sued by the PA Department of Revenue.
B L 0 C K
B. ^ The above asset has been or will be reported a d tax paid with th
0 N L Y to be filed by the decedent's representative. e Pennsylvania Inheritance Tax return
C. ^ The above information is incorrect and/or debt d d
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You must complete PART ~ and/or PART ^3 be an
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uctions were paid by you.
ow.
PART If you indicate a different tax rate, please state you
relationship to decedent: tFFICIAL USE ONLY
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PA DEPARTMENT OF REVENUE
TAX RETURN - COMPUTATION OF TAX ON ABOVE ASSETCS) Pp,~
LINE 1. DOD Valuation 1 ~ 1
2. Percent Taxable 2 X
2
3. Amount Subject to Tax 3 I 3
4. Debts and Deductions 4 - ~
5. Amount Taxable 5 ~
6. Tax Rate 6 b
7. Tax Due 7 ~
8
PART DEBTS AND DEDUCTI NS CLAIMED
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DATE PAID PAYEE DES RIPTION AMOUNT PAID
TOTAL CEnter on Line 5 f Tax Computation) $
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
c~mplete to t~ bes o~~npvrledge and belief.
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