HomeMy WebLinkAbout05-25-11 (2)BUREAU OF INDIVIDUAL TAXES FILE N0. 21 10-11$9
PO BOX 280601 ACN 11131037
WIRRISBURG PA 17128-0601
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND
'~" -AYER RESPONSE
QEY-1565 EY •FP ~ r y~'~ 4J! ~ ~~~ ~{
Ct.itl'iAf GCJ M~~~~ .::
~~ F A.
402 ADAMS ST EXT
ENOLA PA 17025-2901
IRENE H RADABAUGH
DATE 05-09-2011
EST. OF EDGAR E ROCHE
SSN 172-36-1696
DATE OF DEATFI 10-31-2010
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
PSECU provided the Department with the infonation below, which has been used in ealculatina the
potential tax dua. Records indicate that at the death of th• above-named decadent, 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 cell C717) 787-8327 with questions. _
COMPLETE PART 1 BELOW ^ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 1 195320 64 0-S1 Date 09-29-1994 To ensure proper credit to the account, two
Established ~ copies of this notice gust accompany
Account Balance 36 8 .7 7 payment to the Repistar of Wills. Nake cheek
~` payable to "Register of Wills, Aeent".
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
X 50.000
$ 184.39
X .15
$ 27.66
PART
CHECK
C ONE
BLOCK
ONLY
A. ® The above inforwation and tax due is correct.
Remit payment to the Resister of Wills with two copies of this notice to obtain
a di scbunt or avoid interest, or check box "A"arid return this notice to the Repistar of
Wills and an official essassunt will be issued by the PA Department of Revenue.
B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the estate representative.
C. ~ Tha above infor a 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
Q re latlonship to decedent:
TAX RE TURN - COMPUTATION OF TAX eN 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 7 X
8. Tax Due 8 +~
PART DEBTS AND DEDUCTIONS CLAIMED
^3
DATE P AID PAYEE DESCRIPTION AMOUNT PAID
NOTE: If tax payments are Bade within three
months of the decedent's date of death,
deduct a 5 percent discount on the tax due.
Arty Inheritance. Tax due will become delinquent
nine months after the dat• of death.
Under penalties of perjury, I declare that the facts I have reported above are tyyrue, cor/root and
eompla to the b st mwl dge and belief. HOME C 7~7 ) /JOB ~6Zz J~/~3/~f
WORK C )
TAXPAY SIGNATURE TELEPHONE NUMBER DATE