HomeMy WebLinkAbout08-30-11 (2)~~ ~~~ PENNSYLVANIA
BUREAU OF INDIVIDUAL TAXES I N H E R I TA N C E
Po Box 280601 pn ~ INFORMATION
HARRISBURG PA 17128-0601 (~.r~1~'~n$~/~V~~,a NOTICE
~~ DFPARTl~ENT OF.REy~~~~ ~ AND
,,. ,_- REN-1543 ~EX AFP, (U5-~?,I t TAXPAYER R E S P O N S E
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9 MARK CIRC W ~~~L~12 ~'_' ~..~{~ p~
CARLISLE LE
PA 17013
PART
TAX
FILE N0. 21-'~~~g2~
ACN 11151503
DATE 08-03-2011
EST. OF MARY E SHOWERS
SSN 194-16-4593
DATE OF DEATH o7-16-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACC UO NT
^ SAVINGS
® CHECKING
^ TRUST
^ CERTIF.
ORRSTOwN BANK
Records indicate that at
deceased and the death of Provided the department with the information
notif any amount other the above-named
Y the de than zero i decedent, yp~ were a below, which
If you believe ~a rtment of your relationshis reflected below Joint owner/beneficiar was used in calculatin
it to the above he information is incorrect, p to the deceased b n the Potential y of this account. 9 the inheritance tax
Please rail 717-787-83?7 9 Box C in PART 1 tax ma spouse of the
address. Please obtain written corre thonkf om the fina cio~leinstner note n0 If You are the due.
COMPLETE PART with questions. below and writin Y„be due~~ but you must
1 BELOW * ution, attach a copy toothie form aAdT turn
Account No. 143000016 SEE REVERSE SIDE FOR F
Date ILING AND PAYMENT
07-1p-2002 INSTRUCTIONS
Account Established To ens
Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
CHECK
ONE
BLOCK
ONL Y
$ 439.14
X 50.000
$ 219.57
X •15
$ 32.94
TAXPAYER RESPONS
mm~
ure proper credit to the account, two
copies of this notice must accompany
payment to the Register of Wills. Make check
payable to "Register of wills, ggent".
NOTE: If tax payments are made within three
months of the decedent's date of death,
deduct a 5 percent discount on the tax due.
Any inheritance tax due will become delinquent
nine months after
the date of death.
A• ^ The above
information and tax due is correct.
Remit payment to the Re
a discount or sister of wills with two
an official assessment twilltbeor return copies of this
this notice notice to obtain
issued by the PA to the Register of wills and
B• ^ The above Department of Revenue.
asset has been or will be reported and tax
filed by the estate re
presentative. paid with the Pennsylvania inheritance
C• ~ The above tax return
Com lete PARTorma ion is incorrect
p ~ and/or PART ~ and/or debts and
LJ below. deductions were paid.
PART If indicating a different
relationship to decedent; tax rate, please state
TAX RETURN ~ ~ ~
- CALCULATION OF TAX ON
LINE 1. Date Established J01NT~TRUSr
2• Account Balance 1 ACCOUNTS
3• Percent 2 $ ~ 34 ~ /11/'
Taxable 3 X
4• Amount Subject to Tax 4 $
5• Debts ~
and Deductions 5
6• Amount Taxable y
6 $ ~la•s~
~• Tax Rate ~
$ • Tax Due _ . / ~ ....
PART
DATE PgID
PAYEE
DEBrs - ~~ ~~ .
AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
Under TOTAL CEnter on Line 5 of Tax
penalties of perjury, I declare
complete Computation)
to the best of my knowled a that the facts ~
g and belief. I reported above are
/~'~'~..,.. true, correct and
PAYER SIGNATURE HOME ~~~ ~
_~. ,
WORK ~ ~
TELEPHONE NUMBER - '-!1
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