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HomeMy WebLinkAbout09-26-11COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: BERNARD STEVEN S 343 N HANOVER STREET CARLISLE, PA 17013 -------- fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: ssN: is4-3o-4ioa FILE NUMBER: 211 1-1015 DECEDENT NAME: BERNARD SAMUEL J DATE OF PAYMENT: 09/ 26/ 201 1 POSTMARK DATE: 09/26/201 1 couNTY: CUMBERLAND DATE OF DEATH: 08/26/201 1 AMOUNT ACN ASSESSMENT CONTROL NUMBER 11160810 ~ 5147.17 TOTAL AMOUNT PAID: REMARKS: SEAL CHECK#7094 5147.17 INITIALS: DB RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REV-1162 EX(11-96) N0. CD 015001 REGISTER OF WILLS BUREAU OF INDIVIDU,1ct(TAX~S PO BOX 280601 ~ _._ HARRISBURG PA 17128,y0d0i ~' penny (iania DE PAR7t~ENT 9F REVENUE _ 1 'J REY-1543 EX AFP (05-11) PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE N0. 21 ~! .. ~ ~~5 AND ACN 11160810 TAXPAYER RESPONSE DATE 09-08-2011 h ,n _~~ i C, SF! ~t,.P~ . ~'1 Cl lr~` ~' . ~!~ STEVEN S BERNARD 343 N HANOVER ST CARLISLE PA 17013-1928 EST. OF SAMUEL J BERNARD SSN 164-30-4108 DATE OF DEATH 08-26-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST FCU provided the department with the information below, which was used ire calculating the inheritance tax due. Records indicate that at the death of the above named decedent, you were a joint owner/beneficiary of this account. If you are the Spouse of the deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2. If you believe the information is -ncorrect, please obtain written correction from the financial institution, attach a copy ~o this form and return it to the above address. Please call 717-787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 7836-11 Date 09-08-1981 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance ~` 20,655.78 payable to "Register of Wills> Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to Tax $ 3,442.70 months of the decedent's date of death, Tax Rate X .045 deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due g 154.92 nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain C H E C K a discount or avoid interest, or return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. C ONE BLOC K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return O N L Y 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 OFFICIAL USE ONLY ~ AAF relationship to decedent: PA DEPARTMENT DF REVENUE TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1. Date Established 1 1 2. Account Balance 2 $ 2 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ 4 5. Debts and Deductions 5 - 5 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X 7 8. Tax Due 8 $ $ PART DEBTS AND DEDUCTIONS CLAIMED ^3 DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) S Under penalties of perjury, I declare that the facts I reported above are true, correct and complete to the best of my knowledge and belief. HOME C 117 ) 2~3-o33G _ S~ S 53~,,~ WORK c 'l l7 ~ ~ oq . 2g 1?', 9- Z6- v TAXPAYER SIGNATURE ~ TELEPHONE NUMBER DATE .~ BUREAU OF INDIYIDUAL TAXES PU BDX 288681 ~~. ~; ~,._ -pQn~~{Va11ia HARRISBURG PA 1712818 - - DEPARTMEN9~OPI~d~ENUE r - REX-1543 ~~~ ~~ (05-11) uu CLERK '~ PENNSYLVANIA INHERITANCE TAX'. INFORMATION NOTICE .FILE No. 21 _ 1,-~~~.~ AND ACN 11160809 TAXPAYER RESPONSE .DATE o9-08-2011 nzpF,.~p,.~-~: ,~, ;RT ~~~.. C(~r- ='~i ~A BETTY L BERNARD 343 N HANOVER ST CARLISLE PA 17013-1928 EST. OF SAMUEL J BERNARD SSN 164-30-4108 DATE OF DEATH 08-26-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS 70: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. MEMBERS 1 ST FCU provided the department with the information below, which was used in calculating the inheritance tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If y0U are the Sp0U5e Of the deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2. If you believe 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. Please call 717-787-8327 with questions. COMPLETE PART 1 BELDW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 7836-11 Date 09-08-1981 To ensure prover credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance ~` 20 , 655.78 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to Tax $ 3,442.70 months of the decedent's date of death, Tax Rate ~( ~~ deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due $ • 00 nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT A. © The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain C H E C K a discount or avoid interest, or return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. C ONE B L 0 C K g. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return O N L Y 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 - CALCULATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS PAD 1 1 2 $ 2 s X 3 4 $ 4 5 - 5 6 $ 6 7 X 7 8 $ 8 OFFICIAL USE ONLY ~ AAF PA DEPARTMENT OF REVENUE PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) 5 Under penalties of perjury, I declare that the facts I reported above are true, correct and c~o_mpl~et~e t~o the best of my knowledge and belief . HOME C1~? ) Z4j - ~ ~~~ TAXPAYER SIGNATURE TELEPHONE NUMBER DATE