HomeMy WebLinkAbout10-05-11PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES ~ FILE NO. 21 11-0839
PD BDX 260601 pen ns l ~~~
HARRISBURG PA 17126-0601 ~ ~ . ~ ~ ~ ~; ~ ~~ -~ AND ACN 11159250
DEPARTMENT OP RE,NEWUE. ~7f4pi~lPAYE R R E S P O N S E
; C DATE 09-01-2011
FEV-1543 EX AFP '(dpi-1])~.. ~~I
** EMMA G METZGER
2737 LISBURN RD
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CAMP HILL PA 17011-8009
EST. OF JACK G METZGER
SSN L78-2b-9352
DATE OF DEATH 07-15-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKIN(
TRUST
CERTIF.
PNC BANK N A 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 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 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 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 5140042942 Date 11-30-2010
To ensure proper credit to the account, two
Established copiers of this notice must accompany
Account Balance $ 5
604
~~ payment to the Register of Wills. Make check
.
, payable to "Register of Wills, Agent".
Percent Taxable X 50.000
Amount Subject to TaX
$
2
802
UU NOTE: If tax payments are made within three
.
, months of the decedent's date of death,
TaX Rate ~( , ~~ deduct; a 5 percent discount on the tax due.
Potential Tax Due
$ • 0 0 Any inheritance tax due will become delinquent
nine months after the date of death.
PART TAXPAYER RESPONSE
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT
A. 1.. ,9 The above information and tax due is correct.
LJ 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.
0 N E
~
B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return
0 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~at'gr~~e se state OFFICIAL USE ONLY ~ AAF
relationship to decedent: ~
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PA DEPARTMENT OF REVENUE
TAX RE TURN - 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 +fi G
5. Debts and Deductions 5 - 5
6. Amount Taxable 6 $ 6
7. Tax Rate 7 X 7
8. Tax Due 8 $ g
PART DEBTS AND DEDUCTIONS CLAIMED
^3
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
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 7 / ~ `- S .. ~ ~ ,~
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TAXPAYER SIGNATURE TELEPHONE: NUMBER D T
TOTAL (Enter on Line 5 of Tax Computation) $
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