HomeMy WebLinkAbout10-05-11j PENNSYLVANIA INHERITANCE TAX
BUREAU OF INDIVIDUAL rnxES rr;~:;~,r, - _ INFORMATION NOTICE
PO BOX 280601 :,~
HARRISBURG PA 17128-0601 ~y Vaf11$L Q~= A N D
o+:~RRtME"r.~RE„E""~"~, C TAXPAYER RESPONSE
REV-1543 EX 0.FP (OS -11) '''J
FILE N0. 21 11-0165
ACN 11162540
DATE 09-21-2011
i
~ ~'1~ ~ J ~ ~ ~` vv TYPE OF ACCOUNT
EST. OF BURTON W MCINTIRE ~ SAVINGS
C~ ~~~~ i~~ SSN 213-38-0563
~ ~,~," ~ CHECKING
~~`~~~,~~~~ ~ ,;~~~~~~. DATE OF DEATH O 1 - 02 - 2011 ~ rRUST
C(J1`(r ~' ,~ ~`/J~~i QQ COUNTY CUMBERLAND ~ CERTIF.
REMIT PAYMENT AND FORMS T0:
BOPHA T MCINTIRE
318 BEVERLY RD REGISTER OF WILLS
CAMP HILL PA 17011-2813 1 COURTHOUSE SQUARE
CARLISLE PA 17013
PSECU
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 ac~:ount. 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
notify the department of your relationship to the deceased by checking Box C in PART 1 below and writin
If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form andDretusn
it to the above address. Please call 7;7-787-832, with 9 'spouse" in PART 2.
questions,
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT' INSTRUCTIONS
Account No. 0213380563 Date 05-12-1999
To ensure proper credit to the account, two
Established copies of this. notice must accompany
Account Balance $` 3,517.67 payment to the Register of Wills. Make check
Percent Taxable X payable to "Register of Wills, Agent".
16.667
Amount Subject to Tax $` 586.29 NOTE: If tax payments are made within three
Tax Rate X months of the decedent's date of death,
. 0 0 deduct a 5 percent discount on the tax due.
Potential Tax Due $ Any inheritance tax due will become delinquent
` ~ ~ nine months after the date of death.
PART
TAXPAYER RESPONSE
FAILURE TD RESPDND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT
A. ^ The above i f
n ormat>.on and tax due is correct.
Remit payment to the Register of Wills with two
i
C H E C K
a discount or avoid interest
o cop
es of this noti~:e to obtain
0 N E ,
an official assessment will be r return this
i notice to the Register of Wills and
C
~ ssued by the PA Department of Revenue
B L 0 C K
0 N L Y
B. ~ The above asset has been or will b
e reported .
filed by the estate representative and
. tax paid with the Penn3cylvania inheritance tax return
PART
-' -••--~=~•~~a d uirrerent tax rate, please state
relationship to decedent:
TAX RETURN - CALCULATION 0
LINE I
2
3
4
5
6
F TAX ON _IOINT/TRUST ACCOUNTS
Date Established
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Amount Taxable
7. Tax Rate
8. Tax Due
1
2 $ `-
s X
4 +fi
5
6 +~
7 X
8
OFFICIAL USE DNLY ~ AAF
PA DEPARTMENT DF REVENUE
PAD
1
2
3
4
5
6
7
8
~.
DATE PAID PAYEE
DEBTS AND DEDUCTIONS CLAIMED
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
complete to th best of my knowledge and belief. '
O J / ~, ~ 1~ HOME C? l~ ~ ~7 _ ~ s
TA PAYER SIGNATUR WORK (-7 ~ . C ~- 'O JbJ j/
TELEPHONE NUMBER DAT/E
C. ~ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART 3^ below.
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