HomeMy WebLinkAbout10-07-11BUREAU OF INDIVIDUAL TAXES
PO BOX 28D601
HARRISBURG PA 17126-06D1
•,;, PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE FILE
Pennsylvania AND ACN
DE PARTMENT OF REVENUE TAXPAYER RESPONSE DATE
REV-1543 EX AFP (OS-11) '~.
N0. 21 -- ~~-~~~~~.~
11164872
09-30-2011
TYPE OF ACCOUNT
EST. OF PAUL E RICE ^ SAVINGS
SSN 189-18-7254 X^ CHECKING
DATE OF DEATH 03-12-2011 ^~~usT
COUNTY CUMBERLAND~~ °- ~ t~kTIF.
REMIT PAYMENT AND FORMS TO: :'}~ °? _
MARY E RICE REGISTER OF WILLS _,.~~ ~
23 STONEHEDGE DR 1 COURTHOUSE SQUARE .__-~~ ~_~
CARLISLE PA 17015-9120 CARLISLE PA 17013 ~`>;
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WELLS F ARG 0 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. 1010230618918 Date 03-04-2009 _ To ensure proper credit to the account, two '
Established copies of this notice must accompany
Account Balance 93 137.00 payment to the Register of Wills. Make check
~ payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 46,568.50 months of the decedent's date of death,
Tax Rate X ~ lrj deduct a 5 percent discount on the tax due.
Any inheritance tax due will become delinquent
Potential Tax Due ~` 6,985.28 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
0 N E an official assessment will be issued by the PA Department of Revenue.
B L 0 C K g. ^ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return
ONLY ~~y/-, filed by the estate representative.
C. y\~ The above informs ion is incorrect and/or debts and deductions were paid.
[`~ Complete PART 2~ and/or PART 3LJ below.
PART If indicating a different tax rate, please state OFFICIAL USE ONLY ^ AAF
relationship to decedent:
^2 PA DEPARTMENT OF REVENUE
TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAII
LINE 1. Date Established 1 1
2. Account Balance 2 $ 2
3. Percent Taxable 3 X 3
4. Amount Subject to Tax 4 +fi 4
5. Debts and Deductions 5 S
6. Amount Taxable 6 $ 6
7. Tax Rate 7 X 7
8. Tax Due 8 $ $
PART DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I reported above are true, c)/orrect and/ ~~ ~(J--~`
complete to the best of my knowledge and belief. HOME C ~ ) 1~` ~ G
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,1" J! (,'tom J G~.~ /~,~-c.~. W O R K C )
TAXPAY SIGNATURE TELEPHONE NUMBER DATE
TOTAL (Enter on Line 5 of Tax Computation) S A