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HomeMy WebLinkAbout10-20-11BUREAU OF INDIVIDUAL TAXES , ~~ y"-~ Po eox 280001 pennsy vaha HARRISBURG PA 17128-0601 DEPARTMENTO EJE~JuE REV-1543 EX AFP (05 -i1) PENNSYLVANIA INHERITANCE TAX ..{I~ ~ORMATIDN NOTICE FILE N0. 21 ~ I (` ~~~~ ~ , L- ; ~'.Tj4XPAYERNRESPONSE ACN 11166071 DATE 10-06-2011 ~.'+ ~ '1 i GU ~ i i i~ ~ ~ TYPE OF EST. OF ANTHONY R MAYESKI ~ F ! i^~!' SSN 186-10-4655 ~ts ~-' ~ ~'t~ ~ l;~~ .'~T DATE OF DEATH 09 - 17 - 2011 (Jas ~~ ~ ~ ^~ ~~ COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: RUBY A MAYESKI REGISTER OF WILLS 500 SPRING HOUSE RD 1 COURTHOUSE SQUARE CAMP HILL PA 17011-1454 CARLISLE PA 17013 ACCOUNT SAVINGS © CHECKING TRUST CERTIF. CITIZENS BANK OF PENNSYLVANIA 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 art 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. 6100745074 Date 12-29-1988 To ensure proper credit to the account, two Established copies of this notice must accompany $ 5,594.57 payment to the Register of Wills. Make check Account Balance payable to "Register of Wills, Agent". Percent Taxable X 50.000 Amount Subject to Tax $ 2,797.29 NOTE: If tax payments are made within three months of the decedent's date of death, Tax Rate ~( , 15 deduct a 5 percent discount on the tax due. 4 1 9.5 9 Any inheritance tax due will become delinquent Potential Tax Due $ nine months after the date of death. PART TAXPAYER RESPONSE FAILURE Tt~ RESPOND WILL RlSULT IN ~ \ FFICIsA:I:° 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 CHECK 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. [ BLOC K ~ JJ B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return O N L Y fil d by the estate repre sentative. C. he above Complete informs ion is PART 2~ and/or incorrect and/or debts and deductions were paid. PART b l ~ e ow. PART It indicating a different ta~r,~teup~ase state relationship to decedent: ~U1~~// JJCC...• TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS 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 1 2 $ 3 X 4 +~ 5 - 6 $ 7 X 8 $ PAD OFFICIAL USE ONLY ~ AAF PA DEPARTMENT OF REVENUE 1 2 4 5 6 7 8 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 an d c lete to t he be of my knowledge and belief. HOME C ~~ y ~) /~/ " l [/ t ~ 7 70 // yy TA AY R SIGNATURE TELEPHONE NUMBER DATE IUTAL itnter on Line 5 of Tax Computation) $ c~ ~T i, > ~ :, ~a ~3 A vf:'~Smiv,n ~~}s. ~u ~. ,r ~i Y~ ~ ~^ s s s a ~ r~ ~~~~ ~; , . ~~^ ,.,,g 4{, ~1. j +^t' ^.~ } ' ,. i F !'v'' ~... j~`~~~ ".y ~ tAr !^~ D .` ~ \ h ~ ~~ ~~~~ ~~~ ~~~\ ~ ,~~ ~~~ rv U#' ~' ~~ ~ .i.~~J ClE ~t~ CF QRPHF~J'S Cr C11~~`_~ ~~,~~~~~ I`\~ (` `vw\~ I D `~ t 4~ D {`` J 1 5 ~~`.~ ~~~~1 ~ ~~~ 1 ~'.~ .i..~ 'h .~..~