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HomeMy WebLinkAbout10-25-11BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 ,_~ pennsylvania DEPARTMENT OF REVENUE. REV?I•~,3-Ek ~~FP_(05 -11J PENNSYLVANIA INHERITANCE TAX ff INFORMATION NOTICE FILE N0. 21~ I I "~' i~j _ AND ACN 11168512 / ~ _,; .- ~} TAXPAYER RESPONSE DATE 10-18-2011 fit'.. ~v ,a C..) ., .E ....,, ~;~ %; C ~~ KENNETH W RIDER ~~~~_~ I , , , .~i~S ~~ 108 STANDLAKE WAY MECHANICSBURG PA 17055-9241 EST. OF MARTHA K RIDER SSN 162-22-6901 DATE OF DEATH 02-22-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF 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 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. 6100682900 Date 06-06-1966 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance ~` 6 , $ 1 1.23 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 TeX $ 3,405.62 months of the decedent's date of death, Tax Rate ~( , lrj deduct a 5 percent discount on the tax due. 5 1 0 . 8 4 Anv inheritance tax due will become delinquent Potential Tax Due ~` 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 0 N L Y B. ~ The above filed by asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return the estate representative. C. ~ The above Complete informs ion is PART 2~ and/or incorrect and/or debts and deductions were paid. PART 3^ below. PART If indicating a different tax ra please state relationship to decedent:Q tJ ~`P 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 3 4 5 6 7 8 PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I reported above are ue, correct and com le a to the best of my knowledge and belief. / // r-~ HOME C 7( ~ ~O~P -' - ~ .l ,~ WORK C ) - ~ ~XPAYER SIGNATURE TELEPHONE NUMBER DATE TOTAL (Enter on Line 5 of Tax Computation) 8