HomeMy WebLinkAbout10-28-11. ~~.
~ PENNSYLVANIA INHERITANCE TAX
BUREAU OF INDIVIDUAL TAXES r, --, ~N~A R MAT I O N NOTICE F I L E
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HARRISBURG PA 17128-0601 DEPARTMENTOFR YEE}u6 AND ACN
~CPAYER RESPONSE DATE
REV-1543 EX AFP (OS -11)
N0. 21 _I~-- ~~~~
11166511
10-07-2011
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EST. OF LAURA D EDMUNDS
SSN 176-34-9020
CL~R`~ ~,~, DATE OF DEATH 08 - 31 - 2011
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C~)~!~~~~'~'_~'°A'<~(~~' ~~. PP. COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
SANDA 0 EDMUNDS REGISTER OF WILLS
2005 HARVARD AVE 1 COURTHOUSE SQUARE
CAMP HILL PA 17011-5428 CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
BELCO COMMUNITY CREDIT UNION 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 he 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. 123510 Date 07-27-2011
To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 56 ~ 601.65 payment to the Register of Wills. Make check
payable to "Register of wills, Agent".
Percent Taxable X 50.000
Amount Subject to Tax $ 28 ~ 300 .83 NOTE: If tax payments are made within three
months of the decedent's date of death,
Tax Rate X .045 deduct a 5 percent discount on the tax due.
Potential Tax Due $` 1 , 273.54 Any inheritance tax due will become delinquent
nine months after the date of death.
PART TAXPAYER RESPONSE
1^
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 ~
0 N L Y B. ~7V The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax r
t
fvled by the estate representative. e
urn
C. ~ The above informs ion is incorrect and/or debts and deductions were paid
Complete PART ~ and/or PART ~ below. .
PART if indicating a different tax rate, please state
relationship to decedent:
TAX RETURN - CALCULATION
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
OF TAX ON JOINT/TRUST ACCOUNTS
1
2 $
3 X
4
5
6 $
7 X
8 $
PAD
1
2
3
4
5
6
7
8
OFFICIAL USE ONLY ~ AAF
PA DEPARTMENT OF REVENUE
PART DEBTS AND DEDUCTIONS CLAIMED
3^
DATE PAID PAYEE DESCRIPTION AMr111 A1T owrn
Under penalties of perjury, I declare that the facts I reported above are true, correct and
compl to to the be my knowledge and belief. HOME C ~ ~
~ l' /~
~XPAYE SIGNATURE ~'~'l~ ~~
TELEPHONE NUMBER DATE
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