HomeMy WebLinkAbout10-26-11 (2)BUREAU OF INDIVIDUg4.TAXES
PO BOX 280601 ;-~-'.
HARRISBURG PA 171'28: 0601
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penr~vania
DE PARTMENY~6F REVENUE
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REV-1543 E% AFP (05-11)
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE FILE N0. 21 ' ll- l ~~~
AND ACN 11166736
TAXPAYER RESPONSE DATE 10-10-2011
` ~ 1 EST. OF GEORGE R OTTO
SSN 197-24-3060
~~,: ~~
'~"~.'vt `" • '.-" DATE OF DEATH 0 9 - O 1 - 2 011
Lf" ~_ ` ~ ~~' 1 COUNTY CUMBERLAND
C,-~~ ~`4 REMIT PAYMENT AND FORMS T0:
REETA OTTO REGISTER OF WILLS
106 SUNSET DR 1 COURTHOUSE SQUARE
NEW CUMBERLAND PA 17070-3059 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 jue.
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 muss
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 farm and return
it to the above address. Please call 717 787-8327 with puestions.
COMPLETE PART 1 BrLOW * SEE RE\itRSE SYDE FOR FILING AND PAYMENT' INSTRUOTIONS
Account No. 6100901661 Date 02-23-1995 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance 27 780.53 payment to the Register of Wills. Make check
ty ~ payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 13, $90.27 months of the decedent's date of death,
Tax Rate ~( lrj deduct a 5 percent discount on the tax due.
Any inheritance tax due will become delinquent
Potential TaX Due ~` 2, 083.54 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
C 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
0 N L Y filed by the estate representative.
C. •~The above informs ><on 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
relationship to decedent: ~~ i;S E~-
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
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
^S
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I
compkete to the best of my knowledge and belief.
~~ _. ~ l it fZ'
TAXPAYER SIGNATURE
reported above are true, corrGect and
HOME C !~~) %"_~U- (~~-S~~
WORK C ) l`L'>~~~-4~~~ /~
TELEPHONE NUMBER DATE
TOTAL (Enter on Line 5 of Tax Computation) S