HomeMy WebLinkAbout10-24-11-~ PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE FILE N0. 21 11-0991
BUREAU OF INDIVIDUAL TAXES A N D
Po Box 2so6o1 Pennsylvania ACN 11167310
HARRISBURG PA 17128-0601 P~ ,~, Y TAX P AY E R R E S P O N S E
PAftTMENT DF R~YEa E
NSF , ,.., ,, _. DATE 10-12-2011
REV-1545 EX RFP (05 ,11~
OFPNtERY ~F.i!~T
CHARLES D~~~{~~ ~'^~;~~ ~, {,} ~A
3423 BEDFORD
CAMP HILL PA 17011-2714
EST. OF MARY R DUNLEVEY
SSN 166-14-9832
DATE OF DEATH 08-28-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
PSE CU 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 yDU 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. 0166149832-S1 Date 11-25-1986 To ensure proper credit to the account, two
Established copies of this notice must accompany
ACCOUnt Balance 356.99 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 ~` 17$.5U months of the decedent's date of death,
Tax Rate X . 045 deduct a 5 percent discount on the tax due.
Any inheritance tax due will become delinquent
Potential TaX DUe $ 8 • U3 nine months after the date of death.
PART TAXPAYER RESPONSE
FAILURE TD 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
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 ion is incorrect and/or debts and deductions were paid.
Complete PART ~2 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
OFFICIAL USE ONLY ~ AAF
PA DEPARTMENT OF REVENUE
1
2
3
4
5
6
7
8
PART
DEBTS AND DEDUCTIONS CLAIMED
TOTAL CEnter on Line 5 of Tax Computation) S
Under penalties of perjury, I declare that the facts I reported abovea7re true, correct and
c plete to the bes~my knowledge and belief. HOME C / 1 7 ) ~ (O -3 ~~ ~~ G
-~/ --- WORK ( ) /Q --Z -//1,,,~_
TAXPAYER SIGNATURE
LEPHONE NUMBER
DATE ~-
DATE PAID PAYEE DESCRIPTION AMOUNT PAID