HomeMy WebLinkAbout10-24-11 (2)• ~ PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE FILE N0. 21 11-0991
BUREAU OF INDIVIDUAL TAXES r
Po eox 2eo6ol pe1111i(~1`1l~ p ~F L!" AND ACN 11167311
HARRISBURG PA 17128-0601 oEFARTMENT,.DFREVENUE '1 ': TAX P AY E R R E S P O N S E
~~ DATE 10-12-2011
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EST. OF MARY R DUNLEVEY
SSN 166-14-9832
DATE OF DEATH 08-28-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
CHARLES DUNLEVEY REGISTER OF WILLS
3423 BEDFORD DR 1 COURTHOUSE SQUARE
CAMP HILL PA 17011-2714 CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
PSECU 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. 0166149832 Date 11-25-1986 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance 1 , 136.75 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 $ 568.38 months of the decedent's date of death,
TeX Rate X .045 deduct a 5 percent discount on the tax due.
Any inheritance tax due will become delinquent
Potential Tax Due $` 25.58 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
BLOCK B. ~ The above asset has been ar 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 OF TAX ON JOINT/TRUST ACCOUNTS
LINE I. 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 true, correct and
comp a to the best of Iny knowledge and belief.
` HOME C ~ ~ ~ ) ~ ~~ ~ ~ ~a d
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~
~ WORK C ) ~(J •-Z Sl~~~
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,XPAYER SIGNATURE TELEPHONE NUMBER DATE
~
~U,A~1-,
TOTAL CEnter on Line 5 of Tax Computation) S