HomeMy WebLinkAbout10-24-11 (3)~, PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE FILE NO. 21 11-0991
BUREAU OF INDIVIDUAL TAXES C r';
Po eox zso6ol ~~r~.~lVania ~I ~- ~~ AND
ACN 11167312
HARRISBURG PA 17128-0601 DEP~RTME TOFREVENUE ~', ~ TAX P AY E R R E S P O N S E
.._v DATE 10-12-2011
REV-1543 E% AFP (05-11)
n t• TYPE OF ACCOUNT
EST. OF MARY R DUNLEVEY ~ SAVINGS
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~~ $SN 166-14-9832 ^ CHECKING
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~~~ DATE OF DEATH 08-28-2011 ^ TRUST
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REMIT PAYMENT AND FORMS T0:
CHARLES DUNLEVEY REGISTER OF WILLS
3423 BEDFORD DR 1 COURTHOUSE SQUARE
CAMP HILL PA 17011-2714 CARLISLE PA 17013
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 art 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-$7 Date 10-09-2001 To ensure proper credit to the account, two
Established copies of this notice must accompany
ACCOUnt Balance 6 8 5. 0 8 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 $ 342.54 months of the decedent's date of death,
Tax Rate ~( .045 deduct a 5 percent discount on the tax due.
Any inheritance tax due will become delinquent
Potential Tax Due $ 15.41 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
CHECK 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.
BLOCK B. ~"rIrLF 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 incorr~ect and/or debts and deductions were paid.
Complete PART 2~ and/or PART IJ below.
PART If indicating a different tax rate, please state OFFICIAL USE ONLY ^ AAF
relationship to decedent: PA DEPARTMENT OF REVENUE
TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD
LINE 1. Date Established 1 1
2. Account Balance 2 $ Z
3. Percent Taxable 3 X 3 -
4. Amount Subject to Tax 4 $ 4
5. Debts and Deductions 5 S
6. Amount Taxable 6 $ (,
7. Tax Rate 7 X 7
8. Tax Due 8 $ 8
PART DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I reported above are true, correct and
co to to the best of my knowledge and belief. HOME C ~~~) ~ l1 ~ ~ ~~G
WORK C ) /~J '~ ~/
XPAYER SI NATU E TFI FPHf1NF NIIMAFR I1oTF ~
TOTAL CEnter on Line 5 of Tax Computation) 8