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Home My WebLink About10-24-11 (8)BUREAU OF INDIVIDUAL TAXES PO BOX 260601 HARRISBURG PA 17128-0601 ~~ penny !va'na DEPARTMEN?t`O,E REVENUE I~'^-~'- REV-1543 E% AFP (05-11) PENNSYLVANIA INHERITANCE TAX ~' ~,NFORMAT~I DN NOTICE FILE N0. 21 11-0991 ACN 11167553 !,. TAXPAYER RESPONSE DATE 10-13-2011 EST. OF MARY R DUNLEVEY CC SSN 166-14-9832 ~~L~~ ~,r ~~,.n ;.~~,~ ~~7 DATE OF DEATH o8-28-2011 ~Rr~~H~, v ~'`'" ~ COUNTY CUMBERLAND Cl/ 1r'~~ ~ ~ r 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 y0U 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-S51 Date 11-09-2005 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance $ 13, 023.32 payable to "Resister of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax ~` 6 ~ 511.66 months of the decedent's date of death, Tax Rate X .045 deduct a 5 Dercent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due $ 293.02 nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO RESPDND 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 BLOC K B. ~ihe 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 3^ 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 $ 2 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ 4 5. Debts and Deductions 5 5 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X 7 8. Tax Due 8 +fi 8 PART DEBTS AND DEDUCTIONS CLAIMED ^3 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I reported above are true, ycorrect and comple to the best of my knowledge and belief. HOME C~/~ ) /~ j ~ ~(p~ /U,L~h... WORK ( ) l6 TAXPAYER SIGNATURE -' TELEPHONE NUMBER DATE TOTAL (Enter on Line 5 of Tax Computation) S