HomeMy WebLinkAbout11-02-11~~ PENNSYLVANIA INHERITANCE TAX ff n~7
INFORMATION NOTICE FILE N0. 21-- ~1- 11 I I
BUREAU OF INDIVIDUAL TAXES AN D
Po Box zao6ol @(~ ~i 1'}l~d ; • ~ ACN 11169162
HARRISBURG PA nlze-o6o1 p ~'- `r ~~AXPAYER RESPONSE
DEPARTMEyT,sF REVENUE. - ;I ~ ~, DATE 10-21-2011
REV-1543~Ex-Aff G05 U-:) ~ .. L~J
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COLLEEN M MCCARTHY
243 STONER RD
MECHANICSBURG PA 17055-9603
EST. OF CELIA B FARRELL
SSN 195-16-6849
DATE OF DEATH 10-04-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
MEMBERS 1ST FC U 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 :s 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.
-: _._ _._~._~_ _...__..~-~. r---
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 203728-11
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
Date 09-19-2007
Established
~ 3,381.29
X 50.000
$ 1,690.65
X .045
g 76.08
To ensure proper credit to the account, two
copies of this notice wust accowpany
paywent to the Register of Wills. Make check
payable to "Register of Wills, Agent".
NOTE: If tax paywents are Wade within three
wonths of the decedent's date of death,
deduct a 5 percent discount on the tax due.
Any inheritance tax due will becowe delinquent
nine wonths after the date of death.
A. ~ The above inforwation and tax due is correct.
Rewit pavsent 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
an official essesswent will be issued by the PA Departwent of Revenue.
C ONE
B L 0 C K B. ~ 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. ~e above inforwa ion is incorrect and/or debts and deductions were iaaid.
Cowplete PART 2~ and/or PART ~ below.
PART If indicating a different tax rate, please state ~ `t
2 relationship to decedent: `~~~ ';~;
~;~
TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAp ~`'
LINE 1. Date Established 1 1
2. Account Balance 2 $ 3351. dq z ~ ` `~~~
X
S. Percent Texabl• 3
4. Amount Subject to Tax 4 ~ ~ _ ~~}
5. Debts and Deductions 5 - ~ ~ ~~~ D b 5
6. Amount Taxable 6 $ 6
7. Tax Rate 7 X ~'~
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8. Tax Due 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
com lete to the best of my knowledge and belief. HOME C"]~7 ) ~Q/-Saa9 \~
WORK ( ) /~ ~"
-XPAYER SI NAT E TELEPHONE NUMBER DATE
TOTAL CEnter on Line 5 of Tax Computation) S
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