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Home My WebLink About11-18-11 (4)B PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE NO. 21 11-0083 BUREAU OF INDIVIDUAL TAXES pennsylva~~' n~~ r "' AND Po box 260601 ACN 11003596 HARRISBURG PA 17126-0601 oePAaTMEN70FREYEf+k~E- ~ ;~ TCAYER RESPONSE DATE 11-08-2011 YEY-1543 E% 4FP (r5-Il) ~"- -.'~.~J >>r'1 firaV I ~ F"' I~' CLERK a~ oRP~an,~-s cau~r CIIMBF~L tis'VD r~ ~ Pq EMILY A BROWN 124 1/2 E HIGH ST HUMMELSTOWN PA 17036-2303 ~iEST. OF JUDITH E POGUE SSN 204-30-7433 DATE OF DEATH 01-11-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. SUN LIFE FINANCIAL IRA 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 ,l pint owner/beneficiary of this account. If you ere 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 end writing "spouse" in PART 2. If you believe the information is incorrect. Dl ease 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. - - ~ONPLETE PART 1 BELOW w SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 1212501718D6 Account Balance Percent Taxsble Amount Subject to Tax Tax .Rate Potential Tax Dua Date 01-11-2011 Established S 9,779.32 X 100.00 $ 9,779.32 X .045 $ 440.07 To ensure proper credit to the account, two copies of this notice oust aeewparo payment to the Resister of Wills. Make check payable to "Resister of Wills, Asent". NOTE: If tax payments era made within three months of the decedent's data of death. detluct a 5 percent discount on the tsx duo. Arty inheritance tax due will become delinquent nine wonths after the dat• of death. A. ~ The above information and tax due is correct. Resit payment to the Resister of Wills with two copies of this notice to obtain a discount or avoid interest, or return this notice to the Resister of wills and CH E C K an official assessment will be i ssued by the PA Department of Revenue. C 0 N E ~ BLOC K 6. ~ The above asset has bean or will be reported and tax paid with the Pennsylvania inheritance tax return 0 NL 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 Lf indicatin6 a different tax rate, please state relationship to decadent: TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Data Established 1 2. Account Balance 2 ~ 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 ~ 5. Debts and Deductions 5 - 6. Amount Taxable 6 ~ 7. Tax Rate 7 X 8. Taz Dua 8 ~ PART DEBTS AND DEDUCTIONS CLAIMED $^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I da dare that the facts I reported above are true, .ceo~r rect angtlQ ncompla'tI• to/~he best of my knowledge and belief. HOME (~~ ) 3~ '-~O 1 '1 n.L~.(A/L //S~li-rf...I~t_i WORK (~~ ) -~i S~"~S` f~ .Ie ,/