HomeMy WebLinkAbout11-22-11 (3)BUREAU OF INDIVIDUAL TAXES
PO BDX 280601 t. F QF
HARRISBURG PA 17128-0601 - ~ i t _
~EPAF,,.~..~;R11Ey€~E;-:. ,,.,.,1 ^ TAXPAYER RESPONSE
REY-154a~RAP/ '(~S-Y1 )~~ ~
PENNSYLVANIA INHERITANCE
INFORMATION NOTICE
1'''~~~a 'rr~ ~ AND
TAX
FILE N0. 21 11-0083
ACN 11003600
DATE 11-OS-2011
LU11 i°~uV C~2 ~~I ~ ~~~ ~r a
ORPyR~Rg aOURT
Y ~-p ClJMBP~L.4NG CO., Pq
DAVID V ~ POGUE
1201 SCENERY DR
MECHANICSBURG PA 17050-1942
EST. OF JUDITH E POGUE
SSN 204-30-7433
DATE OF DEATH 01-11-2011
COIINTY CUMBERLAND
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
^ TRUST
CERTIF.
LINCOLN FINANCIAL ANNUITY providetl the department with the information Gel ow, which was used in calculating the inheritance tax due.
Records indicate that at the death of the above-named decedent, you were a Jofnt owner/beneficiary of this account. If you are the Spouse of the
deceased and any amount other than zero 1s 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 DeloW and Wrlttng "spouse" 1n PART 2.
If you believe the information is incorrect, Dl ease obtain written correction from the financial institution, attach a coDY to this form and return
it to the above address. Please call 717-787-8327 with Questions.
CONPLETE PART i $ELOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 924473096
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
Date 01-11-2011
Established
$ 86,191.33
X 25.OD0
$ 21,547.83
X .045
$ 969.65
To ensure proper credit to the account, two
copies of this notice ^ust accowp aflir
paywsnt to the Register of Wills. Make check
payable to "Register of Wills, Agent".
NDTE, If tax paywents are wade within three
wonths of the decedent's dat• of tleath.
deduct a 5 percent discount on the tax due.
Aro inheritance tax due will becowe delineuent
nine wonths after the date of death.
A. lYl Tha abeva inforwation and tax due is correct.
{~ Rewit Daywent 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 end
an off iciel assesswent will b• issuetl by the PA Departwent of Revenue.
C ONE ~
BLOC K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return
ONL Y filed by the estate representative.
C. ~ The above informs eon 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
relationship to decadent:
TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date 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. Taz Rate 7 X
8. Tax Due 8
PART DEBTS AND DEDUCTIONS CLAIMED
DATE P AID PAYEE DESCRIPTION AMOUNT PAID
TOTAL CEnter on Line 5 of Tax Computation) 6 \,,f
Under penalti e/s~ of perjury, I deals re that the facts I reported above are true, eo r/~rect and ,~`\V yV~
complete ~th~est of my knowled9a and belief. HOME C7~7 ) 7gOp'~5~~
/!U LA`,LC_l~!=! WORK ( ) ~ ~ ~
TAXPAYE S~IIGNA RE TELEPHONE NUMBER DA" TE, 1~