HomeMy WebLinkAbout11-03-11BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
DEPARTMENT OdIS~YENtlE
,I
REV-1343 EX qFF `rl ~~"-~}t]
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE FILE No. 21 '- I l '~~~3
- ~ ~. ~1,'~ AND
~ PAYER RESPONSE ACN 11169411
~'.~,~ DATE 10-24-2011
..` i ~ f w ~ lt! ' •.J ~~t F i ~ ~ • ~.i C5
CLERK a^^~
ORPFi,~l~l'S CC~.~ftT
ELEANOR SEAMAN CIJ~.~F,t ~{';,.~~`±~; ,~~'~) PA
1210 SUSQUEHANNA ST
HARRISBURG PA 17102-2753
EST. OF CLARK R SEAMAN
SSN 163-22-8619
DATE OF DEATH 03-14-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
SOVEREIGN BANK 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. 0354004251 Date 03-05-1982
To ensure proper credit to the account, two
Established copies of this notice roust accompany
Account Balance $ 1 , 942.36 paywent to the Register of Wills. Make check
Percent Taxable X payable to "Register of Wills, Agent".
50.000
Amount Subject to Tax $ 971.18 NOTE: If tax paywents are wade within three
Tax Rate wonths of the decedent's date of death,
X . 1 5 deduct a 5 percent discount on the tax due.
Potential Tax Due $ 145.68 Any inheritance tax due will become delinquent
nine wonths after the date of death.
PART
TAXPAYER RESPONSE
ILUR•: TQ SPlfND W L 7t UL I N flFFI , L 'fAX SSES T
A. ~ The above info t'
rwa ion and tax due 1s correct.
CHECK Rewit paywent to the Register
a discount or av
id i of Wills with two copies of this notice to obtain
0 N E o
nterest,
an official assesswent will be or return this
is
d b notice to the Register of Wills and
C
~ sue
y the PA Departwent of Revenue.
B L 0 C K
0 N L Y B. ~ The above asset has been or will b e reported and tax paid with th
P
filed by the estate representative e
ennsylvania inheritance tax return
C. dThe
ab
i .
ove
nforna ion is incorrect
Cowplete PART ~2 and/or PART 3^ and/or debts and deductions
b
l were paid.
e
ow.
rnKi ar indicating a different
relationship to decedent tax rate, please state
Q(L~
P
nFE'
\
: ~
~ II:IAL 115E O
L ~F°
TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ~~ t1fPAKTNENi' OF REYEttUE
LINE
1.
Date Established
1 ACCOUNTS 0
PAD
1
2. Account Balance 2 $
u
3. Percent Taxable 3 X x
4. Amount Subject to Tax 4 ~` "~`' ~
5.
Debts and Deductions 5
- 4 ~ -
6. Amount Taxable 6 $ ~ ~
7. Tax Rate
7
X 6
8. Tax Due 8_ $
~ ~ 7
~ s ~ ,
PART
DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION
AMOUNT PAID
TOTAL CEnter on Line 5 of Tax Computation) g
Under penalties of perjury, I declare that the facts I reported above are true, correct and ~
~ete to the best f my knowledge and belief. % ~
L lea^0i~ti0ME C 7~7 , a3g_l8b 7
~ ~ ` ~' ~~> L~vC., Do~i~ {,+rr -we~r~c c 7 ~ 7 ~ 9 ~! Y - y 3'~l -/-I 1
TAXPAYER SIGNATURE //
L.Ofe}trn t'YI~~TELEPHONE NUMBER DA'T~
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