HomeMy WebLinkAbout12-06-11r',-r \r ,~~.
BUREAU OF INDIVIDUAL TAXESf
PD BDX 260601 @~
HARRISBURG PA 17128-0601 i 'p~p~RTMEN7 OFP
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REY-1543 EX RFP (05-11)
PENNSYLVANIA INHERITANCE TAX ~/
INFORMATION NOTICE FILE N0. 21 ~ II-~0
AND ACN 11178057
TAXPAYER RESPONSE DATE 11-28-2011
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' i t rc_l.~ _~ t i~f 1~ ~ TYPE OF ACCOUNT
1
EST. OF
WILLIAM I HINDERLITER
^ SAVINGS
C~E~~ ~~ SSN 172-30-2679 ^ CHECKING
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~ DATE OF DEATH 04-27-2011 ^ rRUST
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CI~FwiF'{-'J, rSr., ; ;~r~ ``,,
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~ COUNTY CUMBERLAND
CERTIF.
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t REMIT PAYMENT AND FORMS T0:
JANE E HINDERLITER REGISTER OF WILLS
# 5 1 COURTHOUSE SQUARE
6324 FORREST DR CARLISLE PA 17013
MECHANICSBURG PA 17050-2822
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. 1685280230 Date 12-21-2000 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance ~` 10 , 572.98 Payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 5, 286 .49 months of the decedent's date of death,
Tax Rate ~( , lrj deduct a 5 percent discount on the tax due.
Any inheritance tax due will become delinquent
Potential Tax Due $ 792.97 nine months after the date of death.
PART TAXPAYER RESPONSE
1
O D L FFY X~i1SSESS
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
C 0 N E ~ an official assessment will be issued by the PA Department of Revenue.
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. ~ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART ~ below.
PART If indicating a different tax ~~cc e, please state ~~ FI ~~ ON~L
relationship to decedent: J ~U' VSO
DEp/l~RZ`MEN'( DF REVENUE
TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS U~pAD
LINE 1. Date Established 1 1 .
-
2. Account Balance 2 $ 2 ~
3. Percent Taxable 3 X 3 _
4. Amount Subject to Tax 4 $ ,C. 0
5. Debts and Deductions 5 - 5
6. Amount Taxable 6 6
7. Tax Rate 7 X 7
8. Tax Due 8 $ ~ $
PART DEBTS AND DEDUCTIONS CLAIMED
^3
DATE P AID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I reported above are true, correct and
complete to the best f m k owledge and belief. HOME C 7/~ ) 7 6 ~ -' D E g d
WORK C ~ /a~~_ //
T XPAYER SIGNATURE TELEPHONE NUMBER DATE
TOTAL (Enter on Line 5 of Tax Computation) 8