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HomeMy WebLinkAbout12-28-11BUREAU OF INDIVIDUAL 7AXES PO BOX 280601 41ARRISBURG Pq 17128-8601 '~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE Pennsylvania AND oEPgRTME"rG~gEV~;~i '~~l'~PAYER RESPONSE REV-1543 E% AFP ~(p5-11) _ _~~ v =..+' ri; ~- CATHY ~~~~- ~ti? .; (~ ,~::,j S WATERS ~II~"_~ ~ ., ~~ 116 W HILLCREST DR CARLISLE PA 17013-1215 FILE N0. 21 11-0564 ACN 11179006 DATE 11-30-2011 EST. OF ROYAL S DONIVAN SSN 160-20-2591 DATE OF DEATH 05-04-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS © CHECKING TRUST CERTIF. SOVEREIGN BANK ecords indicate that at the death of the above-named decedent, provided the department with the information below, which was used in calculating the inheritance tax due. deceased and any amount other than zero is reflected below wonethe~Potentialb Tax~Dlueylinehlnote~nottaxlma 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, lease obtain written correction from the financial institution, attach a coypu are the spouse of the it to the above address. Please call 717-787p8327 with y be due, but you must COMPLETE PART 1 BELOW * questions. py to this form and return SEE REVERSE SIDE FOR FILING AND PAYMFNr ru~T.,.~,.______ Account No. nr.ollziz~~s --- ..,.., uace 10-21-2008 ----......,~ ~„~~ Established To ensure proper credit to the account, two Account Balance copies of this notice must accompany $ 1 ~ 176.19 Payment to the Register of Wills. Make check Percent Taxable X payable to "Register of Wills, Agent". Amount Subject to Tax 16.667 $ 1 9 6. 0 4 NOTE: If tax payments are made within three Tax Rate X months of the decedent's date of death, Potential TaX Due 15 deduct a 5 percent discount on the tax due. $ 2 9 . 4 1 Any inheritance tax due will become delinquent PART nine months after the date of death. 1^ TAXPAYER RESPONSE FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT A• ~ The above information and tax due is correct. C H E C K aediscounteor avoideinterest,~ or weturnwthistnoticelto thetRegistercoftWillsaand C 0 N E ~ an official assessment will be issued by the PA Department of Revenue. 0 N L Y B' ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return filed by the estate representative. C• The above informs ion is incorrect and/or debts and deductions were omplete PART 2~ and/or PART ~ below. paid. PART If inns .•~~:.._ _ ^ 2 - -----~,~y uirrerent relationship to decedent: to rate, please state TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST LINE 1 . Date Established 1 ACCOUNTS r®~ Z~`~ 2. Account Balance 2 $ n ~ ~ ,`~ (~ 3. Percent Taxable g X (le t!l~n~' 4. Amount Subject to Tax 4 $ ~ O(„~ 5. Debts and Deductions 5 - 6. Amount Taxable 6 $ ~(~ ©I , ~f 7. Tax Rate T X ~U- B. Tax Due $ $ ~62 ,0 DATE PAID PAYEE PAD 1 2 4 5 6 7 8 AIMED DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) Under penalties of ~ perjury, I declare that the facts I reported above are true, correct and q~P to to he est of my knowledge and belief. c/k. ~~~ HOME ( / ) ~5E3 - 7~~7 TAXPA ER SIGNATURE WORK ( ~ ) ~~ J jG TELEPHONE NUMBER ~ ~ ~~ ATE DEBTS AND DEDUCTIONS CL OFFICIAL USE ONLY ~ AAF PA DEPARTMENT DF REVENUE . -e ,;: ~, `f'+ p5 }i.( -~f~ ^'E /, ~ 5 ~~'+ {~ ~~ S.-, a ~~ 3 '~ h ' ~ 6 ~~~ ',~ ~~~ ~~~.~. I~ _`~S ` V V~ e~..~ O `~'q \~ \\\\l! ,_`vt' ~~, ~~ ~ ~. :~ ~ ~` "` j ,. ,v'v`1~.1 j,r'(•C~J ..~~~ ~,~.: .~~~ ;,.~ ~~,: ~~1 .ir ' - ~1: . ~ i 4`d tip r..:~ , sl .~., i"t •:-t