HomeMy WebLinkAbout01-04-12BUREAU OF INDIVIDUAL TAXES
PD BOX 280601 ~,~ perh~~~il~i"rania
HARRISBURG PA 1712 0601`' DE PARTMENT, d~REVEN UE
-
REY-1543 E% AFP (05 -11)
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE FILE N0. 21 - I ~ ' vCJ1`~
AND ACN 11183764
TAXPAYER RESPONSE DATE 12-23-2011
C~~~,4~ ';~`~ F;T
•--ri,~ ,, ice) i-'(~
CYNTHIA ~',~~'MU~LLER
3801 CHIPPENHAM RD
MECHANICSBURG PA 17050-9127
EST. OF JAMES CRIBBEN
SSN 395•-16-319b
DATE OF DEATH 10-09-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
WELLS F ARG 0 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 Sp0U5e 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 i',ncorrect, please obtain written correction from the financial institution, attach a copy to this form and return
it to the above address. Please ca',11 717-787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
.Account No. 10102181393093 Date 10-31-2008
To ensure proper credit to the account, two
E stablished copies of this notice must accompany
Account Balance $ 12, 648 . 9b payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 50.000
Amount Subject to Tax $ 6, 324.48 NOTE: If fax payments are made within three
months of 1:he decedent's date of death,
Tax Rate ~( 1 rj deduct a 5 percent discount on the tax due.
Potential Tax Due
$
948 . b7 Any inheritance tax due will become delinquent
nine months after the date of death.
PART TAXPAYER RESPONSE
1^
W IL TE;~ ,,#tES .._. D' WILL'- RE~tl,Twm A~ I I:IAL. T S
A. ~ TFje above information and tax due is correct.
Remit payment 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 and
0 N E an official assessment will be issued by the PA Department of Revenue.
B L 0 C K ~
O N L Y B. ~Xj Trye 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 paid.
Cqmplete PART 2~ and/or PART 3~ below.
PART it indicating a different tax rate, Please state \
~
relationship to decedent: UFF CIAL
US ONLY
AA
f'A DCP~If~~ltCf~IT- OF REVENUE
TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS pp,~ ,~
LINE
1.
Date Established 1 ~
1 -
2. Account Balance 2 $ 2
3. Percent Taxable 3 X ~ ~ ~ '
i
4. Amount Subject to Tax 4 $ k
~ 4
5. Debts and Deductions 5 - 5
6. Amount Taxable 6 $ b
7. Tax Rate 7 X 7 -
8. Tax Due 8 $ 8
,.
PART DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE DESCRIPTION eMnnuT aern
=,(~r( can pine ~ or iax [;omputation) S
Under penalties of perjury, I declare that the facts I reported above are true, correc and
omplete to the best of my kn w edge and belief . HOME C ) cj~- ~6 9~
WORK C ) ~-(-(Z
X YER SIGN URE TELEPHONE NUMBER DATE
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