HomeMy WebLinkAbout01-04-12BUREAU OF INDIVIDUAL TAXES I O N N O T I C E
PD BDx zaB6gl pe~vania AND
HARRISBURG PA I7r7;i~s~ beo7.~' TAXPAYER RESPONSE
~ '. - DEP/~RTMEN~ OF REVENUE
-,i ~ REV+1546 ~Gd( AFP (05.11)
FILE N0. 21 11-0781
ACN 11181030
DATE 12-13-2011
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HARRY L MITTEN
6278 SPRING KNOLL DR
HARRISBURG PA 17111-6893
EST. OF HARRY F MITTEN
SSN 188-12-5067
DATE OF DEATH 07-05-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
® savlNGs
CHECKING
TRUST
CERTIF.
PNC BANK NA 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.~F~XERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 5000970499 Date 04-18-2011
To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 1 ~ 382.00 payment to the Register of Wills. Make check
Percent Taxable payable to "Register of Wills, Agent".
X 100.00
Amount Subject to Tax ~ 1 i 382. ~0 NOTE: If tax payments are made within three
months of the decedent's date of death,
Tax Rate )( .045 deduct a 5 percent discount on the tax due.
Potential Tax Due $ 62.19 Any inheritance tax due will become delinquent
PART nine months after the date of death.
TAXPAYER RESPONSE
AIl:WtE"'~'D '.RESPOND WILL'' R£SUL't IN 11tt° tiFF'ICIAL TAX ASSES T
A. ~ The above inforoation and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
C CHECK a discount or avoid interest, or return this notice to the Register of Wills and
0 N E J 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.
Cowplete PART ~2 and/or PART 3~ below.
PART If indicating a different tax rate, please state
relationship to decedent:
TAX RETURN - CALCULATION
LINE I. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
~ PENNSYLVANIA INHERITANCE T
INFORMAT
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3 X
4 ~
5
6
7 X
8
OFFICIAL USE ONLY ~ F
PA' DERAR'~'I~ENT'Of it£YE~{UE ~
PAD. ,
~ ',
'2_
. 3
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5
,I 6
7 _.,
e
s
PART
DATE PAID PAYEE
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation) g
Under penalties of perjury, I declare that the facts I reported above are true, correct and
c p ete to the best my knowledge and belief.
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