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HomeMy WebLinkAbout01-09-12 (2)~' PENNSYLVANIA INHERITANCE TAX i INFORMATION NOTICE BuREau of IND1vIDUAL TAXES ~ FILE NO. 21 11-0971 Po Box zeacol p@i1I1S'~/tY~'1 AND ACN 11183202 HARRISBURG PA 1712E-sbol r~ oepnnn.+ewTOFeEVea~' TAXPAYER RESPONSE ~ DATE 12-21-2011 REY-1543 E7I AFP (OS-11] > i~_ - _ -, ~~:~ ((~~,,~ t E ELIZABETH K STONER 651 CANDLEWYCK RD LANCASTER PA 17601-2853 TYPE OF EST. OF RUSSELL F ELLENBERGER SSN 207-07-6629 DATE OF DEATH OS-13-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 ACCOUNT SAVINGS © CHECKING TRUST CERTIF. M & T BANK provided the departwent 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 ownerlbeneficiary of this account. If yoU 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. 30556503 Date 08-28-1964 To ensure proper credit to the account, two Established copies of this notice Bust accowpany 118 , 757.47 pavwent to the Register of Wills. Make check Account Balance $` payable to ^Register of Wills. Agent". Percent Taxable X 16.5b7 Amount Subject to Tax $ 19,793.31 NOTE:' If tax pavwents are wade within three wonths of the decedent's date of death, TaX Rate X . 15 deduct a 5 percent discount on the tax due. 2,969.00 Am inheritance talc due will becowe delinquent Potential Tax Due $ nine wonths after the date of death. PaT TAXPAYER RESPONSE 1 _., _ FAILURE.-TO-RESPOND-WILL RESULT-IN AN OFFICIAL TAX ASSESSMENT A. ~ The above inforwation and tax due is correct. Rewit paywent 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 assesswent will be issued by the PA Departwent of Revenue. B L 0 C K B. ~ The above asset has been or will be reported and tax paitl with the Pennsylvania inheritance tax return D N L Y filed by the esta#e representative. C. ~ The above inforwation is incorrect and/or debts and deductions were paid. Cowplete PART a and/or PART ~ below. PART If indicating a different tax rate, please state relationship to decedent: TAX RETURN - CALCULATION LINE 1. 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 OF TAX ON JOINT/TRUST ACCOUNTS 1 2 s $ X - 4 -- - . _ .- 5 6 7 X 8 $ pFFICIAL USE'ONLY ~ AAF PA DEPARTMENT``OF REVENUE PAD 1 2 __~_ 'Y_ .> _ ~~ 5 b 7- 8_ PART DEBTS AND DEDUCTIONS CLAIMED 0 TOTAL CEnter on Line 5 of Tax Computation) 6 Under penalties of perjury, I declare that the facts I reported above are true, correct and complete to a best of my knowledge and belief. HOME ~ ) <\~ ~,~-~- - . ~~ ~ ~ -~- e..s-4~, WORK ~. ~ ~ ~ a3F5' - ~~ 3 a.~ TAXPAYER SIGNATURE TELEPHONE NUMBER D E DATE PAID PAYEE DESCRIPTION AMOUNT PAID