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HomeMy WebLinkAbout12-20-11~` PENNSYLVANIA INHERITANCE TAX BUREAU OF INDIVIDUAL TAXES ~ INFORMATION NOTICE PD eox zeo6ol ~11t15y~V~111'~ (}'~" AND ACNE N0. 59 ~ ~ - ~/ _/.3 3 3 HARRISBURG PA l~lza-o6ol 11178994 DEPARTMENT OF REVENUE - in TAXP AY E R R E S P O N S E REY-1543EX AFP'(OS-111 -~-~ ~ DATE 1 1- 3 0_ 2 0 1 1 ,_ IJ L V $ C 1 I C. ~a.~ 4't L. ~` FRANK J TEZAK 8 ANNETTE DR ENOLA PA 17025-1801 EST. OF FRANK J TEZAK SSN 193-12-9209 DATE OF DEATH 11-16-2011 COUNTY PERRY REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS P 0 BOX 223 NEW BLOOMFIELD PA 17068 TYPE OF ACCOUNT X~ SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST FCU 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 yoD 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 I BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 266483-00 Date 06-17-2005 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 2,541.48 payment to the Register of Wills. Make check Percent Taxable X payable to "Register of Wills, Agent". 16.667 Amount Subject to Tax $ 423.59 NOTE: If tax payments are made within three Tax Rate months of the decedent's date of death, X . 0 4 5 deduct a 5 percent discount on the tax due. Potential Tax Due $ 19.06 Any inheritance tax due will become delinquent nine months after the date of death. PART ~ 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 Remit payment to the Register of Wills with a discount or avoid i t two copies of this notice to obtain n erest, or return this an official notice to the Register of Wills and C 0 N E ~ assessment will be issued by the PA Department of Revenue. B L 0 C K ONLY g, ~}i The above asset has been or will be reported and ~i tax paid with th P filed by the estate representative. e ennsylvania inheritance tax return PA I f C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART ~2 and/or PART 3LJ below. RT l,iuica a ng a airrerent tax rate, please state relationship to decedent: TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS 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 1 2 3 X 4 5 - 6 7 X 8 $ OFFICIAL USE ONLY ~ AAF PA DEPARTMENT OF REVENUE PAD 1 2 3 4 5 6 7 8 DATE PAID PAYEE DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) g Under penalties of perjury, I declare that the facts I reported above are true, correct and complete to the best of my knowledge and belief. l i HOME c -~ ~ ~ ~ '73 z ~ 3d~r ~ i~~~ ~ WORK ( ~ ~. TAXPAYER S NATURE TELEPHONE NUMBER Herr '/ /j~ PENNSYLVANIA INHERITANCE TAX BUREAU OF INDIVIDUAL TAXES _ ~•' I N F O R MA T I O N N O T I C E Po Box 2BO6o1 AND FILE N0. ~$~i ~ //-/'3 ~ HARRISBURG PA 17128-0601 pE~f'~S~/~Va111a ~ ~ ~f ACN 11179675 DEPARTMENT;OF REVENUE ~ r TAXPAYER RESPONSE REV'-i54~iEXAFP (OS-11) -.. ~ DATE 1 2- 0 6- 2 0 1 1 r. ;'. ._ r'~~ -i _ J i.: ~ P Cll '~ ~_ FRANK J TEZAK III 25 COVE RD DUNCANNON PA 17020-9514 EST. OF FRANK J TEZAK SSN 193-12-9209 DATE OF DEATH 11-16-2011 COUNTY PERRY REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS P 0 BOX 223 NEW BLOOMFIELD PA 17068 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. CITIZENS BANK OF PENNSYLVANIA 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 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. 6100710955 Date 11-09-1984 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $• 36 ~ 268.93 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 50.000 Amount Subject to TaX ~` 18 ~ 134.47 NOTE: If tax payments are made within three months of the decedent's date of death, Tax Rate ~( deduct a 5 . 1 5 percent discount on the tax due. Potential Tax Due $ 2 ~ 720.17 Any inheritance tax due will become delinquent nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT 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 Will C 0 N E ~ an official assessment will be issued by the PA Department s and of Revenue. B L 0 C K 0 N L Y B. ~ The above asset has been or will b e reported and tax Paid with the Penns lv i filed by the estate representative . y an a inheritance tax return C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART ~ 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 a X 4 5 6 7 X E $ OFFICIAL USE ONLY ~ qAF PA DEPARTMENT OF REVENUE PAD 1 2 3 4 5 6 7 8 PART DATE PAID PAYEE DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION TOTAL CEnter on Line 5 of Tax Computation) S AMOUNT PAID Under penalties complete to the of perjury, I declare that the facts I best of reported above are true, correct and `~ J " my knowledge and belief. 7 ~ ~~ -+ -i~- H O M E C ""7 1 ~) 7~ z "" x'~ b ~: /~. ~ ~, I"mo 1 -r `` / W O R K C ) XPAYER SIGN URE TELEPHONE NUMBER DATE -~ PENNSYLVANIA INHERITANCE TAX BUREAU of INDIVIDUAL rnxES . ~ INFORMATION NOTICE PD eox 280601 . ~ ` pEinnS~/LVa~1a AND FILE HARRISBURG PA 17128-0601 1 ~ A C N - bEP"R'"'ENT~R~,~"~E TAXPAYER RESPONSE REV-1543 EX AFP (05-11) DAT E .. C'~ ~ ": .. ~ ~ ~ ., d n' ~ ~;~ ULLrt. , l_; Cpl , - r~ FRANK J TEZAK 8 ANNETTE DR ENOLA PA 17025-1801 N 0. sre ,~ 1- i l -% 3 ~3 11178996 11-30-2011 EST. OF FRANK J TEZAK SSN 193-12-9209 DATE OF DEATH 11-16-2011 COUNTY PERRY REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS P 0 BOX 223 NEW BLOOMFIELD PA 17068 TYPE OF ACCOUNT SAVINGS © CHECKING TRUST CERTIF. MEMBERS 1ST FCU 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 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. 266483-11 Date 06-17-2005 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 14,709.81 payment to the Register of Wills. Make check Percent Taxable X payable to "Register of Wills, Agent". 16.667 Amount Subject to Tax $ 2,451.68 NOTE: If tax payments are made within three Tax Rate months of the decedent's date of death, X . 0 4 5 deduct a 5 percent discount on the tax due. Potential Tax Due $ 110.33 Any inheritance tax due will become delinquent nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT' A. ^ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice t C H E C K a discount or avoid interest, or return this notice to th o obtain R C 0 N E an official assessment will be issued by the e PA Departm t egister of Wills and f ~ B L 0 C K 0 N L Y B. The above asset has been or will be reported and en tax paid with o Revenue. th P filed by the estate representative . e ennsylvania inheritance tax return PART If indicating a different tax rate, please state relationship to decedent: TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS LINE I. Date Established 1 2. Account Balance 2 $ 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 $ 5. Debts and Deductions 5 6. Amount Taxable 6 $ 7. Tax Rate ~ X 8. Tax Due g $ PART DATE PAID C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART ~ and/or PART 3^ below. DEBTS AND DEDUCTIONS CLAIMED PAYEE 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 complete to the best of my knowledge and belief. - / HOME c /7) 7 323 ~~~t~' ~,(. WORK C ) ~ TAXPAYER SI ATURE TELEPHONE NUMBER DATE `' OFFICIAL USE ONLY ~ AAF PA DEPARTMENT OF REVENUE PAD 1 2 3 4 5 6 7 6