HomeMy WebLinkAbout01-17-12 (2)°.~ PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
FILE
BUREAU OF INDIVIDUAL TAXES ~. AN D AC N
PO BOX 280601 ~ennsylvania~~ ~ ~'=-
' `~y~ DATE
HARRISBURG PA 17128-0601 DEPARTMENT OF REVENUE" - ,~ T AXP AY E R R E S P O N
-REV-Y 543 Ex AFP (05-11) ' ~.,,J
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WILLIAM H LACKEY
35 LONGVIEW DR
MECHANICSBURG PA 17050-2722
EST. OF BETTY J LACKEY
SSN 235-38-3815
DATE OF DEATH 07-05-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
N0. 21 11-0771
12100920
01-05-2012
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
SOVEREIGN BANK provided the department with the information below, which was used in calculating the inheritance tax due.
deceaseddandtanyaamounte ther thanezeroeisareflectedtbelowwonethe~P tentialb TaxlDueylinehlnote~no tax mayo be due,hbut you must he
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. 1681727293 Date 11 - 17 - 1998 To ensure proper credit to the account, two
Established copies of this notice must accompany
payment to the Register of Wills. Make check
Account Balance $ 43,503.48 payable to "Register of Wills, Agent".
NOTE: If tax payments are made within three
Percent Taxable X 50.000
Amount Subject to Tax $ 21 r 751 • 74 months of the decedent's date of death,
X • 1 5 deduct a 5 percent discount on the tax due.
Tax Rate Anv inheritance tax due will become delinquent
Potential Tax Due $ 3 r 262 • 76 nine months after the date of death.
PART TAXPAYER RESPONSE
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT
H E C K A. ~ The above information and tax due is correct.
Remit payment to the Register of Wills with
a discount or avoid interest, or return this
an official assessment will be issued by the
two copies of this notice to obtain
notice to the Register of Wills and
PA Department of Revenue.
C ONE
B L 0 C K
0 N L Y
B. ~ The above asset has been or will be reported and
filed by the estate representative.
tax paid with
the Pennsylvania inheritance tax return
C. ~ The above informs ion is incorrect and/or debts
Complete PART ~2 and/or PART ~ below. and deductions were paid.
PART If indicating a different tax rate, please state
relationship to decedent:
TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. 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
R_ Tax Due $ $
PAD
OFFICIAL USE ONLY ~ AAF
PA DEPARTMENT OF REVENUE
1
2
3
4
5
6
7
8
DEBTS AND DEDUCTIONS CLAIMED
PART
DATE PAID PAYEE DESCRIPTION
AMOUNT PAID
TOTAL CEnter on Line 5 of Tax Computation) S
Under penalties of perjury, I declare that the facts I reported above are true, correct and t L
complete to the best of my knowledge and belief. HOME C 7~7 ) ~9 ~~ ~`~~
,~.f WORK C ~ r ri'7 f l r-
~t~~.,..,J /~ EXEC~7a DATE
TELEPHONE NUMBER
TAXPAYER SIGNATUR