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HomeMy WebLinkAbout01-17-12BUREAU OF INDIVIDUAL TAXES Po Box zaosol p@n~~1~~tl~a' HARRISBURG PA 17128-0601 DEPARTMµ7''T-~06 REVENk1E REV-1545 E7(~Afp ~(D5-11) PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE N0. 21 ,', `;~ AND ACN 12101210 ,;~~ TAXPAYER RESPONSE _ DATE 01-06-2012 ( ~ , ~ ~.. CLEE~{ ~,~~ Cl)r r ;"ti is t / N/-( KAREN J COMP 13 MILLERS GAP RD ENOLA PA 17025-1008 EST. OF DAVID ]: COMP SSN 204-30-9300 DATE OF DEATH 07-13-2011 COUNTY CUMBERLAND REMIT PAYMENT AND f~ORMS TD: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. SD VEREIGN BANK 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 thi;> 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 BEL01V ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 2471705448 Date 09-06-1997 To ensure proper credit to the account, two Established copies of this notice oust accompany Account Balance $ 40,256.40 payment to the Register of Wills. Make check Percent Taxable X payable to ''Register of Wills, Agent". 50.000 Amount Subject to Tax $ 2U, 128.20 NOTE: If tax payments are made within three Tax Rate months of the decedent's date of death, X . 1 5 deduct a 5 percent discount on the tax due. Potential Tax Due $ 3, 019.23 Any inheritance tax due will become delinquent nine months after the date of death. PART TAXPAYER RESPONSE 1 AILURE : TO ESPOND,~ 1iILl. `RESOL.7 IN /IN, 0~;1=~I~tL TAX: ~-SSESSiM~Nr A. ^ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtai CHECK a discount or avoid interest, or return this notice to the n Register of Will d C 0 N E ~ an official assessment will be issued by the PA Department s an of Revenue. B L 0 C K 0 N L Y B. ~ The above asset has been or will be reported and f tax paid with the Pennsylv i i iled by the estate representative. an a nheritance tax return ~. The above informs ion is incorrect and/or debts and deductions omplete PART ~z and/or PART 3~ belo were paid. w. rarci +r inalcaiing a different t~C rate, please state relationship to decedent: ~SSi+o.21 TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 q _ `p _ ~q ~-"~ 2. Account Balance 2 _ $ L-{ (~ `~C ~ Q 3. Percent Taxable 3 X Q~ Q O 4. Amount Subject to Tax 4_ $ ~.©1``a ,~~ 5. Debts and Deductions 5 - 6. Amount Taxable 6_ $ ~~ ~~ ( a~ 7. Tax Rate ~ X ~ ~ 8. Tax Due 8_ $ ~ 0 0 OFFICIAL USE ONLY ~ AA PA DI_P~4RTt#ENT OF REVENUE P~1i3; 1 ~ d 5 ', b 7 $ a PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) g Under penalties of perjury, I declare that the facts complete to the best of my knowled e d b I reported above are true, correct and g an elief. G1iw OM ~ ~ ~~ HOME (r-1h ) tlla ln• 1oOr]~ TAXPAYER IGNATUR WORK ~hl~l )~34 ll°141 ~o101y ~- `c7-1'a- TELEPHONE NUMBER DATE :, ~~t ,;, ;, ',~ q 4 E '. y ttf ~? F !( ~, ~- i '` d m Pi: a o ~r Y' ~'A M ~ ~ a r W 8 qF,~;N S ~~ u~d ~~~ ~~~ ;~j #~t ~~~ ~~1 ~j~ .,.., f ~t .r..}