HomeMy WebLinkAbout01-27-12~~ PENNSYLVANIA INHERITANCE TAX ~~ _~~- l'a-~
,f 1. - ., INFORMATION NOTICE FILE N0. ~}
BUREAU OF INDIVIDUAL TAXI
Po Box zaoeol ''~"~~~` AND ACN 12104257
HARRISBURG PA 1T1z6-o6o1~~~:".9~ M To e' TAXPAYER RESPONSE DATE 01-18-2012
REV-1543 EX RFP (05-11)
l''IJ~iH1127 ~i~"~~~ 34
CLERK ~F
ORPHAJV'S COIJRz
CiJMRFPI-AN~'r CO.. PA
NANCY A OLSON ~ u. M OrKLA ab
87 SMITH RD
GARDNERS PA 17324-9000
TYPE OF
EST. OF EDWARD C OLSON
SSN 399-50-8226
DATE OF DEATH 04-0 ~ LO~~~'R~~
COUNTY ADAMS
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
117 BALTIMORE ST RM 102
GETTYSBURG PA 17325
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 Sp0U5e 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 I 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 7I7-787-8327 with questions. _
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 6200175679 Date 05-16-2003 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance 1 , 453.96 payment to the Register of Wills. Make check
payable to "Register of Wills, Agent•'.
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 726.98 months of the decedent's date of death,
Tax Rate ~( , 1Fj deduct a 5 percent discount on the tax due.
Any inheritance tax due will become delinquent
Potential Tax Due $ 109.05 nine months after the date of death.
PART TAXPAYER RESPONSE
~..tlRE°Tfl R~ LL $UL: IN' 0 fICtAL TA3C £ N'T
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 Wills and
an official assessment will be issued by the PA Department of Revenue.
ONE
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.
Complete PART ~z and/or PART ~ below.
PART If indicating a different tax r te, p ase state
~
~ flFFIAI.. 13S LY,
AAA
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relationship to decedent: u.S
~ P ,
'
Q t~A DEPART~iiT flF REYEHi~E,
TAX RE TURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PA1~~
,
LINE 1. Date Established 1 1 ' ,
2. Account Balance 2 $ 2
3. Percent Taxable 3 X -',~ - - - -._._
4. Amount Subject to Tax 4 4
5. Debts and Deductions 5 rj -
6. Amount Taxable 6 $ {>
7. Tax Rate 7 X C) 7
8. Tax Due 8 $ $
PART
DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
V
TOTAL CEnter on Line 5 of Tax Computation) S
Under penalties of perjury, I declare that the facts I reported above are true,~/ctSoJrrect and/
complete to the best of my knowledge and belief. HOME Cj~l~ ) y Ob`~~3 "t'C~
TAXPAYER IGNATURE TELEPHONE NUMBER DATE