HomeMy WebLinkAbout01-27-12 (3)~ PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE `~-~- ~a--\~La
BUREAU OF INDIVIDUAL FILE N0.'~$t
~~~t ''~'1; AND ACN 12104258
PO BOX 260601 r ,[~ r=.,/ ,~ f",~~~9~~~a
HARRISBURG PA 17126-06B~ ,~ , ~gcgRMF ip~ yENUE TAX P AY E R R E S P O N S E
~{ t`11;,;i~.r+; "` DATE 01-18-2012
REN-154 fh (85 -11)
~~!?~~AN27 A~II~ 3~
CLERK
ORPHAN`S CQURT
CUNIR~RI_A~I(~ C~.. PA
NANCY A OLSON C u ~'~ ~R 1-g ~ D
87 SMITH RD
GARDNERS PA 17324-9000
TYPE OF ACCOUNT
EST. OF EDWARD C OLSON ~ SAVINGS
SSN 399-50-8226 ® CHECKING
DATE OF DEATH 04-07-2011 ~ TRUST
COUNTY ADAMS C~(.r-78FR~~n1,~ ^ CERTIF.
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
117 BALTIMORE ST RM 102
GETTYSBURG PA 17325
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 1 below and writing "spouse" in PART 2.
If you believe the information is incorrect. Dlease 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. 6200175970 Date 05-16-2003 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance 833.71 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 $` 416.86 months of the decedent's date of death,
Tax Rate ~( lrj deduct a 5 percent discount on the tax due.
Any inheritance tax due will become delinquent
Potential Tax Due ~{` 62.53 nine months after the date of death.
PART TAXPAYER RESPONSE
A. ~ The above information and tax due is correct.
Remit payment 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
an official assessment will be issued by the PA Department of Revenue.
C ONE
BLOC 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 ~2 and/or PART ~ below.
PART If indicating a different ta~~~ ~p~e~se state ~ 0 ~%,OSE ONLY ~AAF~,
relationship to decedent: CC
pq DEFART~IEI~T OF ~tEVENl1E
TAX RE TURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS f'A13
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 S ,
6. Amount Taxable 6 $ 6"
7. Tax Rate 7 X 7` ~
8. Tax Due 8 $ b $
PART
DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
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~J7 )1~ Ia'~ .~a''~
~~~ b WORK C ) I''°'~
TAXPA- YEB SI~6NA URE TELEPHONE NUMBER DATE
TOTAL (Enter on Line 5 of Tax Computation) S