HomeMy WebLinkAbout03-17-06 (2)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG I PA 17128-0601
*'
INFORMATION NOTICE
AND
-TAXpAYER RESPONSE
FILE NO. 21 05-1098
ACN 06108037
DATE 02-22-2006
REV-151i5 EX AFP (0'-00)
~sr1 OF JOHN F CONRAD
S .-'S~ NO. 174-20-2134
DATE OF DEATH 12-13-2005
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
o CHECKING
D TRUST
[Xl CERTIF .
** KARLA J ROBERTS
1604 NEWVILLE RD
CARLISLE PA 17013
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
COMMUNITY BANKS has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedentl yoU were a joint owner/beneficiary of
this account. If you feel this information is incorrectl please obtain written correction from the financial institutionl attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 351169314 Date 09 - 15 - 2 0 05
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
Tax
x
,::!li~!_~~I_jl;11~~;
To insure proper credit to your accountl two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Willsl Agent...
NOTE: If tax payments are made within three
(3) months of the decedent.s date of deathl
you may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
[CHECK ]
ONE
BLOCK
ONLY
A. ~ The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interestl or you may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
B. [J The above asset has been or will be reported and tax paid with the PennSYlvania Inheritance Tax return
to be filed by the decedent.s representative.
C. [] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
If you indicate a different tax rate, please state your
relationship to decedent:
PART
~
TAX
LINE
RETURN - COMPUTATION
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
I
2
3 X
4
5
6
7 X
8
PART
[!]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
I
$
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best of my knowledge and belief.
TAXPAYER SIGNATURE
HOME ( )
WORK ( )
TELEPHONE NUMBER
DATE