HomeMy WebLinkAbout03-04-05COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE INFORMATION NOT I C E
BUREAU OF INDIVIDUAL TAXES AN D
nEPr. zsobol TAXPAYER .RESPONSE
HARRISBURG, PA 17128-0661
REY-1543 EX AFP (09-00)
JO S DEEDS
8 HELEN AUE
MECHANICSBURG PA 17055
820.04
X 50.000
410.02
X .15
61.50
PNC BANK 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 decedent, you were a ]pint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this farm 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 (7171 787-8327.
COMPLETE PART 1 BELOW ~ ~ * SEE REVERSE SIDE FuR FILING AND PAYA~€NT INSTRUCT:.^.!:.`,
Account No. 5140047831 Date 10-01-1969 To insure proper credit to your account, two
Established C27 copies of this notice must accompany your
t t th R ister of Wills Make check
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
OF TAX ON JO NT/TRUST ACCOUNTS
paymen o e eg
payable to: ^Register of Wills, Agent".
NOTE: If tax payments are made within three
C3) months of the decedent's data of death,
you may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine C9) months after the date of death.
A. ~ The above information and tax due is correct.
ayment to the Register
it
t
of Wills with two copies of this notice to obtain
p
o rem
1. You may choose
a discount or avoid interest, or you may check box °A° and return this notice to the Register of
CHECK Wills and an official assessment will be issued by the PA UePartment of Revenue.
C ONE
BLOCK
8.
~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
0 N LY 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.
- - ase state our
dicate a different tax rate, Ple Y €~=;~i €~€_€~€~€,:€€~ :::::~:::::Alr;i€€1~5~~~i€?:_~ii
....,,~~_.,.~ ..:::::::::::-::= :~::::::;.::.:.:.:.:...
:~:
If You in
PART
' nshi
to decedent : ;
~€€isi~fisii~€'€'~€=~::~::;:;::.;:;~,€:<;_;:;.:.;:::-:::~:::::~~:::::=:;:~°:::..:- ::..............:
~siii €ssi€si~ ~€€ ::~~~~ ~~!`~1~1~i ~~, `.'•:
TAX RETURN - COMPUTATION
LINE 1: Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
b. Amount Taxable
7. Tax Rate
8. Tax Due
2 $ ~~ ~`} -
3 X ~• OOc~
y ~~~ -UZ
5
b
7
r, `~ ~
FILE N0. 21 ~'
ACN 05105712
DATE 02-23-2005
EST.- OF, AGNES I ORR
- S'.S. '1~0`? 148-30-5293
DATE OF DEATH OS-29-2004
COUNTY CUMBERLAND
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
TAXPAYER RESPON
PART
~ ~~ ~
DATE PAID PAYEE
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Conputatson) ~
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best of ny knowledge and belief. HOME l7 ) !D -7/~/
WORK ( 1 U
~~. TAXPAYER S ATU TELEPHONE NUMBER D E
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