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HomeMy WebLinkAbout03-19-12BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 REY ~ PENNSYLVANIA INHERITANCE TAX ~r- INFORMATION NOTICE FILE N0. 21 ~o~ 3o~.J ~, AND ACN 12110857 _ a ;~~~U~ ~~ TAXPAYER RESPONSE ~,-r ji~4H1~`) DATE 02-15-2012 S~:~S~.~,d~-~t~t : PATRICIA A LONG APT 507 1101 LINDHAM CT MECHANICSBURG y~~12 ~~ AR t 9 ~~ ~~~ { CL~~~ ~~ ~Rp~N'~ C~41~ I ~t)A~R~~tt ~4~ ,~~ PA 17055-5422 EST. OF WAYNE E LONG SSN 191-2b-6575 DATE OF DEATH O1-o1-2012 COUNTY CUMBERLAND REMIT PAYMENT AND FCIRMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA li'013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. ORRST OWN 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 this account. If you 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 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 4410641501 Date 07-21-2004 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check Account Balance ~ ~ 25 ~ 02b • 74 payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to Tax $` 4 >' 171 • 21 months of the decedent's date of death, deduct a !i percent discount on the tax due. Tax Rate X • 00 Any inheritance tax due will become delinquent Potential Tax Due $ • 00 nine months after the date of death. PART TAXPAYER RESPONSE ~ ATttlitE 7 E~S ^ _.... The above information and tax due is correct. A . ~ Remit payment to the Register of Wills with two copies of thie: notice to obtain discount or avoid interest, or return this notice to the Register of Wills and C H E C K a an official assessment will be issued by the PA Department of Revenue. C 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. ~e above informs ion is incorrect and/or debts below ART ~ and deductions were Paid. . ~ 2 and/or P Complete PART PART If indicating a different tax rate, please state relationship to decedent: --c L1au yti TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS AD LINE 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 1 2 $ 3 X 4 5 6 '~ 7 X 8 $ PART _.-.~ ... r.. oevrr 1}FI~I USE QNL' AAF PA DEpARTi1ENT OF REVENUE 1 2 ' __ .. a . 6 s ~ z 8 ~ ~ DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID IUINL 1C111C1 - -- Under penalties of perjury, I declare that the facts I reported above 'a7re true, coQrrect and complete to the best of my knowledge and belief. HOME C ( ~~L ) ~ ( ~ 3 Z Q /~ ~~ WORK C ) ~' 16 t z TAXPAYER SIGNATURE ~1, TELEPHONE NUMBER DATE BUREAU OF INDIVIDUAL TAXES PO BOX 280601 pennsylvani; HARRISBURG PA 17128-0601 DEPARTMENT OF REVENUE REV-1543 E% RFP (05-17] PENNSYLVANIA INHERITANCE T INFOg TION NOTICE :(;~~`~~J`~:1,_1 ,,4~~~1G AND S P O N S E ~~taau~r~.',T;A)C~ER RE _ FILE N0. 21 1a - _~~- ACN 12110855 DATE 02-15-2012 ~Ot2 ~iAR ~ 9 PM 12= 10 EST. OF WAYNE E LONG SSN 191-26-6575 CLERK ~ jDATE OF DEATH of-O1-2012 a~~-~ANpSr~~a«R'~UNTY CUMBERLAND ~l)1e~R~f?~_~~'1~ ~~~ REMLT PAYMENT AND FORMS T0: PATRICIA A LONG ~+ REGISTER OF WILLS APT 507 1 COURTHOUSE SQUARE 1101 LINDHAM CT CARLISLE PA 17013 MECHANICSBURG PA 17055-5422 TYPE OF ACCOUNT SAVINGS © CHECKING TRUST CERTIF. ORRSTOWN BANK provided the department with the information below, which was used in calculating the inheritance tax due. Recessed dandtanyaamounteother thanezeroeisareflectedtbelowwonetheDPotentialb Taxi DueylinehinoteDno tax mayobe due h but you must he 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 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 149000679 Date 08-11-2010 To ensure proper credit to the account, two copies of this notice must accompany Established payment to the Register of Wills. Make check Account Balance $ 46 i 610 • 62 payable to "Register of Wills, Agent". X 1 6 .6 6 7 NOTE: If tax payments are made within three Percent Taxable Amount Subject to Tax ~` 7 ~ 768 • 59 months of the decedent's date of death, • 0 0 deduct a f. percent discount on the tax due. Tax Rate X Any inheritance tax due will becone delinquent Potential Tax Due $ • 00 nine months after the date of death. PART TAXPAYER RESPONSE 0 I S A. ^ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this: notice to obtain a discount or avoid interest, or return this notice to the Register of Wills and CHECK an official assessment will be issued by the PA Department of Revenue. BLOC K B. ~ The above asset has been or will be reported and tax Paid with th(! Pennsylvania inheritance tax return C ONE 0 N L Y filed by the estate representative. C, ~e above informs ion is incorrect and/or debts and deductions were paid. Complete PART ~2 and/or PART ~ below. OF C A USE N PART If indicating a different tax rate, p3,®se~~'tate PA DEPARTMENT OF REiIENUE relationship to decedent: J, TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS AD1 ~ LINE 1. Date Established 1 2. Account Balance 2 '~ ~ 2 3. Percent Taxable 3 X 3 `-' 4. Amount Subject to Tax 4 $ ~ 5. Debts and Deductions 5 a 6. Amount Taxable 6 $ ~ 6 7 X 7 7. Tax Rate $ ~ ' 8. Tax Due 8 DEBTS AND DEDUCTIONS CLAIMED PART DESCRIPTION AMOUNT PAID DATE PAID PAYEE s TOTAL CEnter on Line 5 of Tax Computation) 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 ~ ~1 ~ ~~_ ~ ~ woRK c ~ - '~ - l~. TELEPHONE NUMBER DATE W <.` .~ '~y _~.~ m '.~ t ~ x W, ~ ~ 1 ~ y G /' ~ i„ .~ : ~~' G d G rte ~~ ~' ~J / J ~ r . G ~ ~ _ _ r.. it rr .~r+ :r .~... ~ ~~ ,,. {' ~,~w ~~Y ~• ~ o ~ y ~ aka a~ m C1 .d r. 9 ,b r '.. J ~ O ~ ~~ N O ~. ~', !'~.'.. -~ i ~'a1 1` 3 L"~i ~i" -' "1 ' ! ', ~ t - lil ~' ~ 3 ~ ~~ i _ ~~ ~~ ,. N~ y ~ , , ~ it ~• ~ ~~ 3 .~ ~J ~~