HomeMy WebLinkAbout03-29-12 (2)PENNSYLVANIA INHERITANCE TAX
BUREAU OF INDIVIDy~. r. INFORMATION NOTICE FILE N0. 21 11-1250
Po Box ZBO6o1 ~~. ``~,', ~~` C (`~" !" ~`~ AND
HARRISBURG PA 17~~'B"D~O~~` r_~ vania ACN 12107968
~ ~ ~~i •DEP/q'TM€f(1fOFREVENUE TAXPAYER RESPONSE
jj DATE 02-03-2012
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SHIRLEY A NICHOLS
423 HILLSIDE RD
NEW CUMBERLAND PA 17070-1863
EST. OF ROBERT A NICHOLS
SSN
DATE OF DEATH 09-15-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
SOVEREIGN 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 y0U art 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. 0771102224 Date 07-03-2007
To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 544
81 Payment to the Register of Wills. Make check
. payable to "Register of Wills, Agent".
Percent Taxable X 50.000
Amount S ubject to Tax $ 272
41 NOTE: If tax payments are made within three
. months of the decedent's date of death,
TeX Rate X ~ 15 deduct a 5 percent discount on the tax due.
Potentia
l TaX Due ~` 40.86 Any inheritance tax due will become delinquent
nine months after the date of death.
PART TAXPAYER RESPONSE
0
~~`~ TO R£ D W3 ,RESfrI;'fy:,I N FI Iq~L TAX SSlIE#~T
A. ^ The above information and tax due is correct.
Remit payment to the Register of Wills wlth two copi es 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
0 N E an official assessment will be issued by the PA Depa rtment of Revenue.
[ B L 0 C K ~ g, ~ 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. 1`/The above informs ion is incorrect and/or debts and deductions were paid.
"'---111°°° Complete PART 2~ and/or PART 3^ below.
PART tr inaicaiing a dlTterent tax rate, please state
relationship to decedent: ~
TAX RETURN - CALCULATION
LINE 1. Date Established
2. Account Balance
3. Percent Tar.~ble
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS ~ppD
1
2 $
s X
4 +~
5
6
~ X
$ $
,~ OFFICIAL USE DNLY ~ AA~
PA DEP~-RTl1ENT OF REVENUE
1
2
3
4
5
6
7
PART DEBTS AND DEDUCTIONS CLAIMED
^3
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perj ry, I declare that the facts I reported above yare true, correc~ gnd~
c mplet to the best of knowled and elief. HOME C 1 ~• ) IIJJ~~33
• \~ ~ WORK C ) `] }
TA AYER SIGNAT TELEPHONE NUMBER D TE
IUTAL lCnLer on Line 5 of Tax Computation) S