HomeMy WebLinkAbout03-29-12 (4)~'B PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OP INDIVIDUAL TAXESr•r ~ ~ ~r~ ~ -~, F I L E N0. 21 11 - 1250
Po eox 2eocol ;s ~ ~~i~l~ri5~ld: AND ACN 12107970
HARRISBURG PA 17128-0681 ~, ~-D€P7iRTM~ENTDFRtVQf~U~ TAXPAYER RESPONSE
~~ REV-1543 E%~AFP (05-11) DATE 02-03-2012
TYPE OF ACCOUNT
EST. OF ROBERT A NICHOLS ^ savlNGs
SSN HECKING
C~ ~.R~ ~!~- DATE OF DEATH 09-15-2011 ^ TRUSr
GRPHFt1~l~~ ~~~-'~'~ COUNTY CUMBERLAND ~ CERTIF.
f 1 rn1 /t-,in ~ p
il~~:ti~:"S;_;'1I'ytJ ~.,'~, P/-I REMIT PAYMENT AND FORMS TD:
SHIRLEY A NICHOLS REGISTER OF WILLS
423 HILLSIDE RD 1 COURTHOUSE SQUARE
NEW CUMBERLAND PA 17070-1863 CARLISLE PA 17013
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 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 ~ SSE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0575131131 Date 09-28-1998 To ensure proper credit to the account, two
Established copies of this notice must accompany
10 ~ 002.84 payment to the Register of Wills. Make check
Account Balance $ payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 5 ~ 001 .42 months of the decedent's date of death,
Tax Rate X . 1 5 deduct a 5 percent discount on the tax due.
Any inheritance tax due will become delinquent
Potential TaX Due $ 750.21 nine months after the date of death.
P~T TAXPAYER RESPONSE
1 AILUR " E R SUL t+~ '~ 01~FI IAL T SE5 NT
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
C 0 N E ~ an official assessment will be issued by the PA Department of Revenue.
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. I_A The above informs ion is incorrect and/or debts and deductions were paid.
WJ Complete PART 2~ and/or PART 3^ below.
PART If indicating a different tax ratej~lease state OFFCIAL~~JSE [~Y ^ AAF
relationship to decedent: -~~:A}im PA DEPARTMENT OF REVENUE -
TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD
LINE 1. Date Established 1 1
2. Account Balance 2 $ 2
3. Percent Taxable 3 X ~ 3 _ - __ -
4. Amount Subject to Tax 4 $ 4
5. Debts and Deductions 5 - 5
6. Amount Taxable 6 6
7. Tax Rate 7 X 7
8. T a x D u e B $ 8 ~ ~' ~~ "a ~ '~~"
PART DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perj y, I declare that the facts I reported above tru cprre and
omple a to the best of y knowle ge a d belief. 41
~ HOME C ~~ ) ~~
\ WORK C ) ~~.
TAXPAYER SIG TURE TELEPHONE NUMBER DA E
IUTAL ctnLer on Line 5 of Tax Computation) S