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HomeMy WebLinkAbout03-29-12 (5)~'~' PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDI~ L~{,>~€~; Ei~L FILE N0. 21 11-1250 Po BOX 280601 ~ ~ - ~ ~ ylvania AND ACN 12107971 HARRISBURG PA Ifj<2I~Qb~14` p~ q T ENT OF REVENUE TAX P AY E R R E S P O N S E (-_ DATE 02-03-2012 REY -1543 EX pFP (RS -11) ~•. ~ ~i#~ ~~ Nisi ! i = ~ ~u' TYPE OF ACCOUNT EST. OF ROBERT A NICHOLS ~ SAVINGS {\ fir- CLEF-' SSN CHECKING ~~?~NQ~1~4 ~C~~~T DATE OF DEATH o9-15-2011 ~ TRUST ~;~)~;,~-,r.,~ ,~,1,:~~~ ~,r} p~ COUNTY CUMBERLAND X^ CERTIF. 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 S OVE REIG N 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 INSTRUCTIDNS Account No. 0775149057 Date 07-03-1997 To ensure proper credit to the account, two Established copies of this notice must accompany AcCOUnt Balance $ l U ~ 014.27 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 50.000 Amount Subject to Tax NOTE: If tax payments are made within three $ 5, UU7. 14 months of the decedent's date of death, Tax Rate X ~ lrj deduct a 5 percent discount on the tax due. Potential Tax Due Any inheritance tax due will become delinquent $ 751.07 nine months after the date of death. PART FAI ~ TAXPAYER RESPONSE RE 0}I13-,~~~.I:.~ ~#l~"i•- I t7~IC ~ #IENT 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 an official assesswent will be issued by the PA Department of Revenue. ONE 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. The above informs ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3^ below. PART If indicating a different tax rat please state ~< OFF~IAL USE ONLY ~ AAF relationship to decedent: ~ pA DEPARTMENT OF REVENUE TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS pAp LINE 1. Date Established 1 1 2. Account Balance 2 +~ 2 3. Percent Taxable 3 X _ 3 4. Amount Subject to Tax 4 $ ~ 5. Debts and Deductions 5 - 5 6. Amount Taxable 6 ~ 7. Tax Rate 7 X 7 8. Tax Due g $ 8 "° ~ ~,~~~, PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of pe ry, I declare that the facts I reported above (@`~/ rue, or a gal d5 comple a to the best my knowledge nd belief. HOME C ` I ) ~~f ~~ J~J \~ WORK C ) ?, TAXPAY R SIG TURE1 TELEPHONE NUMBER D TE (VIAL itnier on Line 5 of Tax Computation) S