HomeMy WebLinkAbout03-29-12 (7)s~ PENNSYLVANIA INHERITANCE TAX
BUREAU DF IND1vlDUal_ ,.,. ; ~ INFORMATION NOTICE
~~ ~1~,~~_ ~ FILE N0. 21 11-1250
PO BOX 280601 ,.(„~,..,-'-,._p,@~l~nia AND ACN 12107973
HARRISBURG PA 171za-o,rpl,_ ~--'_~berah'rri6f~mdAevewue TAXPAYER RESPONSE
;rl -; , , DATE
REV-1543 E% AFP ( 05-11) 0 2 - U 3 - 2 U 12
;A! ~ ~„$~`~ ~ ~ ~`; ~ ~ ; ~ ~ TYPE OF ACCOUNT
EST. OF ROBERT A NICHOLS ~ SAVINGS
CLERK( ~~!= ssN ~ CHECKING
c r-~n i~r DATE OF DEATH 09-15-2011 ~ TRUST
ORPH'A~J",.. ~V~~l ~ COUNTY CUMBERLAND ~ CERTIF.
REMIT PAYMENT AND FORMS T0:
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 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
wccount No. U//'~337785 Date 02-01-2002 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 10 ~ 284.91 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 paywents are made within three
$ 5 ~ 142 • 46 months of the decedent's date of death,
Tax Rate X . 15 deduct a 5 percent discount on the tax due.
Potential Tax Due Any inheritance tax due will become delinquent
$ 771 • 37 nine months after the date of death.
P~r TAXPAYER RESPONSE
1 ,
`AlLttit£ T S , ND ` 1L LT ` i AX S£MENT
A. ^ The above information and tax due is correct.
Remit payment to the Register of Wills with two copies 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 Departsent of Revenue.
[ B L O C K ~
0 N L Y B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return
filed by the estate repre sentative.
C. The above
Com
l
t informs ion is
PART ~ incorrect and/or debts and deductions were paid.
T
p
e
e
n and/or PAR
below.
mac-' n n
PART If indicating a differen
l
ti r e, pl se t
\
t
°O CIAL
USE
~OHLY ~AAF
re
a
onship to decedent ~
~
` PA DEPARTMENT flF REVENUE
TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD'
LINE
1.
Date Established 1
-1 _~
2. Account Balance 2 $ z
3. Percent Taxable 3 X ~
4. Amount Subject to Tax 4 $
4
5. Debts and Deductions 5 - ~
6. Amount Taxable 6 $ 6
7. Tax Rate 7 X 7
8. Tax Due g $ ,$ ~ ~ n ~, a
PART DEBTS AND DEDUCTIONS CLAIMED
^3
DATE PAID PAYEE DESCRIPTION eMniiur pArn
Under penalties of perjury, I declare that the facts I reported above are true, corre t and
c mplet to the be t of y know edge nd belief. HOME C ~~ ) ~ ~ _ ~~~
~• ~ \.. WORK C ) -! /~
TAX AYER SIGNA RE TELEPHONE NUMBER DATE
_ ~~~^- ~~~~~_~ ~~~ jinn ~ yr IaX l,O mpULaLlOn) S