HomeMy WebLinkAbout03-29-12 (8)~ PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL T ~~ r_ FILE N0. 21 11-1250
Po Box zeo6ol ~~, ~l~$~(~Y~'118 AND
HARRISBURG PA 17128-06111"-/ ACN 12107974
~fC- OePA{tTMENT [~p~vENUE TAXPAYER RESPONSE DATE 02-03-2012
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C! ERK OF
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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 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. 0775515562 Date 09-03-2004
To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 10 , 013.59 payment to the Register of Wills. Make check
"
payable to
Register of Wills, Agent".
Percent Taxable X 50.000
A1110Unt Subject t0 Ta X $ 5,006.$0 NOTE: If tax payments are wade within three
months of the decedent's date of death.
Taz Rate X ~ lij deduct a 5 percent discount on the tax due.
Potential TaX Due $ 751.02 Any inheritance tax due will become delinquent
nine wonths after the date of death.
P~r
1 TAXPAYER RESPONSE
AI R SPO L ~ ES 1::T.:I#t Ai~t•; I A AX ~ASSS N
A. ~ The above information and tax due is correct.
Remit payment to the Register of Wills with two c opies of this notice to obtain
C H E C K
0 N E a discount or avoid interest, or return this noti
an official assessment will be issued by the PA D ce to the Register of Wills and
epartwent of Revenue.
BLOC K ~
O 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 representative.
C. The above informs ion is
~ incorrect and/or debts and deductions were paid.
Complete PART
2 and/or PART ® below.
PART
If indicating a differen x ra e, pl a fe ~ ~ ~ ~ F C L S E$~
relationship to decedent ~~+ ~~~ ,~,~ ,Ot..Y ~°AF
TAX RETURN - CALCULATION
LINE I. 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
PA DEPARTMENT DF REVENUE
OF TAX ON JO NT/TRUST ACCOUNTS PAD
1 1
s X 2
3
4 $ 4
5 - 5
6 S 6 ..
7 X ~
PART DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE DESCRIPTION eMniiur oArn
Under penalties of perju I declare that the facts I
om lete o the bes of m knowledge an belief.
\ \\y'~~~
XPA ER SIGNAT E
reported above are rue, corm and
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