HomeMy WebLinkAbout03-29-12 (11)j PENNSYLVANIA INHERITANCE TAX
BUREAU OF INDIVIDUAL Ax _ .,_ INFORMATION NOTICE
Po Box zaocol r~:~`;'`~`";~; i±-~~b ywania AND FILE N0. 21 11-1250
HARRISBURG PA ~~a~'B~ospi,-;' pe~~ ~ TAXPAYER RESPONSE ACN 12107977
T NT OF REVENUE DATE
k ~l'~.' ,.. _._~ 'J
~~~~ -~ 02-03-2012
REV-1543 E% AFP (05.11)
::L~~~~R29 A~i~~ 4b
CLERK CF
ORPH,~t~k'S COURT
CUMF~RI ~',I','~ ;~ , PA
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 SgUARE
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 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
r•ccounc no. U//-~~4'~/41 Date 04-28-2010
To ensure proper credit to the account, two
Established copies of this notice must accompany
ACCOUrIt Balance $ 1 D ~ 057.31 payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 50.000
Amount Subject to Tax $ 5, 028.66 NOTE: If tax payments are made within three
months of the decedent's date of death,
Tax Rate ~( 15 deduct a 5 percent discount on the tax due.
Potential Tax Due $ 754.30 Anv inheritance tax due will become delinquent
nine months after the date of death.
PART TAXPAYER RESPONSE
1
FAILED 0 ~ S D" I~! F I TA SS~r3SSM~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
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 Department of Revenue.
[ B L 0 C K ~
0 N L Y g, ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return
f11ed by the estate repre sentative.
C. dThe above
Complete informs ton is
PART ~
d/ incorrect and/or debts and deductions were paid.
an
or PART , a ~ below.
~J ~ I'~
PART If indicating a differen ra pl se a`e , OI,1~3~4L USE DNLY ~ 1~1F,~
relationship to decedent:
PA DEPARTMENT OF REVENUE
TAX RETURN - CALCULATION OF TAX ON J T/TRUST ACCOUNTS s~'AD L.,
LINE 1. Date Established 1 ~ ~
2. Account Balance 2 •~ ~
3. Percent Taxable 3 X 3
4. Amount Subject to Tax 4 $ ~
5. Debts and Deductions 5 - ~~ 5 c
6. Amount Taxable 6 $ .~ 6 _~
7. Tax Rate 7 X \ 7 ~~"
8. Tax Due g $ ~~ ~ ~ `-' ~'-
~B ~~
PART
DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMf~ll\IT o.rn
- - ~ ~ yr (ax t,o mpULaLlOn) $
Under penalties of perjur I declare that the facts I reported above r true c ect nd
let e, 1~the bes of m nowledge nd ief. HOME C ~ ) ~ ~ 7 ",~/
.~ WORK C ~ a
TAXPAYER SIGNAT E TELEPHONE NUMBER D TE