HomeMy WebLinkAbout03-29-12 (12)'~~ PENNSYLVANIA INHERITANCE TAX
BUREAU OF INDIVIDUAL T -fir .:_ _ INFORMATION NOTICE
"~~~ ~ r ~+~ AND FILE N0. 21 11-1250
PD Box 2BO6o1 ~ ~~~~'a ACN 12107978
HARRISBURG PA 17128-060 ~' E oeNnprMENr nuE
~~`~.,.,~~, ,;4f~~ TAXPAYER RESPONSE DATE 02-03-2012
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~ REV-1543 EX Aft 'f75-Il)
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EST. OF ROBERT A NICHOLS
SSN
DATE OF DEATH 09-15-2011
COUNTY CUMBERLAND
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
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
unt nv. 1U.7554U4U3 Date 04-07-2006 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 10 ~ 005.43 payment to the Register of Wills. Make check
Percent Taxable payable to "Register of Wills, Agent".
X 50.000
Amount Subject to Tax $ 5, 002.72 NOTE: If tax Dayments are made within three
Tax Rate months of the decedent's date of death,
X . 15 deduct a 5 percent discount on the tax due.
Potential Tax Due
$
750'41 Any inheritance tax due will become delinquent
nine months after the date of death.
Par
1 TAXPAYER RESPONSE
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FA UR `' T
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ew~ _ L X~ 'SSESSMENT
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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 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. IAA The above informs ion is incorrect and/or debts and deductions
'-F' Complete PART 2~
d/
PAR
3 were paid.
an
or
T
~ below.
PART if indicating a different tax rate, ease state
relationship to decedent:- 1~f
TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS \'AD
LINE 1. Date Established 1
2. Account Balance 2 $
3. Percent Taxable 3 X
4. Amount Subject to Tax 4 $
5. Debts and Deductions 5 -
6. Amount Taxable 6 $
7. Tax Rate 7 X
8. Tax Due g $
=OFFICIA!„~~ 1.4S~E ~ONi~Y ~ AAF
PA DEPARTMENT i]F REVENUE
i
2
3
4
5
6
7
PART DEBTS AND DEDUCTIONS CLAIMED
3^
DATE PAID PAYEE DESCRTPTTnN ...,,~~.~T .,. r,.
-~ - - ~ ~ ~ ~~ :ax vvmpucauonl $
Under penalties of perjury, I declare that the facts I reported above ar`er~true ourrect and
omple to the best of y knowledge an belief. H 0 ME C {r ) ~ L 5
woRK c ) 3
TAXPAYER SIG TURE TELEPHONE NUMBER DA E