HomeMy WebLinkAbout03-29-12 (13)~ PENNSYLVANIA INHERITANCE TAX
BUREAU OF INDIVIDUAL f~~~';.''`.::F', C}a= h INFORMATION NOTICE FILE
PO BOX 280601 1- ~,,~
HARRISBURG PA 17126 06p,~j ( ?~1~t1~1$ ~ `~n~a TAXPAYERNRESPONSE ACN
~ ,~, DFPAR ME{Ji~O. R ENUE
REV-1543 EX RFP (OS-11) DAT E
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ORPHa~N`~ ~ ~Un t
N0. 21 11-1250
12107979
02-03-2012
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
^ savlNGs
^ 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. 105554053b Date 05-09-2006
To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance ~` l U ~ 001.15 payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 50.000
Amount Subject to Tax $ 5000 58 NOTE: If tax payments are made within three
TaX Rate months of the decedent's date of death,
X 1 5 deduct a 5 percent discount on the tax due.
Potential Tax Due $ 750.09 Any inheritance tax due will become delinquent
nine months after the date of death.
PART TAXPAYER RESPONSE
0 ...~ ~ - _. - _
CHECK
C ONE
BLOCK
ONLY
A. ^ The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or return this notice to the Register of Wills and
an official assessment will be issued by the PA Department of Revenue.
C
^ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return
filed by the estate representative.
~he above informs ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/o~PART 3^ below.
PART If indicating a different tax ra
relationship to decedent:
TAX RETURN - CALCULATION
LINE 1. 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
state
OF TAX ON JOINT/TRUST ACCOUNTS
1
2 $
i X
4
5
6
7 X
8 +fi
~~ ar R Of``ICIAL US~ONLY~ ^ AAA
PA DEPARTMENT OE REVENUE
PAD a
i ~~
1 2
'a . .-~.
4
5
b
7
8 m
riarci DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE DESCRIPTION
AMOUNT PAID
TOTAL CEnter on Line 5 of Tax Computation) g
Under penalties of perjury, declare that the facts I reported above ar t,ue, correc~ and
c~nplete. the best of my kno edge and belie «~ /~%
.`\v~T1 ~ ~ HOME C 1
` WORK C ) '1~ '1
TAXPAYE SIGNATUR TELEPHONE NUMBER d J'
E