HomeMy WebLinkAbout04-25-12PF~IMSI~LVANIA INHERITANCE TAX f~
' ~`~'-~ INFORMATION NOTICE ~Z.~( /~
BUREAU OF INDIVIDUAL TAXES ~;• ~ (~ F I L E ND . 21 "'
Po eox zao6ol pennsyituania - ~ AND ACN 12126631
HARRISBURG PA 17128-0681 DE PARTMENTOFREVENUE TAXPAYER RESPONSE DATE o4-20-2012
REV-1543
TYPE OF ACCOUNT
+ C~;'~ ~~
C EST. OF CARL S MARTIN ^ SAVINGS
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ir;
ORP',~rv;; ~J,,J` ssN 196-14-1862 ~ CHECKING
,
~,~~~,~~,-i~,, h~.`~} ~~~~ ~~ DATE OF DEATH 03-27-2012 ^ TRUST
COUNTY CUMBERLAND ^ CERTIF.
REMIT PAYMENT AND FORMS T0:
MILDRED E MARTIN REGISTER OF WILLS
8382 NEWBURG RD 1 COURTHOUSE SQUARE
NEWBURG PA 17240-9710 CARLISLE PA 17013
CITIZENS BANK OF PENNSYLVANIA 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 y0U 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 BELDW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 6100641341 Date 05-03-2000 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $` 56, 035.10 payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $` 28, 017.55 months of the decedent's date of death,
Tax Rate ~( 15 deduct a 5 percent discount on the tax due.
Any inheritance tax due will become delinquent
Potential TaX Due $ 4,202.63 nine months after the date of death.
PART TAXPAYER RESPONSE
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT
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
an official assessment will be issued by the PA Department of Revenue.
ONE
[
B L O C K B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return
0 N L Y sled by the estate representative.
C. ~he above information is incorrect and/or debts and deductions were paid.
Complete PART ^2 and/or PART ~ below.
PART If indicating a different tax a e, p}ease state
relationship to decedent: ~ CD( SEs_
TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established
2. Account Balance
3. Percent Taxably
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
1
2 $
3 X
4 $
5
6 $
7 X
8 $
PAD
OFFICIAL USE ONLY ^ AAF
PA DEPARTMENT~flF REVENUE
1
2
3
fj
5
6
7
8
PART DEBTS AND DEDUCTIONS CLAIMED
3^
TOTAL CEnter on Line 5 of Tax Computation) S
Under penalt ies of perjury, I declare that the facts I reported above are true, correct and
complete to the best of my k
owledge and belief. H OME C )
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AXPA~~GNATU~E ~ TELEPHONE NUMBER DATE
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
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