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HomeMy WebLinkAbout05-03-12PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE N0. 21 - ~~~ BUREAU OF INDIVIDUAL TAXES PD sox zao6ol PE11i'1S~/~Va1118 AND ACN 1212'668 HARRISBURG PA lrizB-o6al oePnRTMENronaeveNUe TAXPAYER RESPONSE DATE o4-20-2012 REV-1543 EX APP f05-11) ,`,f.1„k~r ~_~ ~ ~., ~ r TYPE OF ACCOUNT EST. OF DIANE T EBERLY ~ SAVINGS v~~F<, ,~~ SSN 172-28-8119 ~ CHECKING ~. ~. ~~Py' ~ ~ ~~ ~OU~r J DATE OF DEATH 06 - O 1 - 2011 ~ TRUST Ct1~~~i;~=~( 4''.; ,) CO. PA COUNTY CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FORMS T0: LEE R EBERLY REGISTER OF WILLS 57 OAKWOOD AVE 1 COURTHOUSE SQUARE MECHANICSBURG PA 17055-4730 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 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 tha above address. Please call 717-7$7-8327 with ouestions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 6100707725 Date 03-09-1992 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ ~ 220.01 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 $ ~+~ 110. O1 months of the decedent's date of death, Tax Rate ~( lj deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due $ 616.50 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 0 N E an official assessment will be issued by the PA Department of Revenue. B L 0 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 filed by the estate representative. C. The above information is incorrect and/or debts and deductions were paid. / ~" ~~! ~'(J~ ~~~ ~Q~ Complete PART ~ and/or PART 3^ below. y~/)Air~~ / A~ A~,~l/_ /J_~`,`x~; S .~,~/ PART If indicating a different tax rate, please state OFFICIAL USE ONLY ~ AAF 2^ relationship to decedent: PA DEPARTMENT OF REVENUE TAX RETURN - CALCULATION OF TA X ON JO INTL%~T ACCOUNTS PAD p © ~ LINE 1. Date Established 1 ~O 1 2. Account Balance 2 $ C1 2 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ ~ 4 5. Debts and Deductions 5 5 6. Amount Taxable 6 $ n 6 7. Tax Rate 7 X 7 8. Tax Due 8 $ ) ~ r)~ $ PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I reported above are true, correct a~/nd complete tdo Iglie best of y kn ledge and belief. HOME C ) ~ O /\J//~ ~ W O R K C ) --s ~ T XPAYER SIGNATURE TELEPHONE NUMBER AT TOTAL (Enter on Line 5 of Tax Computation) S ~ PENNSYLVANIA INHERITANCE TAX BUREAU DF INDIVIDUAL TAXESY'j i ~~~~~ ~, ~F .~-,~}, ~.. INFORMATION NOTICE FILE N0. 21 ~ ~~ "~.,/ ~~'~ Po Box 260601 (k ~ ~ehnsylv,~~~ ,ANb ACN 12126686 HARRISBURG PA 17126-0601 ~ ,.,pFPnRTMervT.oEaevENUei TAX P AY E R :~ R E S P O N S E DATE 04-20-2012 REV-1543 E% AFP (OS-11) ~~~ i _~ ~~4~ ~ : ~ _ TYPE OF ACCOUNT . ., r EST. OF DIANE T EBERLY ^ SAVINGS / SSN 172-28-8119 X^ CHECKING CLERK ~~~ C~R~ ~, ~R~~~~S 1~~~j QRp}~{Ahj';,, DATE OF DEATH 06 - O 1 - 2011 ^ TRUSr CUr~RER,_r.,i.~~-~ ~~(; pQ CtJhRRER~A~ COUNTY- CUMBERLAND ^ CERTIF. REMIT PAYMENT AND FORMS T0: LEE R EBERLY REGISTER OF WILLS 57 OAKWOOD AVE 1 COURTHOUSE SQUARE MECHANICSBURG PA 17055-4730 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 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. Flease call 117-78i-o"s 27 with quesL-ions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 6100714683 Date 06-26-1975 To ensure prover credit to the account, two Established copies of this notice must accompany Account Balance 21 969.26 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 ~` 10,984.63 months of the decedent's date of death, Tax Rate ~( ~ lrj deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due ~` 1 , 647.69 nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO RESPDND 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 0 N E an official assessment will be issued by the PA Department of Revenue. BLOCK ] ONLY y~,fi `I o, ~ ~ /a~~~ 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. ~J(~ The above information is incorrect and/or debts and deductions were paid. / ~`--Y Complete PART 2^ and/or PART ^ below. ~~ /~ _ f j ~ ~~ ~d J~ ~1~, `~~ ~`~~ PART If indicating a different tax rate, please state relationship to decedent: ~~ ~•=` TAX RETURN - CALCULATION OF TAX ON JO INT~I~~ACCOUNTS LINE 1. Date Established 1 A ~/ 2. Account Balance 2 $ 3. Percent Taxable 3 ~ 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 $ ~ 7. Tax Rate 7 X 8. Tax Due 8 $ C , OFFICIAL USE ONLY ^ AAF PA DEPARTMENT OF REVENUE PAD 1 2 3 4 5 6 7 8 PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perj ry, I declare that the facts I reported above are true, correct and ,~ complete to the best o my nowledge and belief. HOME C ) T'-~~~~ ' ~\- WORK C ) ,~ L TA AYE IGNATURE TELEPHONE NUMBER A TOTAL (Enter on Line 5 of Tax Computation) S ~~~ '~ a ~~~ a s ,- 0 {..~. ±>> ~~:- ~,.; ~; s:~ (~, (~ I - i~ C~ ~ `~ ~ ~ ~~ ~'~, ~ '~ ~" ~. ~` ~ ~ ~' 3 }..a y6 jry.9 !~' '~j ~ ~r} ~~ ~F:/ NT },p' ~~y~y r~ V[ i!J %~ jy eyk ~r~ (°' -S