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HomeMy WebLinkAbout05-16-12 (2)BUREAU of INDrvIDU~~fAp~~s ~ ~ . FILE N0. 21 - ~ ~ -L~~.7~-~~L~~ Po Box zao6ol ~ ' ' ACN 12128053 HARRISBURG PA 17128 ,~01' -DEPAR~FI~',T~FREVENUE TAX P AY E R R E S P O N S E _~.~, DATE 04-26-2012 REV-1543 EX RFP (DS -11) ^~1~2 ~~Y ! ~ ~,j4M ~. L~ TYPE OF ACCOUNT EST. OF HAROLD W HELMAN ~ SAVINGS -- - SSN © CHECKING ~ ~ - DATE OF DEATH 04-07-2012 ~ TRUST Gr~~] „`,~ ' ""n j,'~ COUNTY CUMBERLAND ~ CERTIF. CUME~r.'?I_A~"J,~ tJ(,,, PA REMIT PAYMENT AND FORMS T0: SUSAN M RIDGE REGISTER OF WILLS 59 TANGLEWOOD DR 1 COURTHOUSE SQUARE GLEN ELLYN IL 60137-7830 CARLISLE PA 17013 SOVEREIG N 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 y0U are the Sp0U5e 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 thi> form and return .t to the above address. Please c,.,, ?;? ?87-832? with questions. COMPLETE PART 1 BELOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0471703702 Date 02-26-1981 To ensure proper credit to the account, two Established copies of this notice must accompany 5 9 9 8 8 . 9 6 payment to the Register of Wills. Make check Account Balance $ , payable to "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to Tax S` 9,998.36 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 ~` 1,499.75 nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO RESPOND WILL R£SULT 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 0 C K ~ g, ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return 0 N L Y ~~,q filed by the estate representative. C. The above informs ion is incorrect and/or debts and deductions were paid. ''ff--''''Complete PART ~ and/or PART ~ below. PART If indicating a different tax rate, please state ' OFFICIAL USE ONLY I AAF C P p/1 UGN relationship to decedent: U.V~~4L C S i ~ T~,2~ . PA DEPARTMENT OF REVENUE TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1. Date Established 1 1 2. Account Balance 2 $ _~9~ g~1IQ. ~~/ 2 3. Percent Taxable 3 X ~~,,. / / 9 3 4. Amount Subject to Tax 4 +fi ~l-, 9 9R. 3(0 4 5. Debts and Deductions 5 - r~ 6. Amount Taxable 6_ $ J ~ cJ q g , 3~ 7. Tax Rate 7 X lf,s 7 8. Tax Due 8 $ ~'i/9.'~' g PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID ~'~` PENNSYLVANIA INHERITANCE TAX ~; INFORMATION NOTICE p~"~ ania AND ~(rPAYER SIGNATURE TELEPHONE NUMBER DATE IUTAL ~tnLer on Lane 5 of Tax Computation) $: Under penalties of perjury, I declare that the facts I reported above are true, correct and compl~et~e^-t-o the best of my knowledge and belief. HOME C (r~ii ~ ~{ 9-Jam-//~/' `7l ( ~.~ eECC We~1E- c 6 3v ~ i / s - ~ s :~ ~ `V~'