HomeMy WebLinkAbout05-29-12~ PENNSYLVANIA INHERITANCE TAX
~~, INFORMATION NOTICE ~ ~'
BUREAU OF INDIVIDUAL TA~' ,.. ~ FILE ND. 21 - ~.~-~~ ~,~
Po Box 260601 nn~y~ ~V,d A N D
HARRISBURG PA 17128-0601;,',_ ~ ~~ 'J'` ACN 12131265
DEPAF'TMENT OFIR~~NUE TAXPAYER RESPONSE DATE 05-14-2012
REV-1543 E% RFP f0J5 -11)
;~) ~~"~~' ~?~ ~.-~~,~ ~ _ ~v TYPE OF ACCOUNT
EST. OF LAVERE L BRENNEMAN ~ SAVINGS
" '- " ^^ SSN ~ CHECKING
DATE OF DEATH 04-12-2012 ~ TRUST
CUMBtRLAND CO. PA COUNTY CUMBERLAND ~ CERTIF.
REMIT PAYMENT AND FORMS T0:
KATHLEEN L BRENNEMAN REGISTER OF WILLS
1311 ENGLISH DR 1 COURTHOUSE SQUARE
MECHANICSBURG PA 17055-5685 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 yDU 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 t~ 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. 6205018350 Date 04-07-2004 7o ensure proper credit to the account, two
Established copies of this notice must accompany
$ 23.671.12 payment to the Register o~F Wills. Make check
Account Balance payable to "Register of Wills, Agent".
Percent Taxable X 50.000
Amount Subject to Tax ~` 11,835.56 NOTE: If tax payments are made within three
months of the decedent's hate of death,
Tax Rate X 15 deduct a 5 percent discount on the tax due.
Potential Tax Due $ Any inheritance tax due will become delinquent
1 ~ 775. 33 nine months after the date of death.
PART TAXPAYER RESPONSE
FATLURE TO RESPOND WELL 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 a official assessment will be issued by the PA Department of Revenue.
BLOC K ~ g, ~ Th above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return
O N L Y f led by the estate representative.
C. The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART IJ below.
PART If indicating a different tax rate,/ please state OFFICIAL USE ONLY (~y AAF
a relationship to decedent: '1~~6~C--~~
i/ PA DEPARTMENT OF REVENUE
TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD
LINE 1. Date Established 1 ~ 2Gi'~ 1
2. Account Balance 2 $ ~ ~~ ~~ ~ . ~ 7i 2
3. Percent Taxable 3 X ~ ~ 3
4. Amount Subject to Tax 4 $ ~~ ~ ~j, j ~y 4
5. Debts and Deductions 5 - '•, 5
6. Amount Taxable 6 $ ~r ~ ~ , d JS ,~ ~
7. Tax Rate 7 X L~ ~
8. Tax Due g $ ~ 8
PART DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE DESCRIPTION eMniiNr aern
~f..~ ~cnter on pine 5 or iax Computation) S
Under penalties of perjury, I declare that the facts I reported above are true, correct and
complete to the best of my knowledge and belief . HOME C ~ e -1 ~ 1 ~~ "' 7 7c.1~
TAXPAYER SIGNATURE TELEPHONE NUMBER AT
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