HomeMy WebLinkAbout05-29-12 (2)PENNSYLVANIA INHERITANCE TAX'
INFORMATION NOTICE FILE
BUREAU OF INDIVIDUAL TAXES
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HARRISBURG PA l~lzs-o6o1 B~vnarMENroFgEVenu~,,, ` TAX P AY E R R E S P O N S E
_ DATE
"~REY-ti543~ 6X AFP.(US-I17 ~_.t. 'J
No. 21 - I~-C..`~~(„
121312b4
05-14-2012
A
CUMEF~L~iG CO., PA
KATHLEEN L BRENNEMAN
1311 ENGLISH DR
MECHANICSBURG PA 17055-5685
EST. OF LAVERE L BRENNEMAIJ
SSN
DATE OF DEATH 04-12-2012
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS TD:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
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 y~DU 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.
CI)MPLETE PART I BELDW * SEE REVERSE SIDE FOR r'ILIi~iv ATiD Pr,YMENT INSTRUCTIONS
Account No. 6205018253 Date 04-07-2004 To ensure proper credit to the account, two
Established copies of this notice must accompany
payment to the Register of Wills.. Make check
Account Balance $` 2,276.40 payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 1 ~ 138.20 months of the decedent's date of death,
Tax Rate X 15 deduct a 5 percent discount on the tax due.
Any inheritance tax due will. become delinquent
Potential Tax Due $ 170.73 nine months after the date of death.
PART TAXPAYER RESPONSE
FAILURE TD 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 Bind
an official assessment will be issued by the PA Department of Revenue.
C ONE
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 informs zon is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART 3^ below.
PART If indicating a different tax rate, please state OFFICIAL USE> ON _Y [~,AAF
relationship to decedent:
PA DEPARTMENT DF REVENUE
TAX RETURN - CALCULATION OF TAXi~ON JOINT/TRUST ACCOUNTS pAD
LINE 1. Date Established 1 -I ~ ~ J~~7L+~ ty~ 1
2. Account Balance 2 $ Z~ Z 1 ~ ' 1 L~ 2
~, Perrant TaYabl? z X L1 3 .-.
4. Amount Subject to Tax 4 $ ~ ~~ s~ 4
5. Debts and Deductions 5 - ~ ~ 5
6. Amount Taxable 6 $ ~ 6
7. Tax Rate 7 X '-~ 7
8. Tax Due 8 $ G1 8
PART DEBTS AND DEDUCTIONS CLAIMED
3^
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation) S
Under penalties of perjury, I declare that the facts I reported above are true, correc1t and
complete to the best of my knowledge and belief. HOME ~ ~ ~ ~ ) 7~~ - ~~c
TA~P~ER SIGNATURE~~~~~~ ~dw WOTELEPHONE NUMBER A/~ /~
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