HomeMy WebLinkAbout06-20-12 (2)COMMONWEALTH OF PENNSYLVANIA y ~,I CI~ORMATION NOTICE
DEPARTMENT OF REVENUE ~it,~~ F I L E NO. 21 12 - 0 321
BUREAU OF INDIVIDUAL TAXES ~ ~ AND ACN 12502692
Po Box zao6ol „ ~.,- ~3j AXPAYER RESPONSE
HARRISBURG PA 17128-0601 ,t ~~: y~~~~,i DATE 06-15-2012
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REV-1543A AFP (7-00) v
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O~F~-#A~a ~ :~u!!Pr
Ct}MEER4.~ND CO., PA
SALLY J CURRIE
398 ADAMS RD
CARLISLE PA 17015-9347
TYPE OF ACCOUNT
SECURITY
SEC ACCT
STOCK
BONDS
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
VANGUARD has provided the Department with the information listed below which has been used in
t at the death of the above decedent, you were a beneficiary of this asset.
th
t
a
e
calculating the potential tax due. Their records indica
ou feel this information is incorrect, Dlease obtain written correction from the transfer agent, attach a copy to this form and
ce Tax Laws of the Commonwealth of Pennsylvania.
If
it
y
an
return it to the above address. This account is taxable in accordance with the Inher
Questions may be answered by calling (717) 787-8327.
SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
COMPLETE PART I BELOW * * *
09892445777
t No To insure proper credit to your account, two
.
Accoun C2) copies of this notice must accompany your
payment to the Register of Wills. Make check
184 ~ 173.46 payable to: "Register of Wills, Agent".
DOD Valuation
Percent Taxable X 100.00 NOTE: If tax payments are made within three
184 ~ 173 • 46 (3) months of the decedent's date of death,
Amount Subject to Tax 0 4 5 you may deduct a 5% discount of the tax due.
t
Tax Rate X .
Any inheritance tax due will become delinquen
8 ~ 287 • 81 nine C9) months after the date of death.
Potential Tax Due
TAXPAYER RESPONSE
PART
0
FAILURE TO RESPOND WILL
RESUL7 IN AN OFFICIAL TAX ASSESSMENT BASED ON THIS NOTICE
A. ~ The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or You may check box "A" and return this notice to the Register of
C H E C K Wills and 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
C ONE
0 N L Y to be filed by the decedent's representative.
C. ~ The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ^2 and/or PART ^3 below.
PART
If you indicate a different tax rate, please state your
relationship to decedent:
TAX RETURN
- COMPUTATION OF TAX ON ABOVE ASSET(S)
LINE 1. DOD Valuation
2. Percent Taxable
3. Amount Subject to Tax
4. Debts and Deductions
5. Amount Taxable
6. Tax Rate
7. Tax Due
1
2 x
3
4 -
5
6 v
7
PAD
OFFICIAL Ust UNLr U Aar
PA DEPARTMENT OF REVENUE
1
2
3
4
5
6
7
8
PART
0
DATE PAID PAYEE
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
OTAL (Enter on Line 5 of Tax Computation)
AMOUNT PAID
s
Under penalties of perjury, I declare that the facts I have reported above are t/rue, corrgect and
complete the best of my k,_owledge and belief. HOME C ~~ ~ ) ~7~D - l ) I~ a
WORK C ) / o~O' ~cx
TELEPHONE NUMBER DATE
,voevGV crrNa u E
EST. OF HARRY D JONES
S.S. N0. 175-18-2025
DATE OF DEATH o2-24-2012
COUNTY CUMBERLAND