HomeMy WebLinkAbout06-11-12 (4)~~ PENNSYLVANIA INHERITANCE TAX ~n _
J INFORMATION NOTICE FILE N0. 21 ~~~ Cf'~,5~
BUREAU OF INDIVIDUAL TAXES ,,,~., ~^
Po Box zaocol pennsylvar~~;, ~ - r;~~(!t~ ~F AND ACN 12133065
HARRISBURG PA v12e-0601 oePnaTMewTOFaevewuE. TA~yRgYER RESPONSE DATE 05-24-2012
ftEV-1543 EX AFP (05-11)'~ - -' 3~.l.tJ
!! ,., _., TYPE OF ACCOUNT
SAVINGS
'` ''~~~`~ ~ t ~~~ ~ • EST. OF KENYON MCCOY
SSN 171-12-6166 ~ CHECKING
DATE OF DEATH 04-09-2012 ~ TRUST
i.+'~' r + ''~-~~' COUNTY CUMBERLAND ~ CERTIF.
(,.~~W'~v CO•' P~EMIT PAYMENT AND FORMS T0:
EMILY M MILLER REGISTER OF WILLS
236 S WEST ST 1 COURTHOUSE SQUARE
CARLISLE PA 17013-3878 CARLISLE PA 17013
PS ECU 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. Please call 717-787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 8005456051-S2 Date 04-11-1989 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 3,.IO1 .59 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 ~` 1,550.80 months of the decedent's date of death,
Tax Rate )( .045 deduct a 5 percent discount on the tax due.
Any inheritance tax due will become delinquent
Potential Tax Due $ 69.79 nine months after the date of death.
PART TAXPAYER RESPONSE
1^
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 ~ g, ~ 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.
Complete PART 2~ and/or PART ~ below. w-
PART
2 If indicating a different
relationship to decedent: tax rate, please state OFFICIAL USE ONLY ~ AAF
^ PA DEPARTMENT OF REVENUE
TAX RE TURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS PAD
LINE 1. Date Established 1 1
2. Account Balance 2 +fi ,~U
~ y ~ 1 2
3. Percent Taxable 3 X •
S 3
4. Amount Subject to Tax 4 $ ( ~ 4
5. Debts and Deductions 5 ~~ _ 5
6. Amount Taxable 6 '~ 6
7. Tax Rate 7 X 7
8. Tax Due 8 $ $
PART DEBTS AND DEDUCTIONS CLAIMED
3^
DATE P A3D PAYEE DESCRIPTION AMOUNT PAID, ~
~
C
~
1 ~
-
* ,~ ~
TOTAL CEnter on Line 5 of Tax Computation) 5
Under penalties of perjury, I declare that the facts I reported above are true, correct and ~I~~~J ~~
~ gmple to,th best v~f y knowledge and belief. HOME C )
~ i WORK C ~ r
~ ~
. ~
PAYER SIGN TU E TELEPHONE NUMB R D TE !/W
._
219 North Hanover S
Carlisle, Pennsylvania 1
717.243.
- toll free 1.86G.45i.~
-- fcrx 71 "1.7.43.:
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FUNI:.RAL HOME ~~ CIZEMArORY, INC. infoanoffmarvoli~
May 2, 2012
Emily Miller
236 South WEst Street
Carlisle, PA 17013
Statement of Funeral Expenses for: Kenyon McCoy
Date of Death: April 9, 2012 Account Id: 16526-093
PACKAGE:
Immediate Cremation
OPTION 5 -Cremation $ 1,890.00
Sub Total: $ 1,890.00
MERCHANDISE:
Register Book
Memorial Folders $ 25.00
$ 25.00
Sub Total: $ 50.00
- __
TOTAL FUNERAL HOME CHARGES: $ 1,940.00
CASH ADVANCES:
6 Certified Death Certificates at $ 6.00 each $ 36.00
Newspaper Notice -Sentinel $ 177.00
Newspaper Notice -Johnstown/Short $ 114.75
Coroner's Fee $ 25.00
Sub Total: $ 352.75
--
Total Funeral Expense: $ 2,292.75
Total Payments Made: $ 2,292.75
Payments Made:
Emily M. Miller, POA Check 0882 Apr 30, 2012 2,292.75
Balance: $ 0.00
Please return this portion with your Remittance.
$ Amount Enclosed
Kenyon McCoy
Service ID#: 16526-093
SERVING OUR COMMUNITY SINCE 1 9~7
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