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HomeMy WebLinkAbout06-20-12 (3)LOMMONWEALTR OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES ~l ~ N TICE l ~3 FILE N0. 21 12-0321 Po BDx zao6gl y~ ONSE ~~ ACN 12502689 FUIRRISBURG PA 17128-0601 ~ " ~f 1R ~~ r 1-,~,:~ DATE 06-15-2012 REY-15f3A •FP (i-00) EZ J~N 20 P~ r2• ~ TYPE OF ACCOUNT EST. OF RRY D JONES ^ SECURITY S.S. N0. 175-18-2025 ® SEC ACCT F DEATH 02-24-2012 ^ srocK CUMBERLAND ^ BONDS ~~~ REMIT PAYMENT AND FORMS T0: SANDRA L MEMBRINO REGISTER OF WILLS 457 S OLD MIDDLETOWN RD 1 COURTHOUSE SQUARE MEDIA PA 19063-4859 CARLISLE PA 17013 VANGUARD has provided the Department with the information listed below which has boon used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a beneficiary of this asset. If you feel this inforaation is incorrect, please obtain written correction frog the transfer agent, attach a eepY to this fora and return it to the above address. This account is taxable in accordance with the Inheritance lax Laws of the Commonwealth of Pennsvlvani a. qua stions maY be answered by calling (717) 707-8327. CONPLET-E PART 1 BEL4Y1 ~ * * SEE REVERE SIDE FOR FILING AND PAYMENT INSTRUCTIDNS Account No. 09892445777 To insure proper credit to your account, two (2) copies of this notice oust accomparo your DOD Valuation 1221782.31 payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". Percent Taxable X 100.00 NOTE: If tax payments era made within three ADOUnt SUb'J eCt t0 Tax 1221782 • 31 (3) nonths of the decedent's data of death. Tax Rate X . 045 you nay tladuct a 5Y. discount of the tax due. Aro inheritance tax due will become delinquent Potential Tax Due 51525.20 nine (9) months after the date of death. A. ^ The above inforaation and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two conies of this notice to obtain a discount or avoid interest, or you aay check box "A" and return this notice to the Register of CHECK Wills and an official assa ssmont w311 ba issued by the PA Department of Revenue. C 0 N E ~ BLOC K B. ^ Ths above asset has been or will be reported and tax paitl with the Pennsylvania Inheritance Tex return 0 N L Y to be filed by the decedent's representative. C. ~ Tha above inf ormetion is incorrect and/or debts and deductions were paitl by you. You must cwolete 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 1 2. Percent Taxable 2 X 3. Amount Subiect to Tax 3 4. Debts and Deductions 4 - 5. Amount Taxable 5 6. Tax Rate 6 X 7. Taz Due 7 PART DEBTS AND DEDUCTIONS CLAIMED Under penalties of perjury, I declare that~the facts I have reported above are trueA,~ correct and complete to the bast o my kQn~owledge and belief. HOME C'Ygy) S ~y 7!~ / Gsac~ WORK C~$y~S7'ti- 41/ f~~.~ -.?Ol vn~vrn nrn~u ~~n ~ TCI CDUnuC WIYIICD nATC DATE PAID PAYEE DESCRIPTION AMOUNT PAID