HomeMy WebLinkAbout06-22-12BUREAU OF INDIVIOWL TAXES
PO BOX 280601 pen
NIIRRISBURG PA 17128-0661 ptpA0.T
eEY-1561 Ex AFP (05-11) FILE
ACN
DATE N0. 21 -'c~' W~ 1
12132197
05-21-2012
tQI2 JUN ~~ AM ~ ~ ~ 1 $ TYPE OF ACCOUNT
EST. OF ALVEY L POWELL ^ savlNGs
SSN 217-30-5423 ® CHECKING
,'"``~~(°~ ''
~~ s ~~~T DATE OF DEATH 04-25-2012 ^ TRUST
~D~ AA'rs ~^ F n^
COUNTY CUMBERLAND
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CERTIF.
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REMIT PAYMENT AND FORMS T0:
MILDRED I POWELL REGISTER OF WILLS
420 S FAYETTE ST 1 COURTHOUSE SQUARE
SHIPPENSBURG PA 17257-1739 CARLISLE PA 17013
CITIZENS BANK OF PENNSYLVANIA provi detl the department with the information below, which was used in calculating the inheritance tax due.
Records indicate that at the death of the ebove•named decetlent. you were a Joint owner/beneficiary of this account. If you are the SpOUSe Of the
Qeceased 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 wrttten correction from the financial institution, attach a copy to this form and return
it to the above address. Please call 717-7$7_8$27. with question_s_, _
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 6100796183 Dato 05-21 - 1980 To ensure proper credit to the account, two
Established copies of this notice oust accompany
payment to the Reei star of Wills. Make check
Account Balance $ 2,928.23 payable to "Register of Wills, Aeant".
Percent Taxable X 50.000
NOTES If tax payments are made within three
Amount Subjaet t0 TeX $ 1,464.12 mohths of the decedent's date of death,
Tax Rate ~( , 1 ~j deduct a 5 percent discount on the tax due.
Ara( inheritance tax due will become delinquent
Potential Tax Due $ 219.62 nine months after the date of death.
PART
CHECK
ONE
BLOCK
ONLY
A. ~ The above infonation and tax due is correct,
Remit payment to the Rapister of Wills with two copies of this notice to obtain
a discount or avoid interest, or return this notice to the Register of wills and
an official assessment will ba issued by the PA Department of Revenue.
B. ~ The above asset has been or will he reported and tax paid with the Pennsylvania inheritance tax return
filed by the estate representative.
C. ~ the above infor(m~ incor
Complete PART U-CL and/or PART
and/or debts and deductions were paid.
PART If indicating a different tax rate; please state !,!('~~'~I I i ~. I101~
I
relationship to tlecedent:. ~~ I
I'
TAX RETURN - CALCULATION OF TAX 0 JOINT/TRUST ACCOUNTS
LINE 1. Date Established 1 ~+Cn'-~ Q'
2. Account Balance 2
S
3. Percent Taxable 3 X '
4. Amount Subject to Tax 4 ~
5. Debts and Deductions 5 -
6. Amount Taxable 6
7. Tax Rate 7 X
B. Tax Due 8 +~
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
~ PENNS,IY,L~VA~NtIA INHERITANCE TAX
~~~ GEC (./~rlt+C VI"MATION NOTICE
ny-y( AND
MENT OF REV c~~~ (,'~AYER RESPONSE
ion is
TELEPHONE NUMBER DATE
Under penalties of perjury, I declare that the facts I reported above are true, correct and
complete to the bast oCfl~my ~k/nOy~Illedg~ and belief. HOME C~~~'~ ~~.-_~,~~~~
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