HomeMy WebLinkAbout07-09-12 (2)BUREAU DF INDIYIDVAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
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PENNSYLVANIA INHERITANCE TAX ~Q(
INFORMATION NOTICE FILE N0. 21- rp~-5~C>
~nnsytva RUED ~1~p(I~y AND AcN 12131500
iPARTMENT OF REVE rrr'~., n~ ~}/~YER RESPONSE DATE 05-15-2012
REV-156b E% AFP (R5-1 S: G'~ '~11 ['4411,,,1!1
212 JiJL -9 AM II I ~J~ST. OF THOMAS 0 HENDRY
SSN 439-38-4891
til.wf#<_ ~,'„' DATE OF DEATH o4-z8-zoi2
Q~'{~f's (~(~f COUNTY CUMBERLAND
~~ ~ ~ REMIT PAYMENT AND FORMS To:
LINDA H MYERS REGISTER OF WILLS
1002 BAYTHORNE DR 1 COURTHOUSE SgUARE
MECHANICSBURG PA 17050-2100 CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
MID PENN BK 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 yDU 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 fs incorrect. Dlease obtain written corretti on from the financial institution, attach a coDY to this farm 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. 180D8029 Date 12-2U-2UlU To ensure proper credit to the account, two
Established conies of this notice oust accoaaany
vayaent to the Register of Wills. Meke check
Account Balance g 108,345.58 payable to "Reaistar of Wills. Agent".
Percent Taxable X 16.667
NOTE: If tax oayaents era aade within three
Amount Subject to Tax $ 18,057.96 months of the decedent's date of death,
Tax Rate X . 0 4 5 deduct a 5 oe rcant discount on the tax due.
Any' inheritance tax due will become delineuent
Potential Tax DUO $ 812.61 nine aonths after the date of death.
C. ~ The above inf orwa bon is incorrect and/or debts and deductions were Daid.
Complete PART ~2 and/or PART ~ below.
PART If indicating a different tax rate, ploaso state
^Z relationship to decedent:
TAX RE TURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established 1
2. Account Balance 2 ~
3. Percent Taxable 3 X
4. Amount Subject to Tax 4
5. Debts and Deductions 5
6. Amount Taxable 6 S
7. Tax Rate 7 X
8. Tax Due 8 ~
PART DEBTS AND DEDUCTIDNS CLAIMED
DATE P AID PAYEE DESCRIPTION AMOUNT PAID
Unde penalties of perjury, I declare that the foots I reported above ~a/re tru ell, co~7r r~e~c~t/a,~nd
m to to the est of my knowledge and belief. HOME C [ ~ Z ) / 32- T w ~ f /
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