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HomeMy WebLinkAbout08-01-12~ PENNSYLVANIA INHERITANCE TAX PSECU 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 ~~, BUREAU OF INDIVIDUAL TAXES (''~ ~ ~~~~~. Po Box zaocol ~~ HARRISBURG PA 17128-0601 D T; E E ~'~` ~~~ REV-1543 E% RFP (R5-11) ~ ~ ,I I~~ INFORMATION NOTICE AN D TAXPAYER RESPONSE FILE ACN DATE N0. 21 -/~-G~z, 12134182 05-30-2012 i~12 BUG ~ ~ AM 9' I ~! TYPE OF ACCOUNT EST. OF JOANN A WHITMIRE ^ savINCs SSN 208-24-0716 ® cHECKIN6 ",` `~'~'~=~~•E; ~ QR~t'`b^~d~:, ~~~~~ DATE OF DEATH 05-04-2012 ^ rRUST CUMBE~iLAND CO., PA COUNTY CUMBERLAND ^ CERTIF. REMIT PAYMENT AND FORMS T0: STEVE WHITMIRE REGISTER OF WILLS 6943 WERTZVILLE RD 1 COURTHOUSE SQUARE ENOLA PA 17025-1039 CARLISLE PA 17013 Account No. 0208240716-S4 Date 06-01-1999 Account Balance Percent Taxable Established $ 2,517.12 X 50.000 To ensure proper credit to the account, two copies of this notice must accompany payment to the Register of Wills. Make check payable to "Register of Wills, Agent". NOTE: If tax payments are made within three Amount Subject to Tax $ 1 ~ 258.56 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 $ 56.64 nine months after the date of death. P~T TAXPAYER RESPONSE ~ FAILURES TO ReE ; ~ ~WI~o R~~S~#~L7~ IN A FFI ~ A SESSMENT ~~ A. ^ Theabove information and tax dueis 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 C 0 N E J an official assessment will be issued by the PA Department of Revenue. B L 0 C K B. i7~i The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return 0 N L Y V~ filed by the estate representative. C. ^ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3^ below. PART If indicating a different tax rate, please state relationship to decedent: TAX RETURN - CALCULATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS ~~~~AD 1 2 $ 3 X 4 +fi 5 6 $ 7 X 8 OFFICIAL ~JSE ONLY ^,,AAF PA DEPARTMENT OF REVENUE .. 1 2 3 4 5 6 7 PART DEBTS AND DEDUCTIONS CLAIMED ^3 IUTAL ctnter on Llne 5 of Tax Computation) S Under penalties of perjury, I declare that the facts I reported above are true, correct and comple to the best of my knowledge and belief. HOME C / ) ~~l'(D~ WORK ( ) TA PAYER SIGNATURE TELEPHONE NUMBER DATE DATE PAID PAYEE DESCRIPTION AMOUNT PAID