The URL can be used to link to this page

Home My WebLink About07-30-12BUREAU OF INDIVIDUAL TAX ~~ ti +" -. F I L E ND . 21 ~ ~ -~~ ~~ PO BOX 280601 ~~jl,,! ACN 12140547 HARRISBURG PA 17128-06D1 i:-- ~*~ R~~`»;~~`~~."',, DATE 07-18-2012 REY-1543 EX RFP (OS -11) ' ~ ~ ~ ~~~ ~0 ~~ 3. ( ~ TYPE OF ACCOUNT a EST. OF FRANK W FORREST © SAVINGS _ SSN ^ CHECKING `-~ -~ . T ~ ~ DATE OF DEATH 07-07-2012 ^ TRUSr 0 ~ ~~ ~ `~~ ~ ~' v ~ ~ COUNTY CUMBERLAND ^ CERTIF. A , { ~y ( ~ ~h ~ ( ~ D O ~ W11~'~ttt-'"' " " ~ REMIT PAYMENT AND FORMS T0: CATHY E FORREST REGISTER OF WILLS 20 S 4TH ST 1 COURTHOUSE SQUARE PERKASIE PA 18944-1810 CARLISLE PA 17013 MEMBERS 1ST FCU 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 y0U 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 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. 214398-0 0 Date 02-20-2002 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance 59 763.13 payment to the Register of Wills. Make check ~ payable to "Register of Wills. Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to Tax ~{` 9, 960.72 months of the decedent's date of death, Tax Rate X .045 deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent Potential Tax Due $` 448.23 nine months after the date of death. PART TAXPAYER RESPONSE 1 FAiLIkRE TO RESPDND< W~LL u \` LT 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 B. ^ 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. a above informs ion is incorrect and/or debts and deductions were paid. f 1/"1~ /f~ ~ D(,(~ omplete PART ~2 and/or PART ~ below. ^_ ~~~,"n~ ~flA`~n/S( V^~- r~Q~~~~ro-,A PART a If indicating a different tax rate, please state relationship to decedent: TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS 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 -~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE ~~~, AND ~r7s.o~ K TAXPAYER RESPONSE 1 2 3 X 4 5 6 ~ X 8 $ PAD OFFICIAL U PA DEPARTMENT SE ONLY ^ AAF OF REVENUE 1 2 3 4 5 6 7 8 PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I reported above are true, correct and complete to the best of my knowledge and belief. HOME C ~ WORK C TAXPAYER SIGNATURE TELEPHONE NUMBER DATE ~`(~ TOTAL CEnter on Line 5 of Tax Computation) S r ~~ \~ ~V ~,~. ..,.~ f„ ~i }a. Et'} {3t ~,{~ ;~~ {~,r C_. ~• I ~~ I ~~ \~ W ~. i fit, ~ ~ c ,~k ~~ t, USA FIRST-~C~4Ay F RE`YER".. }' S. 1