HomeMy WebLinkAbout95-0307REV-1543 EX AFP (8-94)
COMMDNMEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE •
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
INFORMA AND NOTICE FILE -N0. 21 - /S~3 ~~
TAXPAYER RESPONSE ACN 95111740
DATE 04-OS-95
~t. i '. pf. TYPE OF ACCOUNT
~{,v, ~ r" ~ ESTATE OF CAMILLE M KELLY ^ savlNGs
S.S. NO. 847-00-6062 ^ CHECKING
,C J a .~C.. ~ ,~ ~ .DATE OF DEATH 01-10-95 ^ TRUST
~~ ~ ~-~ • ~~ ~ ~~=-~ COUNTY CUMBERLAND ®CERTIFICATE
REMIT PAYMENT AND FORMS T0:
CIL i°FRANC~ES C,M INA REGISTER OF WILLS
Cu~~~~~7;D9,.;SHAFF€R~ CUMBERLAND CO COURT HOUSE
~~IOLA PA 17025 CARLISLE, PA 17013
DAUPHIN DEPOSIT BK 8 T has provided the Depnrtnent with the inforsation listed below which has boon used in calculating the
potential tax due. Their records indicate that at the death of the above decedont, you ware a joint owner/beneficiary of this account.
If you foal this inforsation is incorrect, please obtain written correction fros the financial institution, attach a copy to this fora
and return it to the above address. This account is taxable in accordance with the Inheritenu Tax Laws of the Cossonweelth of Pennsylvania.
Questions eey he answers!! !y cabling C717) 787-8327,
COMPLETE PART 1 BELOW ~ * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 8000179309 Date 01-29-88 To insure proper credit to your account, two
' Established (2) copies of this notice gust accospany your
Account Balance 10, 126.58 Pageant to the Register of hills. Nake check
payable to: ^Rsgistar of Mills, Agent^.
Percent Taxable X 50.000
NOTE: If tax payaents ors sods within three
Amount Subject to Tax 5, 063.29 (3) aonths of the decedent's data of death,
Tax Rate X , 06 you say deduct a 52 discount of the tax due.
Any inheritance tax due will becose delinquent
Potential Tax Due 303.80 nano (9l soothe after the data of death.
PART TAXPAYER RESPONSE
T.~!;~~ii~~~!;!e§':TiEi!i!:~7{~';;!i~7:3;:~t~':'.4iill~E~a~~!e~~11i~~~fP..!i'.ili'•.i!!~aG$..~ .~t':'t'~~__~i~'~,,., .~~:.EITiL!~._.~iii'ii':i<:~:
A. ~ The above inforsation and tax dw is correct.
1. You say choose to resit passant to the Rsgistar of Mills with two copies of this notice to obtain
CHECK a discount ar avoid interest, or you say chock box ^A^ and return this notice to the Register of
C 0 N E ~ Mills and an official ase.sssent will ba issuod by the PA Departsent of Revarnw.
BLOCK B. ^ Tha above asset has boon or will be reported and tax paid with the Pennsylvania Inheritance Tax return
0 N LY to be filed by the decedent's representative.
C. ^ Tha above inforsation is incorrect and/or debts and deductions were paid by you.
You suet cosplete PART 2^ and/or PART 3^ below.
PART If you indicate a different tax rata, plaasa state your ;;E!~i;s;ir~;"~~;2~;~;~;, ' rFi ~~7!~,~i ~ rr;~;;i,;;ii~ ~J!
~Itij,i~;';ki;ih,~~ tiirr},~'';: ~~,}'I,ysy'',,r`, 'y s'; ~ s?!~;:i•.i:~ };viv}','a:;:f <<7:rE,'''~ ';'t~;'j", ~;~j
2 relationshi to decadent : ;~;'r ~ } ',~r'}''','~ ;~'; !~i! y` ~r
^ p ;~''~r'~~,trr'~',,~,,r~ ,, ti~*,,M¢i';'''' . A~' ,.;i~::,.,F,kl~~~s!~jl
,,i}isi?:}~":}k4'4'iYi'i'i'i'i'itii'P''',.•`.iji:iiii:'i},~'::~'E'::,.a!;;k~:'~''?; };;t,y'~ '~}'~.,',;','a7;i
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS i;,rr,;,~,r,;'~"~""<"'~"~~'~'""~~'r~°~°~~-~_"~~'«~ "r~". '. ' '=``~
ri{r:},:}§,2';iii;,;'i'i';i;'i';';i'^'r'i~'r'iprri~'jii'':'i'~4},ii: d.i1~,} ~,,~,jF ~~iS}~i~i}~i~i~i~~~~::}S~
::ik'!:I {'i'i'i;;},S.}!,4 ,ir}!i!,a,:}.22,..}}}'Y,''",W'.4,2i!i!i:i?i:~id,,:S!dd2A ~Y..'r' !?h4hiJ?.r
LINE 1. Data Established 1 :a~;~ i~'s;!i ;, 4;;
=1~};ii ,}iir, :}}': ';';;;'i :;~}}, :;ri;i;t:ir.,}
:ii'`•''iii ~iti';M'ri;i'i':r ' r:a `:!i'i'i[;!:'~4 ::xu,
Account Balance 2 ~'i~'?~'~'' "'~`'''"
2
;'i'};=!:`,i'i'I~;'i!}''iir}i~'n}ia,:} ';'r;!};'i';,s,~-i,,, r}~atiii~i~i~ i' ~~~~i ~ i
3. Percent Taxable 3 X ~i;
ik!:: , rri5'i?}iii:i; 'n5'i ... , ..:.: 4: r;;r, ,
~;ii:i: iiii~ii!i retii'i :Sh'r
i`:itiiiiaii§44,V}Pir r''''''i.,,.,'4i,}i'~}''ai!':Fli!}~:':i'':!ei:};:;:;:}
.:.r..,~,,.,a
4 . Amount Sub jest to Tax 4 i~"~~,`•
D bts and Deductions 5 - y; "'~''' '''i~~`'
!:}' ,
5 •
ir,yrr; }}}s ~'rri:r;<i'r~ i!:'ri!i tiE:4~ tr'ri;i i{I;jr~tii#''. ~i~iiiEi a`~r ~ri~
~;ii;ir;iar,r;! rir,.:,r ..:...:::...:.:.:...:,.~~',. ,rr,,, ,$':::.::.::.r`iliriii;.,:..,:~;~s':
6. Amount Taxable 6 i;4 V~, _ ;,`i, '
i!,}ai€:
:;:,;;}},,.,,, ,,:r,:,,:,:~:;:,:::~':',!r_i,,,:,:,,,i,;,i,:,,,,,:: its },;;
Tax Rats 7 X :,ir,,:.:;,r;, :!:;:;:i: i,:~i'; :~::~;rt,r.~r,.~"~..~,;',":'„i
7 ~';i€?
,:r, ,Y'
'ri'i''-i ii'r5iii}'iEiiia~ijeji~ i;i[ijijiii ~i'riEiij
ii'si
8. Tax Due 8 ''!'~~" `''~~''
€~~r~~.
............ .:.:................:..::.:. ....U...... , ......... ...,.:...............
r::r
PaRT RESTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
omplete to the best of my knowledge and belief. HOME C )
WORK ( ) 9 -~
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