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HomeMy WebLinkAbout09-28-12COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIYIDUAL TAXES PD BOX 280601 HARRISBURG PA 17128-0601 RFC[[C((~RD (- REV-1543A AFP (7-RO) INFORMATION NOTICE AND TAXPAYER RESPONSE FILE N0. 21 - IZ - ~1~1~ ACN 12503579 DATE 08-22-2012 ~~12 SEP 28 PM 12~ ~- J TYPE OF ACCOUNT EST. OF PAULINE F CHRONISTER ^ SECURITY S.S. N0. X^ SEC ACCT ~Rp~'~;~ L~~RT DATE OF DEATH 07-01-2012 ^ srocK {~1MBERLAND DO., PA COUNTY CUMBERLAND ^ BONDS REMIT PAYMENT AND FORMS T0: JUDY A CHRONISTER REGISTER OF WILLS 570 DOGWOOD DR 1 COURTHOUSE SQUARE MECHANICSBURG PA 17055-6176 CARLISLE PA 17013 AMERIPRISE FINANCIAL has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a beneficiary of this asset. If you feel this information is incorrect, please obtain written correction from the transfer agent, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laxs of the Commonwealth of Pennsylvania Questions may be answered by calling (717) 767-8327. COMPLETE PART 1 BELOW * * ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 641103809021 To insure proper credit to your account, two (2) copies of this notice must accompany your 5 7 payment to the Register of Wills. Make check DOD Valuation 815 5 3 5 " . , payable to: Register of Wills, Agent". Percent Taxable X 100.00 NOTE: If tax payments are ^ade within three Amount Subject to Tax 815,535.57 C3) months of the decedent's date of death, Tax Rate X .045 you may deduct a 5Y. discount of the tax due. Arty inheritance tax due will become delinquent 36 699 P 10 t ti l T D , . o en a ax ue nine (9) months after the date of death. PART TAXPAYER RESPONSE ® ~ A. ^ The above information and tax due is correct. 1. You may choose to 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 you may check box "A" and return this notice to the Register of 0 N E ~ Wills and an official assessment will be issued by the PA Department of Revenue. BLOCK B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. The above information is incorrect and/or debts and deductions were paid by you. Y t l t PART ou mus comp e e ^2 and/or PART ^3 below. PART If you indicate a different tax rate, please state your ~^ ~ ~ c' ~ " © relationship to decedent: _ i ' TAX RETURN - COMPUTATION OF TAX ABOVE ASSET(S) ,,~;.;. LINE 1. DOD Valuation 1 f ~s .3. ~7 r~. ; ° 7 ~ 2. Percent Taxable 2 X 7 /~ . 7+- ~~ ~ ~ 3. Amount Subject to Tax 3 ~. . J / ~ r ~ 4. Debts and Deductions 4 ' 5. Amount Taxable 5 ~`y ~` 6. Tax Rate 6 x d >`~'~ 7. Tax Due 7 - PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above a~rye true, correct and complete to the best of my knowledge and belief. HOME C7 ) Z 7 - a~ 3 s ORK AXP R SIGNATURE TELEPHONE NUMBER T