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HomeMy WebLinkAbout09-28-12 (3)COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 ~FCUF~G C ~Fi.(~ vi ~ ... .. ).~ REY-1543A AFP (7-00) INFORMATION NOTICE FILE N0. 21-12-~U7~ AND ACN 12503581 TAXPAYER RESPONSE DATE 08-22-2012 ~'~~2 SEP 28 PM 12~ 4 I TYPE OF ACCOUNT EST. OF PAULINE F CHRONISTER ^ SECURITY ~( ~~.{~~, ~4,. S.S. N0. X^ sEC ACCT (~~}-~;`s v~~~T DATE OF DEATH 07 - O 1- 2012 ^ sroCK ~BERlANp CO., ~ 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 has provided the Departsent with the inforsation 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 inforsation is incorrect, please obtain written correction fros the transfer agent, attach a copy to this fors and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Cossonwealth of Pennsylvania. puestions say be answered by calling C717) 787-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 930064531179004 To insure proper credit to your account, two (2) copies of this notice roust accoapany your 0 1 1 .5 4 paysent to the Register of Wills. Make check DOD Valuation 15, payable to: "Register of Wills, Agent". Percent Taxable X 100.00 NOTE: If tax paysents are lade within three Amount Subject to Tax 15, 011 .54 (3) sonths of the decedent's date of death, Tax Rate X .045 you say deduct a 5Y. discount of the tax due. Any inheritance tax due will becose delinquent Potential Tax Due 675.52 nine C9) sonths after the date of death. P~T TAXPAYER RESPONSE A. ^ The above inforsation and tax due is correct. 1. You say choose to resit paywent to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or you ^ay check box "A" and return this notice to the Register of 0 N E Wills and an official assesssent will be issued by the PA Departwent of Revenue. B L 0 C K ~ B. he above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y ~o be filed by the decedent's representative. C. 111111^ The above inforsation is incorrect and/or debts and deductions were paid by you. You oust cosplete PART ^ and/or PART ^3 below. PART If you indicate a different tax rate, please state your -d © relationship to decedent: ~ ~_' •:z: TAX RETURN - COMPUTATION OF TAX ON ABOVE ASSET(S) F"3j LINE 1. DOD Valuation 1 ~~ 2. Percent Taxable 2 X ~`t<- 3. Amount Subject to Tax 3 4. Debts and Deductions 4 5. Amount Taxable 5 y` ;i~~. 6. Tax Rate 6 X ~` °N 7. Tax Due 7 PART DEBTS AND DEDUCTIONS CLAIMED Under penalties of perjury, I declare that the facts I have reported abov are true, correct and Lete ~o~~ a best of my owledge and belief . wOME C / l ) ~~'~ a~~3 /~ ~cL///"A7/~ ~ L YER SIGNATURE TELEPHONE NUMBER ATE pC~ DATE PAID PAYEE DESCRIPTION AMOUNT PAID