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Home My WebLink About09-28-12 (4)COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE BUREAU OF INDIYIDUAL TAXES rrr}} tt~~~~~r-'1 FILE N0. 21 12- ~U7U Po aox zao6ol~~.~L,V~v4LJ ' AND HARRISBURG PA nlza-ocol r~)~~F~•-••r** r•.,_ TAXPAYER RESPONSE ACN 12503582 ff`` ~~~~~''~~ y ~-"'~ DATE 08-22-2012 REY-1543A AFP <7-00) ~)i2 SE~ 28 PM ~~~ 4 ~ TYPE OF ACCOUNT EST. OF PAULINE F CHRONISTER ^ SECURITY •~, ~ _ ; ,,, S.S. N0. 186-01-4678 X^ SEC ACCT '`'~`~"' `` "' DATE OF DEATH 07-01-2012 ^ STOCK QRPW~fV'S vOVR ~ COUNTY CUMBERLAND ^ soNDs 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 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 Laws of the Commonwealth of Pennsylvania Questions may be answered by calling C717) 787-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 930065615419004 DOD Valuation 4 9 , 2 9 8.2 1 Percent Taxable X 100.00 Amount Subject to Tax 49,298.21 Tax Rate X .045 Potential Tax Due 2, 218 • 42 To insure proper credit to your account, two Cz) copies of this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". NOTE: If tax payments are made within three C3) months of the decedent's date of death, you may deduct a 5Y. discount of the tax due. Any inheritance tax due will become delinquent nine C9) months after the date of death. P T TAXPAYER RESPONSE O 1 _.. ,._ ... ~A A. ^ The above information and tax due is correct. I. You say choose to remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or you way 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 g, he above asset has been or will be reported and tax pa ~~~111 ~ id with the Pennsylvania Inheritance Tax return 0 N L Y ... o be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and ded uctions were paid by you You must complete PART a and/or PART O below. . PART If you indicate a different tax rate, please state your ,~rL' ~~~y"~ y s_, ~~~ © relationship to decedent: ~ z ~ "~'~ - ~ ' ?~ a TAX RETURN - COMPUTATION OF TAX ON ABOVE ASSETCS~ ., ~+ ~+, iii: Y> LINE 1. DOD Valuation 1 -` 2. Percent Taxable 2 X '~~' • ~ ~ ~ 3. Amount Subject to Tax 3 ~~ a ~ ~~ ~ 4. Debts and Deductions 4 - ~., t ~ 5. Amount Taxable 5 : . ~ ,, 6. T a x Rat e 6 X ~-,may,; 7. Tax Due 7 ' PART DEBTS AND DEDUCTIONS CLAIMED Under penalties of perjury, I declare that the facts I have reported above are true, correct and comp ete to the be t of my kno edge and belief. H OME C ~ ` ~, AXP ER SIGNAT RE TELEPHONE NUMBER ATE DATE PAID PAYEE DESCRIPTION AMOUNT PAID