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HomeMy WebLinkAbout09-28-12 (5)COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE Q~ (~ ~;[~ INFORMATION NOTICE 12- IU7U BUREAU OF INDIVIDUAL TAXES F't CV~LL~.~ ! FILE N0. 21 " PO BOX 260601 ~ ~ ~„ AND ACN 12503583 HARRISBURG PA lnza-ocol ~~~IJt~~- i:F -,4, TAXPAYER RESPONSE DATE 08-22-2012 REV -1543A AFP (7-00) 4~~1 SEP 2~ P~ ~~; (} ! TYPE OF ACCOUNT EST. OF PAULINE F CHRONISTER ^ SECURITY ULL=tip; ;~ S.S. NO. 186-01-4678 X^ sEC ACCT ~~I~'S rv~~~Ss DATE OF DEATH 07-01-2012 ^ STOCK ~~~~~~p CQ. 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 Department with the inforwation 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 inforwation 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 Cowmonwealth of Pennsylvania. Questions way be answered by calling C717) 767-8327. COMPLETE PART 1 BELOW * ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 930066569391004 To insure proper credit to your account, two C2) copies of this notice oust accompany your DOD Valuation 32 2 8 3 5 1 payment to the Register of Wills. Make check , . payable to: "Register of Wills, Agent". Percent Taxable X 100.00 Amount Subject to Tax 32, 283.51 NOTE: If tax payments are made within three (3) months of the decedent's date of death, Tax Rate X .045 you may deduct a 5Y. discount of the tax due. Any inheritance tax due will become delinquent Potential Tax Due 1 , 452.76 nine C9) wonths 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. B L 0 C K ~ g, he 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 You must complete PART ^ and/or PART ^3 below. . PART If you indicate a different tax rate, please state your . ,, .. © relationship to decedent: _ ~~~ ' TAX RETURN - COMPUTATION OF TAX ON ABOVE ASSETCS) ~; : LINE 1. DOD Valuation 1 `=t 2. Percent Taxable 2 X s 3. Amount Subject to Tax 3 4. Debts and Deductions 4 5. Amount Taxable 5 r`~ 6. Tax Rate 6 X - 7. Tax Due 7 £' '~~ PART DEBTS AND DEDUCTIONS CLAIMED Under penalties of perjury, I declare that the facts I have reported above are 7't rue, correct and comp ete to the be t of my kn ledge and belief. HOME C ~ ) /~ ~L TAX YE SIGNATURE TELEPHONE NUMBER D TE DATE PAID PAYEE DESCRIPTION AMOUNT PAID