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HomeMy WebLinkAbout09-28-12 (7)COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE f [~C1Cr INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES ~~J~j~,`C,i f AND FILE NO. 21 -1Z , ~U7G PO 80X 280601 ~ .-,- ~ ., ACN 12503585 HARRISBURG PA n12a-o6o1 ( ~:_E~~ ' '' ~„ TAXPAYER RESPONSE RE~I~ ~ ~. ~ _~, DATE 08-22-2012 REY-1543A AFP f7-Ot) ~~~2 SEP ZS P~ ~~: ({ I TYPE OF ACCOUNT EST. OF PAULINE F CHRONISTER ^ SECURITY J_~,.a!; ,: $.$. N0. 186-01-4678 ~ SEC ACCT 0~~`5 CO~JRT DATE OF DEATH 07-01-2012 ^ sTDCK ~~ER~~ (~,~ P~ 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 Departwent 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 frow the transfer agent, attach a copy to this forty 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 (717) 787-8327. COMPLETE PART 1 BELOW * * ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 930079693188004 7o insure proper credit to your account, two (2) copies of this notice wust accowpany your paywent to the Register of Wills. Make check DOD Valuation 47 ~ 062.75 payable to: "Register of wills, Agent". Percent Taxable X 100.00 NOTE: If tax paywents are nade within three Amount Subject to Tax 47 ~ 062.75 (3> nonths of the decedent's date of death, Tax Rate X . 045 you way deduct a 5Y. discount of the tax due. Any inheritance tax due will becowe delinquent Potential Tax Due 2 ~ 117 • 82 nine C9) wonths after the date of death. PART TAXPAYER RESPONSE © ., A. ^ The above inforwation and tax due is correct. 1. You way choose to rewit paywent 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 way check box "A" and return this notice to the Register of 0 N E Wills and an official assesswant will be issued by the PA Departwent of Revenue. BLOC K 8, he above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return O N L Y o be filed by the decedent's representative. C. ^ The above inforwation is incorrect and/or debts and deductions were paid by you. You wust cowplete PART ^ and/or PART ^3 below. PART If you indicate a different tax rate, please state your ,~ ® relationship to decedent: fir{ TAX RETURN - COMPUTATION OF TAX ON ABOVE ASSET(S) LINE 1. DOD Valuation 1 s 2. Percent Taxable 2 X c 3. Amount Subject to Tax 3 4. Debts and Deductions 4 5. Amount Taxable 5 ;+;'ir 6. Tax Rate 6 X 'G, 7. Tax Due 7 PART DEBTS AND DEDUCTIONS CLAIMED Under penalties of perjury, I declare that the facts I have reported above are -7t rue, caorrect and complete~~t'o the be t of my kn wledge and belief. HOME C 7~ ) ~I ~a liL • - TA YER SIGNATURE TELEPHONE NUMBER AT DATE PAID PAYEE DESCRIPTION AMOUNT PAID