HomeMy WebLinkAbout09-28-12 (8)COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 - ~ 2- U7
PD BOX 260601 ACN 12503586
HARRISBURG PA lnzB-o6o1 ~~~~~~~ ~ TAXPAYER RESPONSE
,,,..~,....__ __ _ DATE 08-22-2012
L i~ ~ [ J~i 2 U f I~D ~Z' ~4
ORPHAN'S ''~UUN r
JUDY A CHRONISTE
570 DOGWOOD DR
MECHANICSBURG PA 17055-6176
TYPE OF ACCOUNT
EST. OF PAULINE F CHRONISTER ^ SECURITY
$•$• N0. 186-01-4678 X^ SEC ACCT
DATE OF DEATH 07-01-2012 ^ sTOCK
COUNTY CUMBERLAND ^ BONDS
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
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 faro 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. 930078189378004 To insure proper credit to your account, two
(2) copies of this notice must accompany your
DOD Valuation 172
748
21 Payment to the Register of Wills. Make check
~
• payable to: "Resister of Wills, Agent".
Percent Taxable X 100.00
Amount Subject to Tax 172 ~ 748 • 21 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 7 ~ 773 • 67 nine C9) months after the date of death.
PART TAXPAYER RESPONSE
A. ^ The above inforoation and tax due is correct.
1. You ^ay 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 ^av check box "A" and return this notice to the Register of
C 0 N E ~ Wills and an official assessment will be issued by the PA Department of Revenue.
B L 0 C K 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.
You must cosplete PART ^ and/or PART ^ below.
If you indicate a different tax rate, please state your
PART ~ ' '~ ~"~
~,~
relationship to decedent: +~°
;X
TAX RETURN - COMPUTATION OF TAX ON ABOVE ASSETCS)
LINE 1. DDD Valuation 1
2. Percent Taxable 2 X
3. Amount Subject to Tax 3
4. Debts and Deductions 4
5. Amount Taxable 5
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~7above/'are true, pcorrect and
complete to the b st of my k wledge and belief. HOME ( 7 ~ / ) (p ~ ~ 8 ~ 3
~~ ~ ~
AX ER SIGNATURE TELEPHONE NUMBER ATE
DATE PAID PAYEE DESCRIPTION AMOUNT PAID