HomeMy WebLinkAbout10-16-12BUREAU OF IND]VIOUAL TA%ES
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HARRISBURG PA 1712 R-0601
Pennsylvania
DE PAflTMENT OF REVENUE
REV-1543 EF LFP (05-11)
PENNSYLVANIA INHERITANCES T
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE N0. 21
ACN 12146555
DATE OS-23-2012
CLAIRE HILLISON
1114 FLEETWOOD DR
CARLISLE PA 17013-3512
Date O1-
Established
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
MEMBERS 1ST FCU provi tle0 the department with the information below. which was us etl in calculating the inheritance tax Due.
Recortls intlica to that at the tleath' of the above-nametl tlece0ent. you were a Joint owner/beneficiary of this account. If you are the 5pou5e Of the
deceased and any amount other) than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must
notify the deDa rtment of you rl relationship to the deceased by checking Box C in PART 1 below and Writing "spouse" in PART 2.
If you believe the information is !incorrect, please obtain written correction from the financial institution, attach a copy to this form and return
it to the above atltl ress. Please hall ]ll-]87-8327 with questions.
COMPLETE PART 1 BLOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
account No. 321658+•00
Aecpunt Balance
Percent Taxable
Amount Subject to Tax'.
Tax Rate
Potential Tax Dua
EST. OF STACIE L HILLISON
DATE OF DEATH 08-11-2012
COUNTY CUMBERLAND
REMIT PAYMENT AND F'O RMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
D B To ensure proper credit to th i t
$ 1,682.05
X 50.000
$ 841.03
X .045
S 37.85
e aecoun wo
copies of <his notice oust accompany
payment to the Register of Wills. Make check
payable ko "Register of Wills. Ages k•'.
NOTE: If tax OaYnents are made within Three
months of the decetlenk's date of tleath.
deduck a !i percent tli scount on the tax due.
Arty inhe r:it ante tax due will become delinquent
nine nontlas after the tlake of tleath.
U r~3 :L7
0
" 'T7 ?n
i-n C ;
t
) Ci
A. ^ the above inf ornation and fax due is correct. -0 - ~'~ '-1 r ~ ._T;.
.
Resit paYnen4 to the Register of Wills with two copies of this notice aim ~~^'
r
CHECK a discount or avoid interest, or return this notice to 4he Register o~3'TYl's antl ~ l i~~
ONE an official assesment will be issued by Me PA Oe pa Mnent of (Revenue. C
BLOCK rrc^^~~33 t=
B. ,~Tha above asset has been or will be reported and tax paid wikh the Pann SV
inhe r
M~ -~-1i~~-
i t87R -'r
t
t
~
l
ONLY ,
~
friled by the estate representative.
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~ ax ra
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n
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C. ~ The above inf orna aan is into rreci and/or debts and deductions we na paitl. ~ L7.~.
Qonplete PART ~ and/or PART ~ below. ~-
PART If indicating a d fferent tax rate, please state
r818t10n5h1p t0 tl•CBdent:
TAX RETURN - CALCULAtION OF TAX ON JOINT/TRUST ACCOUNTS ~~~'
LINE 1. Date Established 1
2. Account Balance 2
3. Percent Taxable 3 X
4. Amount Subject to 'T ax 4 $
5. Debts antl Deductigns 5
6. Amount Taxable 6 S
7. Tax Rate ~. 7 X
8. Tax Due g
PART DEBTS AND DEDUCTIONS CLAIMED
^3
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perpury, I tleclare that the facts I repprted above ar/el true, ~cyq~rlf~~y~.~.e~.e](t~a_nd
complete tp th~e~h~e s~t olf my knowletlga and belief. HOME C~~'/ ) ~`r("5'~,~A
~~~~~~~"' ~C c WDRK C :> ~ ~ w ~a
~AXPAYER SIGNATURE i TELEPHONE NUMBER D TE
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