HomeMy WebLinkAbout10-16-12 (2)BUREAU OF INUIY IDUAL TAXES
PD aax zaosBl
HARRISBURG PA 1]124-0601
Pennsylvania
UEPANTMENT OF eEVENUE
RFV-1543 EM xFr (OS -ll)
FILE N0. 21
ACN 12146551
DATE 08-23-2012
PENNSYLVANIA INHERITANCE
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
DENA M HILLISON
1114 FLEETWOOD. DR
CARLISLE PA 17013-3512
EST. OF STACIE L HILLISON
DATE OF DEATH OS-11-2012
COUNTY CUMBERLAND
REMIT PAYMENT AND F'nRMS TD:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
MEMBERS 1ST FCU provi detl the department with the information below. which was used in calculating the inheritance tax due.
Records intli Cate that at the deat hi of the above-named de wtlent. you were a mint owner/beneficiary of this account. If y0U art the SppUSe Of the
deceased and any amount other than zero is reflected below on the Potential Tax Due line, note na tax may be due, but you must
notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing espouse" in PART 2.
If you believe the information is incorrect. please obtain written correctf on from the financial institution. attach a copy to this form and return
it to the above address. Please call 717-787-832] with puesti ons.
COMPLETE PART 1 BLOW ^ SEE REVERSE SIDE FOR FILING AND PAYMENT PNSTR UC 7IONS
Account No
Account Balance
Percent Taxable
Amount Subject to Tax'
Tax Rate
Potential Tax Due
PART
uu Date 01-16-2008
Established
$ 1,354.48
X 16.667
$ 225.75
X .045
S 10.16
Fv `~
G:O
~~
~~
aim ~ ~-
-'-~ l; `J
and f '_~ ~ ~
s - -~
inher~nc e ti9.e'ri Ejrn
C~ `n
O
TOTAL (Enter on Line 5 of Tax Computatian7 B -
Under penalties of per~ury, I declare that the facts I raportetl above are true, corr
an
tl
ee
~c
~~
comp ate
t
o the b st of my knowledge and belief. -l
HOME C~~ / ((
{!!
--
''nn
~~{
}l ~-0`
Et~
/
~
^ ~,J
~~ "`
/ ~
( J~~G WORK ( 7 D CC
XPAYER SIGNATURE ~
i TELEPHONE NUMBER D TE
To ensure proper <redik to the account, two
copies of this notice Host acconpanv
pavnenY t() the Register of Wills. Make check
payable to "R e9ister of Wills, Aaent".
NDTEv It Tax pavnenks are nade within Three
nanths of the tlecetlent's tla to of tleath,
detluct a b percent tliscount on the tax due.
A(ry inhe ri.t an ce Yax due will become tlelinouent
nine months after The date dfWeath.