HomeMy WebLinkAbout10-16-12 (3)BUREAU OF INDIVIDUAL TAXES
PO BOX 260601
HARRISBURG PA 17128-0601
pennsylvania
OEPNnTMENT OF PEVENIIE
PEV-1563 E[ •iP [05 -I1)
PENNSYLVANIA INHERITANCE T
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE N0. 21
ACN 12146550
DATE 08-23-2012
NATHAN HILLISON
1114 FLEETWOOD DR
CARLISLE PA 17013-3512
EST. OF STACIE L
DATE OF DEATH Os-11-2012
COUNTY CUMBERLAND
REMIT PAYMENT AND FCIRMS T0:
REGISTER OF WIL L.S
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
MEMBERS 1ST FCD ~ provided the department with the information below, which was used in calculating the inheritance tax due.
Recortls intlicate that at the tleath pf the above-nametl tlecetlent, you were a joint owner/beneficiary of this account. If you are the spouse Of the
deceased and any amount other khan zero is reflected below on the Potential Tax Due 11 ne, note no tax may be due, but you must
notify the department of your elatlonship to the deceased by checking Box C 1n PART 1 Delow and writing "spouse" in PART 2.
If you believe the information is i correct. please obtain written correction from the financial fns ti tuti on, attach a copy to this form antl return
it to the above address. Please call 717-767-6327 with questions.
COMPLETE PART 1 BE~OW ^ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 289472-. 0 Date 07-21-2006 To ensure proper craait to the account, two
Established copies of 'E his notice oust acconpam
oaynenY to the Register of Wills. Make check
Account Balance
G 2
245
07
"
~
,
.
paY able to
Register of Wills. Agent".
Percent Taxable )( 50.000
NOTE: If 'tax Pavnents are node within t
Amount Subject to Tax ~` 1
122
54 hree
,
.
non the of '[he decedent's date of death,
Tax Rate X .045 deduct a 5 Percent discounk on the tax dua.
Anv inhe ri't ante kax tlue will become deli nquent
Potential Tax Due $ 50.51
nine nont h:s after the tlate of death.
PART TAXPAYER RESPONSE v
N
T
~~
~ rn
A. ^ Tl~e above infonation and tax dus is correct. ~~~177 r. '~I (i'• ~J
i. Remit Pavn ant to the Register of Wills with two conies of this notice to ~si ~~ - ~-~'~~~~
CHECK a tli scount or avoid interest, or return this notice to the Resister of W U}ntl Qh ~
.:j ^-7
~. an official assesswent will be issued by the PA DeparknenY of Revenue. Q
, ~
DNE
BLOCK ~
]7
B. ~~ The above asset has been or will be reportetl and tax Paid wi kh the PennsYlva~~herikaneaYrtax r -i -*
etpr,?7
ONLY (ilea by the estate representative. ~7 ;=~ ~ J
~ ~ m
f_
D
L. ~ Trye above info rna ton is incorrect and/or debts and deductions were Paitl. CJ ^
~~ ~+
CdnPlete PART 2~ and/or PART 3^ below. d T,
PART If indicating a di fere nt tax rate, please state
relationship to decedent:
TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established i 1
2. Account Balance ~ 2 $
3. Percent Taxable 3 X
4. Amount Subject to tax 4 $
5. Debts and Deductipms 5
6. Amount Taxable ~ 6 $
7. Tax Rate ~ 7 X
8. Tax Due ~ 8 ~
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of pa rjury, I declare that the facts I reportetl above /ia re true, /,grrec(tJ and
complpe~te tp~t~h~e best of~ m~y knowledge and belief. HOME C'/~/~ ) `~~ -!5~
~/~i" i~S`zi `--~~ E~Cc~ WORK ( 7 ~D ~!' ~;~
TAXPAYER SIGNATURE II TELEPHONE NUMBER DATE