HomeMy WebLinkAbout10-16-12 (4)BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 1]128-0601
Pennsylvania
DEPAPTMENT nF REVENUE
REV-1543 ES RFP (OS-Ill
PENNSYLVANIA INHERITANCE'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE N0. 21
ACN 12146553
DATE 08-23-2012
DENA M HILLISON
1114 FLEETWOOD DR
CARLISLE PA 17013-3512
EST. OF STACIE I_
DATE OF DEATH OS-11-2012
COUNTY CUMBERLAND
REMIT PAYMENT AND FDRMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQIJARE
CARLISLE PA 1;7013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
MEMBERS 1ST FCU provided the tleDa rtment with the information below, which was used in calculating the inheritance tax due.
Records intli cote that at the death lof the above-named decedent, you were a joint owner/beneficiary of this account. If you are Lhe SpOUSe 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 deoa rtment of your 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 farm and return
it to the above dCd recs. Please caul 717-]57-8327 wf th QuesLi ons.
COMPLETE PART 1 BELOW ^ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 321(55-Ill Date D5-07-2011 To ensure Proper credit to the account, two
Established cooies of this notice Husk acconpanr
A<COUnt Balance $ 8 0 6.62 parnenk to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 16.667
Amount Subde<t to Tax $ 1 34.44 NDTEE If kax paynents are node within three
non the of the decedent's dateof death.
TaX Rata X . 045 deduct a 5 percent discount on the tax due.
Pptential Tax Due $
6.05 Arty inheritance tax due will becone delinouent
nine nontha offer the dake of death.
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cis
A. ^ Trye above inf ornation and 4ax due is correct. Q
Renit Pavnent to the Reei star of Wills with two cooies of this noti
t
l
~ N
O
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ce
o o
(
CHECK ~ a discount or avoid interest, or return this notice to the Re9i star of Wil
~ n C_i C
ONE an official assessnenf will be issued by the PA Department of Revenue.
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[ BLOCK ]
ONLY ~
Z r.
,I
B. M T a above asset has been or will be reported and tax paid with the IP ennsrlvane~lt(iA ri
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tance Tak
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retu%•d i~
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led br the estate rep resentetive. ~~~1.. r.. _
C. ~ ]rye above inf orma eon is inf orrect and/or debts and dedutkions acre paid. Q C
~
~ a
~ -_~ TI
Cgnplete PART
and/or PART ~ below. ~ 0 ~-`_ ~ j
'
'p fi_ {
7l
PART If indicating a di~fBrent tax rate, please state
relationship to de{;adent:
TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established ~~ 1
2. Account Balance 2 +~
3. Perc ant Taxable 3 X
4. Amount Subject to Yax 4 $
5. Debts and Deductions 5
6. Amount Taxable 6 $
7. Tax Rake 7 X
8. Tax Due 8 $
PART DEBTS AND DEDUCTIONS CLAIMED
^3
DATE PAID P,I\YEE DESCRIPTION AMOUNT PAID
Untlar penalties of per]Nry, I declare that the facts I reported above~ia re true, orr talnd
~~p~ o the be~nowl~9e~tl belief. HOME ( 1~~ ) ~ ~'~C~'~lG
/,A// X C- WORK C ) (~ (G I ~
PAYER SIGNATURE I TELEPHONE NUMBER D TE