HomeMy WebLinkAbout10-25-12BUREAU OF INDIVIDUAL TAXES
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HARRISBURG PA 17128-0601
B PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE FILE No. 21 12-0964
' ~* ' AND ACN 12154174
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~~ ~ TAXPAYER RESPONSE DATE 09-28-2012
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EST. OF DOROTHY M SELLERS
SSN 199-05-9229
DATE OF DEATH 08-22-2012
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS TD:
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
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JOHN D BYERLY'"~$ER~D ~0..
316 3RD ST
NEW CUMBERLAND PA 17070-2113
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
SO VEREIG N BANK provided the department with the information below, which was used in calculating the inheritance tax due.
Records indicate that at the death of the above-named decedent, you were a point owner/beneficiary of this account. If you ere the 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 Yyou must
notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PJ~RT 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 address. Please call 717-787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0771042329 Date 12-09-2002 To ensure aroaer credit to the account, two
Established copies of this notice wust accompany
paywent to the Resister of Wflls. Make check
Account Balance ~ 1 , 717.10 Davable to "Resister of wills. Anent".
Percent Taxable X 50.000
NOTE: If tax paywents are wade within three
Amount Subject to Tax $ 858.55 months of the decedent's date of death,
Tax Rate )( , i~j deduct a 5 Dercent discount on the tax due.
Ary inheritance tax due will becowe delinquent
Potential Tax Due ~` 128 • 78 nine wonths after the date of death.
PART TAXPAYER RESPONSE
0 ,.,
A. ~ The above information and tax due is correct.
Rewit payment to the Register of Wills aith two copies of this notice to obtain
CHECK a discount or avoid interest, or return this notice to the Resister of Wills and
C 0 N E ~ an official assessment will be issued by the PA Department of Revenue.
BLOCK B. ® The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return
0 N L Y filed by the estate representative.
C. ~ The above inforwa ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART 3~ below.
PART If indicating a different tax rate, please state ,~4; :~.
2 relationship to decedent: 'j°'
T^AX 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 Tax 4 $ '_
5. Debts and Deductions 5 -
6. Amount Taxable 6 $
7. Tax Rate 7 X
8. Tax Due 8
PART DEBTS AND DEDUCTIONS CLAIMED
3^
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I reported above are true, correct and
complete to the best of my knowledge belief. HOME c )
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TAXPAYER SIGN TU era e e S 1 ~ ESq. TELEPHONE NUMBER DATE