HomeMy WebLinkAbout06-15-05
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COMMONWEALTH OF PENNSYLVANIA
DEP~RTMENT DF REVENUE
BUREA~ OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
*'
INFORMATION
AND
TAXPAYER RES ONSE
FILE
ACN
DATE
REV-1545 EX AFP lD9-00l
i ,~_
<~
Pt
i.
EST. OF AN
S.S. NO.
DATE OF DE
COUNTY
JUNE A DILLER
628 SAW MILL RD
MECHANICSBURG PA 17055
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NO. 21 ()~ - 053t'J
05118478
05-31-2005
TYPE OF
ACCOUNT
iii SAVINGS
D CHECKING
o TRUST
o CERTIF .
A M KIBLER
165-38-0697
TH 02-04-2005
CUMBERLAND
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
SUSQUEHANNA VL Y FCU has provided the Department with the inforllation isted below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above d cedent, you were a joint owner/beneficiary of
this account. If you feel this inforllation is incorrect, please obtain written correction rom the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance wi h the Inheritance Tax Laws of the COllmonwealth
cf ?_"..sylw~r.ia. Q~~~ti=~s ~~~ b; ~~s~~~~d b~ ~~!lins (717) ?!7-B32?
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 11652- 00 Date 06- 04-1999
Established
1,445.48
50.000
722.74
.045
32.52
TAXPAYER RESPONSE
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...........................................................................................................................'...................................................................................................................................................................................................................................................................................................
. . -.. .. . . .
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
Tax
x
PART
[!]
To insure proper credit to your account, two
(2 copies of this notice must aCCOllpany your
pa ment to the Register of Wills. Make check
pa able to: "Register of Wills, Agent".
NO E: If tax payments are lIade within three
(3 months of the decedent.s date of death,
yo may deduct a 5% discount of the tax due.
An inheritance tax due will become delinquent
ni e (9) months after the date of death.
[CHECK ]
ONE
BLOCK
ONLY
A. [] The above information and tax due is correct.
1. You may choose to remit payment to the Register of Will with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" nd return this notice to the Register of
Wills and an official assessment will be issued by the A Department of Revenue.
B. [] The above asset has been or will be reported and tax paid w th the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
C. ~ The above information is incorrect and/or debts and deducti ns were paid by you.
You must complete PART ~ and/or PART ~ below.
OF TAX ON JOINT/TRUST ACCOUNTS
1
2 0
3 X
4
5
6 ()
7 X
8 ts!
DEBTS
DESCRIPTION AMOUNT PAID
f
/1
If you indicate a different tax rate, please state your
relationship to decedent:
PART
~
TAX RETURN - COMPUTATION
LINE 1. Oats Estmblished
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
PART
@J
DATE PAID
PAYEE
)I-
TOTAL (Enter on Line 5 of Tax Co
$
Under penalties of perjury, I declare that the facts I have repo
. ,complete to the best of my knowledge and belief. HOME (
WORK (
TELEPH
)
)
NUMBER
DATE
above are true, correct and
.,,~
..
....
SUSQUEHANNA V ALLEY Feu
From Member:
Remitter:
Payee:
Check Amount:
Fee Amount:
10533
June Ann Diller
JOHN E KRAFT FUNERAL HOMES, INC
****1,498.89
.00
SUSQUEHANNA V ALLEY FCU
From Member:
Remitter:
Payee:
Check Amount:
Fee Amount:
10533
June Ann Diller
JOHN E KRAFT FUNERAL HOMES,INC
**** 1 ,528.48
.00
CASHI R'S CHECK
Date:
CASHI R'S CHECK
Date:
Check#: 117667
March 11, 2005
Check#: 117772
March 25, 2005