HomeMy WebLinkAbout06-13-05
CO"'DNWEALTH OF PENNSYLVANIA
DEPARTIENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG~ PA 17128-0601
*
INFORMATION NOTICE
,-- ,'-~' ~"AND
:TAX;"A'tER RESPONSE
FILE NO. 21 05-0307
ACN 05122764
DATE 06-01-2005
U\I-1545EXAFP 11"'01)
TYPE OF ACCOUNT
jUt! 13 Pii~~T J!oF MARY K KOSER !Xl SAVINGS
S. S. NO. 208-42-5682 0 CHECKING
DATE OF DEATH 02-25-2005 0 TRUST
'<?qtJNTY CUMBERLAND 0 CERTIF.
REHIT PAYHENT AND FORKS TO:
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
DORIS J WAGNER
1671 TRINDLE RD
CARLISLE PA 17013
I1EI1BERS 1ST Feu has provid.d the Depertfilnt with the infor.ation listed bBlow whlch has bHn uud in
calculating th. potBIJUal tax due. ThlIJr records indicate that at the death of thB above dBCedent~ YOU were a joint oWnBr/beneflciary of
this account. If you f..l this infor~tion is incorrBCt~ pleasB obtain written correction fro. thB financial institution~ attach a copy
to this fOM! and rBturn it to the above address. This account is taxable in accordance with the InheritancB Tax Laws of the COlI.onwealth
of P~nsylvania. Questions ~y be answBred by calling (7171 7B7-a3Z7.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 230258-05 Date 05-19-2003
Established
Account Balance 3 , 418 . 71
Percent Taxable )( 50 . 000
Alnount Subject to Tex 1,709 . 36
Tex Rete X .045
Pot""Ua1 Tax Due 76.92
PART TAXPAYER RESPONSE
[!]..I.lI~-1f-,lf_...t_!.__,_}_r._1
To insure proper credit to your account~ two
(2) COpiB5 of this notice .ust BCCO.Pany your
pay.ent to thB Register of Wills. ~ke check
payable to: -Register of Mills~ Agent-.
NOTE: If tine PII~BI'1tS lire Ihde within three
(3) ~nths of the decedent.s dllt. of de8th~
YOU IlaY deduct 8 S% discount of the tax due.
Any inheritance tax duB will becOlle delinquent
nine (9) eonths lifter the dllte of dellth.
[CHECK ]
ONE
BLOCK
ONLY
A. 0 The l!Ibove infor..tion and tax due is correct.
I. You.ay choose to r..it pay..nt to the Register of Mills with bio copies of this notic. to obtain
1!1 discount Dr avoid interest~ Dr YOU ..y check box -A- and return this notice to the Register of
Wills and an official assess.ent will be issued by the PA D8part.snt of Revenue.
B. ~hB abOVB asset has bRan Dr will be reportad and tax paid with the Pennsylvania Inheritance Tax rBturn
to be filed by the decedent"s representative.
C. 0 The above inforllation is incorrect and/or debts and deductions N8re paid by YOU.
You .ust co.plut8 PART ~ and/or PART ~ b8law.
PART
~
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
If you indicate a different tax rate, please state your
relationship to decedent:
PART
~
TAX RETURN - COMPUTATION OF
LXHE 1. Oat. Esi~11sh8d 1
2. Account hlance 2
3. Percent Taxable 3 X
4. Alnount Subject to Tax 4
5. Debts and Deductions 5
6. Amount Taxable 6
7. Tax Rate 7 x
8. Tax Due 8
TAX ON JOINT/TRUST ACCOUNTS
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax COMputation)
I
.
Under penalties of perjury, I declara that the
~let& to the bee) of "" """"1.... and belief.
T ~m"1ruRE ~
facts I
have reported aha"e are true, correct and
HOME ('717)~; 9 - 4 ? ~ 7
WORK () " - / 0 - 0 (
TELEPHONE NUMB DATE
'-
" "'
" '\ i I .
,1'\\\
\\\
\
· t)
'3
~
$\
't"':""\
0;- '''i
~ "1
"",,~ -:'C
"~~i.
. "4-
'. ""~o-
'\~ ..
'- .' ~
..~ $.
.'.... ~......~
> - .lo!~~
'.. $.';e.0
--
.:::::,
~
--
~
--
-;:::.
%
-:::;.
::;.
*
*
~
-::::--:,
-:::;.
;
.:a.
--
*
~
"';.
..:;.
~
-
o
~
4-
~
.-.
....
,")
-;"')
,.,
'-.
\")
....
"
t-
....