HomeMy WebLinkAbout08-07-06
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
'*
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 06-0317
ACN 06129142
DATE 06-28-2006
REV-1545 EX AFP 'D9-DDl
EST. OF RICHARD F BARBA
S.S. NO. 283-30-7202
DATE OF DEATH 03-12-2006
COUNTY CUMBERLAND
TYPE OF ACCOUNT
[Xl SAVINGS
o CHECKING
o TRUST
o CERTIF.
F---.
** ANTO~^O M A~ATORRE
4100 cBENT CREEK RD
MECHANICSBURG PA 17050
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MEMBERS 1ST; FCU has provided the Departllent with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account.;If you feel this inforllation is incorrect, please obtain written correction from the financial institution, attach a COpy
to this form end return it ~o the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 270515-00 Date 08-26-2005
Established
x
.00
100.00
.00
.045
.00
TAXPAYER RESPONSE
To insure proper credit to your account, two
(2) copies of this notice IIUSt aCCOllpany your
paYllent to the Register of Wills. Make check
payable to: "Register of WillS, Agent...
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
NOTE: If tax paYllents are made within three
(3) months of the decedent's date of death,
you lIay deduct a 57. discount of the tax due.
Any inheritance tax due will becolle delinquent
nine (9) 1I0nths after the date of death.
Tax
PART
[]
A.
[ CHECK ]
ONE
BLOCK B.
ONLY
c.
~ The above inforllation and tax due is correct.
~ 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
[] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
[] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
OF TAX ON JOINT/TRUST ACCOUNTS
PART
~
TAX RETURN - COMPUTATION
If you indicate a different tax rate, please state your
relationship to decedent:
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
[!]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
$
I
TOTAL (Enter on Line 5 of Tax Computation)
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best of my knowledge and belief.
~~
TAXPAYER SIGNATURE
HOME (
WORK (.s-'lfl)
TElEPHONE
)
) S-?rY-S'S-r:J7
NUMBER
~/.3/6'
DATE