HomeMy WebLinkAbout10-04-06
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. za0601
HARRISBURG, PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 06-0580
ACN 06145903
DATE 09-07-2006
XEY-1S45 EX IFP 109-001
/
IJt ('-'fA. S~
TYPE OF ACCOUNT
EST. OF OLIVIA H GRIBB 0 SAVINGS
S.S. NO. 199-09-2784 0 CHECKING
DATE OF DEATH 06-26-2006 0 TRUST
COUNTY CUMBERLAND IXJ CERTIF.
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013~::;
Cj r~
:.:,~() c"
LEON A GRIBB
4 BRIDLE LN
CAMP HILL
PA 17011-1403
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CITIZENS BANK OF PA has provided the Deparbnmt with the infoMlation listad belON which haS.:b~ use.fin
calculating the potential tax due. Their records indicate that at the death of the above decadent, you wen ."j8in:t,~_r/benefiC'l.rli"~f
this account. If you feel this infoMlation is incorrect, please obtain written cornction fro. the financial i~tJ~ion,~ltach ~'~oP~~
to this foMl and return it to the above address. This account is taxable in accordance with the Inheritance, Twg~taws of tn8 Co..onw..~th
of PennSYlvania. Uuestions..y be answered by calling (717) )'8'1-11327. . " '.T:J = ,. ;"1"i
COMPLETE PART 1 BELOW. . . SEE REVERSE SIDE FOR FILING AND PAYMENT:~N~TRUCT!9NS
U)
Account No. 6140754240 Dat. 01-05-2000 To insure proper credit to your account, two
Established (2) copies of this notice BUst accnpany your
pay.ant to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Account B.l....c.
P.rcent T.xabl.
A.ount Subj.ct to
T.x R.t.
Potenti.l Tax Du.
x
11.336.73
50.000
5.668.37
.15
850.26
TAXPAYER RESPONSE
NOTE: If tax payeents an .ade within three
(3) BDnths of the decedent's date of death,
YOU ..y daduct a SlC discount of the tax due.
Any inheritance tax due will becne delinquent
nine (9) .onths after the date of death.
T.x
x
PART
[!]
[CHECK ]
ONE
BLOCK
ONLY
A. 0 The above infor.ation and tax due is correct.
1. You.BY choose to re.it pay.ent to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or YOU ..y check box "A" and return this notice to the Register of
Wills and an official assesseent will be issued by the PA DepartBant of Revenue.
B. ~he above asset has bun or will be reported and tax paid with the Pemsylvania Inheritance Tax return
~to be filed by the decedent's representative.
C. 0 The above infor.ation is incorrect and/or debts and deductions were paid by you.
You .ust coeplete PART ~ and/or PART ~ belON.
PART
~
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
If you indic.t. a diff.rent tax rate. please state your
rel.tionship to decedent:
PART
~
TAX RETURN - COMPUTATION
LINE 1. D.te Established
2. Account B.lanc.
3. Percent T.xabl.
4. A.ount Subject to T.x
5. Debts and Deductions
6. A~nt Taxable
7. Tax Rate
8. Tax Due
OF
1
2
3
4
5
6
7 X
8
X
TAX ON JOINT/TRUST ACCOUNTS
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of T.x Co.putation)
I
$
perjury. I decl.re that the facts I
.y knowledge and belief.
C1~
have r.port.d above .re tru.. correct
HOME (::> 7~ 7-ol{",/
WORK ( )
TELEPH E UMBE
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