HomeMy WebLinkAbout12-04-06
COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. Z80601
HARRISBURG, PA l7lZ8-0601 2UGS DEe - 4
-, -r::('( 'Jl
IlV._
...~.
fWil'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 06-0836
06154029
10-25-2006
REV-1545 EX AFP 109-DD>
r.ll~C,'l OF
\.1 _,.1 J\ '" T
00'..'" '.'" '.'" Q Cl'U,R I
. .:-'''';',l''~ V '
CI "..'.:.,' t\~.\n ('(I ,
,,_r:.' -1 '\1 '\;....... ....... ~~ ..
EST. OF DEAN C KEITER
5.5. NO. 162-20-8724
DATE OF DEATH 09-19-2006
COUNTY CUMBERLAND
TYPE OF ACCOUNT
[iJ SAVINGS
o CHECKING
o TRUST
o CERTIF.
DEBRA RILEY
645 KNIGHTBRIDGE DR
HAGERSTOWN MD 21740
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MEMBERS 1ST FCU has provided the Depart.ent with the infor.at!on 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 infor.ation is incorrect, please obtain written correction fro. the financial institution, attach a copy
to this for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co.~nwealth
of Pennsylvania. Questions .ay be answered by calling (717) 787-83Z7.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 160332-00 Date 12-01-1995
Established
Account Balance
Percent Taxable
A.ount Subject to
Tax Rate
Potential Tax Due
x
821.76
50.000
410.88
.045
18.49
TAXPAYER RESPONSE
To insure proper credit to Your account, two
(Z) copies of this notice .ust acco.pany your
pay.ent to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
x
NOTE: If tax pay.ants are .ade within three
(3) .onths of the decedent's date of death,
you .ay deduct a S~ discount of the tax due.
Any inheritance tax due will beco.e delinquent
nine (9) .onths after the date of death.
Tax
PART
[!]
A.
[ CHECK ]
ONE
BLOCK B.
ONLY
c.
~ The above infor.ation and tax due is correct.
~ 1. Vou .ay chaose 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 .ay check box "A" and return this notice to the Register of
Wills and an official asses~ent will be issued by the PA Departaent 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 infor.ation is incorrect and/or debts and deductions were paid by you.
Vou .ust coeplete PART ~ and/or PART ~ below.
If you indicate a different tax rate, please state your
relationship to decedent:
PART
~
TAX RETURN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Allount Taxable
7. Tax Rate
8. Tax Due
PART
[!J
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
OF
1
2
3
4
5
6
7
8
x
TAX ON JOINT/TRUST ACCOUNTS
x
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax CDllPutation)
perjury, I declare that the facts I
.y knowledge and belief.
I
$
correct and
11/;" "t'/otc
DATE
;t:d':~"~
-'
,
...
~ ~ (;i
, (')
i
I
I
~...~~
! ~,,~
!>;;;l$
~,i
'f1~'
!l''''i
~:
i""'q
lll:lllf
,
,~ . '
:.~!
hs I
~t~ f
~:l$ I
I
!
f
I
-,,;;::e.:a:~"~~-
-
-
-
V -
""1 '-
..
.,:) -
~ -
-
-
."" ..
''i-. ..
()) -
j -
-
..
:\:;) -
~ \J fY)
--- -
... :i' ........
() -
3: " f'
.J '- -
-
~ -
~ \J ..
\) -
-
~ ~ ..
\( -
v) ~
.~ ~
-.......:::. ~
Iv') ~ '-
V)
..... ,
$D ~ -........
\..
\Z \j "-~ ....,
~ 0
,,)
,,)
.....
1"')
.,../
0
I".
.,"/
~.':iIt'lI.Hlll1
~~ ~
1\: t~
. ,
~~, ;i..-
~~..J ~
..-.:~ Ci..
. <0
:t C)
. , .::;)
: t
\;fI(I r;~
~~
tt :>
~ . I
L:J 0
:'"
c.J Z
~4
(t ::;
~L tij
e:J
~J'
(3\'
'"
~
~
C\
~ ~
-Q) ~
~ ("
"' :3
\S)
:. .-12
J-:~ .\11
_ X,'\'"
of .~
cx:., ~ ,~
A~~
~