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t~~..~43 EX Arp (10911,*
COltlO'IWUL TH Of PEHHSlLVANIA
OEPARlHENT Of REVENUE
IUREAU Of INDIVIDUAL TAKEI
OEPI. lIDADI
HARRIIlUAQ, PA 171U.0601
INFORMATION NOTICE
AND
TAXPAVER RESPONSE
FILE
ACN
DATE
. ~/C)
NO. 21 ~ q t{
94113119
04"14-94
ESTATE OF BRANDT
S,S. NO, 371"50-0616
DATE OF DEATH 01-04-94
COUNTY CUMBERLAND
TVPE OF ACCDUNT
A ~ SAVINGS
CHECKING
nuST
CERTIFICATE
RENXT PAVNENT AND FORNS TO.
REGISTER OF WILLS
COMBER LAND CO COURT HOUSE
CARLISLE, PA 17013
CARRULL
BRANDl
929 HERMAN DR
MECHANICS BURG
SARAH L
PA 17055
DEFENSE ACTIVITIES FED h.. ptClvldld thl Depart.,nt with thl Inforllllllon lllt,d below which ha. b..n us.d In calcullt1ng thl
pot4N1UIl taw dU:J. Their rlcord. Indicate that at thl d..th of thl above dlc.d.nt, you WUI " Joint ownlr/blnlfltllary of thh IOCOunt.
If YOU f.. I thl' In'or..tlon I. lncorr.ot, pili.. ab'.ln Nflttln oorr.ctlon frol thl flnanolal lnltltutlon, attach a copy to thl~ fori
end return It to thl abOVI ftddr.... 'hit Iccount ,. hltlb'., ,In accordance '11th thl InherltancI TaM law. of thl C(I..onwulth of P.nr""..l~,nia.
Que.tlon. .,y bl an.w~rld uy cI11lng (/11) !""85,1.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAVMENT INSTRUCTIONS
Aooount No. 84359'00 Doto 10-13-87
E.hbllohod
Aooount Boloneo
Poroont To.oblo
A.ount Subjoot to
To. Roto
Potontlol To. Duo
559.24
16,667
93.21
,06
-s.59
TAX PAVER RESPONSE
FAILURl TO RISPOND WILL RISULT IN AN OFFICIAL TAX ASSISINENT BASID ON THII NOTICI
To In.url prnplr crldlt to your ICCOunt, two
Il} cop II' of thl. notlc, IU.t IQco.~any your
pIY.lnt to the Rtgl.tlr of Will.. Hlkl chick
PIYtlblt tal "Rlghhr of Willi, Aglnt".
M
M
HOTEl If tlX Plv..nt. Irl ftldl within thrl'
(3) tonth. of thl d'Cldlnt'. dltl 0' dllth,
yuU ~'V dlduct I S% dl.count of thl tlX dUI.
Any Inhlrltlncl tax dUI will blco.1 dlllnqulnt
nlnl (9) Month. aftlr thl dati of dllth.
To.
PART
II]
[CHECK ]
ONE
BLOCK
ON LV
A. Tht ,bov. Inforllltlon Ind t8M dUI 11 corrlct.
You .IY choo., to rl.lt paY.lnt to thl Rlgl.tlr of Will" with two copll' of thl, not Ie, to obtain
a dl.count or avoid Intlrl.t, or yo~ ..y chlrk box "An and rlturn thl. not Ie, to thl R.gl.tlr of
Willi and an offlnhl a.....Mnt will bl IlIued by thl PA OIPad.lnt of Rlvlnul.
I. 0 Th" abovl IlIIlt hu bltn or wUI bl rlporhd and t.x paid with thl Plnn'vl~anh InllGrlt'ncI Tax return
to be fllld by tht dle,dlnt', reprlllnt.tive.
r,:, .
C. [] Thl ftbove Infor,atlon l~nQorrlvt and/or dlbt. ~nd dlductlon' wlr. ptld by you.
You IU.t co.plltt PART l:J and/or PART [!) btlow.
If you indicate a different tax r.t., pl.... .t.t. your
rolotlonohlp to doo.dont,
OFFICIAL ,USE ONLY 0 AAF
PA DEPARTMENT OF REVENUE
PART
~
'l'AX n!:TUr:tl - Ct'I1PUT^TIOtl Or'
LXNf 1. Doto E.tob110h.d 1
2. Aooount Bolon.o 2
3. P.roont To.ob10 3 M
4. Aoount Subjoot to To. 4
S. Dobt. ond Doduotlono S
6. A.ount To.ob1. 6
7. To. Rot. 7 M
8. To. Duo 8
r,\y' ON .I~~NT 'T!lIJ~T M~MIJNT!Q
PART
~
DATE
DEBTS AND DEDUCTIONS
P.~D
1
:1:
3
4
5
6
7
8 _
CLAIMED
.,. \.....'. .". ...........~. .....-..
-
-
Undor p.n.1tt.. of p.rjury, I d.o10r. th.t tho fo.to I
oOMP1.to to tho b.ot of MY know11dgo ond b.llol,
h_v. rlpart.d .bove
HO!1LJJt7 1
WORK ( )
AMOUNT PAID
!
,
ond
"#1
PAID
~..l
PAVEE
DESCRIPTION
!
TOT^L IEnt.r on Llno S of To. Co.putotlon)
TAXPAVER SIGNATURE