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COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INOIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
'*
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21" C)(,..- sc>S
06124283
05-25-2006
REV-1545 EX AFP CD9-DDl I
EST. OF JOHN H HESS
5.5. NO. 181-07-7308
DATE OF DEATH 03-07-2006
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
!Xl CERTIF.
BARBARA A SHADE
6911 CHATHAM DR
HBG PA 17111
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PNC BANK has provided the Department 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}~eneficia~y ,f
this account. If you feel this information is incorrect, please obtain written correction from the financial instItution; attach a copy
to this form and return it to the above Rddress. This !lccC'unt is taxable in accordanc.. with thy Inhyritance lax Laws of the Comillon-wlta],'th
of PennSYlvania. Questions may be answered by calling (717) 787-8327.
.)
COMPLETE PART 1 BELOW . . . SEE
Account No. 31000218802 Date
Established
REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTlONS-
03-10-2003
-,
't';
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
5,703.27
50.000
2,851.64
.15
427.75
TAXPAYER RESPONSE
To insure proper credit to your account, two
(2) copies of this notice must aCQQlpany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Tax
x
NOTE: If tax payments are made within three
(3) months of the decedent.s date of death,
YOU may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
PART
ill
A.
[ CHECK ]
ONE
BLOCK B.
ONLY
c.
[J The above information and tax due is correct.
1. Vou 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 Oepartment 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.
[J The above information is incorrect and/or debts and deductions were paid by you.
Vou must complete 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
~. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
PART
~
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
OF
1
2
3
~
5
6
7
8
x
TAX ON JOINT/TRUST ACCOUNTS
x
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Computation)
I
$
facts I
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