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COMMONWEALTH OF PENNSYLVANIA *'
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES :'-'^\t',c,rr'-' : '
nEPT.. 280601,__, ,.- ,,-'.r', f'::_~,}C'~~\ , ,~<'~;r\
HARRISBURG, PA 17128-060(:) ii",,':'::"" "~oj! : ~"A:" '
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO.
ACN
DATE
21 04:>-1/1
06137386
07-26-2006
E8T. OF ALICE I HOCH
8.8. NO. 201-52-1671
DATE OF DEATH 04-28-2006
COUNTY CUMBERLAND
TYPE OF ACCOUNT
[X] SAVINGS
o CHECKING
o TRUST
o CERTIF .
RONALD'HOCH
34 LIBERTY CT
CARLISLE PA 17013
REHIT PAYHENT AND FORHS 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/beneficiary of
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 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. 9183308120 Date 01-01-1978
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
2,052.28
16.667
342.05
.045
15.39
TAXPAYER RESPONSE
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to tha Registar of Wills. Make check
payabla to: "Register of Wills, Agent".
x
NOTE: If tax payments ara 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 became delinquent
nine (9) months after the date of death.
Tax
PART
ill
The above information 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.
[CHECK ]
ONE
BLOCK
ONLY
B. [] 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.
C. [] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
PART
[!]
TAX RETURN - COMPUTATION
If you indicate a different tax rate, please state your
relationship to decedent:
PART
~
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
LIN~ l. Date EstablIshed
2, Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3 X
4
5
6
7 X
8
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL CEnter on Line 5 of Tax Computation)
I
$
of perjury, I declare that the facts I
of my knowledge and belief.
:j
have reported above are true, correct
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