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COMMONWEALTH OF PENNSYLVANIA *
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXEjSr.:r,r..\.:-;~. ."-r', ",r-.,-."
DEPT. 280601 ,[ u. " ,", , (. ,'_ ,
HARRISBURG, PA 17128-0601. . . .,:" ,:':' , ',,,'f,
REV-15U EX AFP (09-00) I
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 6<0 -I (1
06137388
07-26-2006
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In
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TYPE OF
ACCOUNT
o SAVINGS
fX] CHECKING
o TRUST
o CERTIF.
EST. OF ALICE I HOCH
S.S. NO. 201-52-1671
DATE OF DEATH 04-28-2006
COUNTY CUMBERLAND
RONALD HOCH
34 LIBERTY CT
CARLISLE PA 17013
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PNC BANK has providad the Department with the inforllation 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 Comllonwealth
of Psnnsy]vania. Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 9119009652 Date 12-23-1980
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
1,140.30
16.667
190.05
.045
8.55
TAXPAYER RESPONSE
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Tax
x
NOTE: If tax paYllents are lIade 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
The above inforllation and tax due is correct.
1. You lIay choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or YOU lIay check box "A" and return this notice to the Register of
Wills and an official assesSllent will be issued by the PA Department of Revenue.
[CHECK ]
ONE
BLOCK
ONLY
B. r=J 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. r=J The above information is incorrect and/or debts and deductions were paid by you.
You IIUSt complete PART ~ and/or PART ~ below.
If yoU indicate a different tax rate, please state your
relationship to decedent:
PART
@J
TAX RETURN - COMPUTATION
LINE 1. 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
PART
f!]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
OF
1
2
3
4
5
6
7
8
x
TAX ON JOINT/TRUST ACCOUNTS
x
PAYEE
I
TOTAL (Enter on Line 5 of Tax Computation)
perjury, I declare that the facts I
my knowledge and belief.
DESCRIPTION
AMOUNT PAID
I
$
have reported above
HOME (i!7'b>
WORK ( >
TELEPHONE NUMBER
are true, correct and
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DATE