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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL if'~':-;:-c:r
DEPT. 280601 . ,l ',,' ',' . ".j
HARRISBURG, PA 17128-0601
-
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
ACN
DATE
FILE NO. 21 OC{Y (tl
06137388
07-26-2006
REV-1543 EX AFP [09-001
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In
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10. I r
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TYPE OF
ACCOUNT
o SAVINGS
[X] CHECKING
o TRUST
o CERTIF.
EST. OF ALICE I HOCH
8.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 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. 9119009652 Date 12-23-1980
Established
Account Balance
Percent Taxable
AMount Subject to
Tax Rate
Potential Tax Due
x
L140.30
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".
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.
Tax
PART
[!]
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 Registar of
Wills and an official assassment will be issued by the PA Dapartment of Ravenue.
[CHECK ]
ONE
BLOCK
ONLY
B. r=J The above asset has been or will be reported and tax paid with tha 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 must complete PART ~ and/or PART ~ below.
If you indicate a different tax rate, please state your
relationship to decedent:
PART
@
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINe 1. Oate Established 1
2. Account Balance 2
3. Percent Taxable 3 X
4. AMount Subject to Tax 4
5. Debts and Deductions 5
6. Amount Taxable 6
7. Tax Rate 7 X
8. Tax Due 8
PART
[!J
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax COMputation)
I
$
perjury, I declare that the facts I have reported above are true, correct and
MY knowledge and belief. HOME ( 4l g) Cj ~ Z - 4- t ~ Y
WORK ( )
TELEPHON NUMBER DATE