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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 06-0747
ACN 06500466
DATE 09-20-2006
REV-154lA AFP l7-DD>
MICHAEL J GALBRAITH
34 BRIDGEPORT DRIVE
MECHANICSBURG PA 17050
REMIT PAYMENT AND FORMS
REGISTER OF WILLS
CUMBERLAND CO COURT
CARLISLE, PA~~3013
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TYPIE OF ACCOUNT
D SECURITY
[X] SEC ACCT
D STOCK
D BONDS
TO:
EST. OF ANNE C LARNEY
S.S. NO. 176-32-2941
DATE OF DEATH 08-17-2006
COUNTY CUMBERLAND
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MERRILL LYNCH has provided the Department with the information listed below which h";;IfJi")l(j)sed i110 ' \ ~-':-i
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a b~o~~crary of:ERis as~t,-'~
If you feel this information is incorrect, please obtain written correction from the transfer agent, attach a capy~-.tp this fPf1ll and, ;' ,",
return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commo~lthof PennsYlvan~~.
Questions lIay be answered by calling (717) -'67-6327. "J c...n'
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 872-47339
DOD Valuation
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
276,782.00
20.000
55,356.40
.15
8,303.46
TAXPAYER RESPONSE
To insure proper credit to your ac:count, two
(2) copies of this notice must acc:ompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, A!lent".
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 Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
[CHECK ]
ONE
BLOCK
ONLY
B. DThe 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. DThe 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
LINE 1. DOD Valuation
2. Percent Taxable
3. Amount Subject to Tax
4. Debts and Deductions
5. Amount Taxable
6. Tax Rate
7. Tax Due
TAX ON ABOVE ASSETCS)
If you indicate a different tax rate, please state your
relationship to decedent:
OF
1
2
3
4
5
(,
7
x
x
PART
[!]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
I
$
perjury, I declare that the facts I
now ledge and belief.
have reported above ~e tr~, correct
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