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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
ACN
DATE
NO.21 06-0747
06500468
09-20-2006
REV-154IA AFP [7-00)
TYPE OF ACCOUNT
D SECURITY
[XJ SEC ACCT
D STOCK
c-':) D BONDS
, "";':) -;J
REMIT ~YMENT AND~RMS-IOI'~
REGISTER lffi;<J!PJLLS 0 I-- ~.S
CUMBER LANDc'~ COUR"F)lOUSEcJ)
CARLISLE, PA~:I;eOl~..> ':1
;::.: '8 (:;:) '" _.J
(r~.' /'
'C)O -0
(=2 r1 ~
MERRILL LYNCH has provided the Department with the information listed below Whic~~":~aeen use~n '
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were ~~eneficiar~' ~this asset.
If you feel this information is incorrect, please obtain written correction from the transfer agent, attach aY~opy to this~rm 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 ansNered by calling (717) 787-8327.
EST. OF ANNE C LARNEY
5.5. NO. 176-32-2941
DATE OF DEATH 08-17-2006
COUNTY CUMBERLAND
JOHN A DEIBLER
34 BLAIR MOUNTAIN ROAD
DILLSBURG PA 17019
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 872-47339
ODD 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 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
[!]
[CHECK ]
ONE
BLOCK
ONLY
A. EltThe above information and tax due is correct.
I, You may choose to remit payment to the Register of Wills with two copies of this notic:e to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the ~~egister of
Wills and an official assessment will be issued by the PA Department of Revenue.
B. D The above asset has been or will be reported and tax paid with the PennSYlvania Inheritanc:e 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
@]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
If you indicate a different tax rate, please state your
relationship to decedent:
PART
~
TAX RETURN - COMPUTATION
LINE 1. ODD Valuation
2. Percent Taxable
3. Amount Subject to Tax
4. Debts and Deductions
5. Amount Taxable
6. Tax Rate
7. Tax Due
OF
1
2
3
4
5
6
7
x
TAX ON ABOVE ASSETCS)
x
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Computation)
I
$
declare that the facts I have reported above are true, correct and
and belief.
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