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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. ~~1 06-0747
06500464
09-20-2006
REV-154IA AFP [7-00'
EST. OF ANNE C lARNEY
5.5. NO. 176-32-2941
DATE OF DEATH 08-17-2006
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SECURITY
[&] SEC ACCT
D STOCK
D BONDS
REMIT PAYMENT AND F~MS TO:
REGISTER OF WIllS ~~
CUMBERLAND ~ COURT ~USE
CARLISLE, P~~7013 ~
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MERRILL LYNCH has provided the Department with the information listed below which has:b~!l-Uged irr"~ .
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a bena,f.~ary of ~ asset.,
If you feel this information is incorrect, please obtain written correction from the transfer agent, attach a copY ~thi.s for.'and
return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the CommDnL~alth of Pe~lvania.
Questions may be answered by calling (717J 787-8327. ~ -(~
FLORENCE H GALBRAITH
936 EMILY DRIVE
MECHANICSBURG
PA 17055
.,
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 account, two
(2) copies of this notice must ac,company 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 becClne delinquent
nine (9) months after the date of death.
Tax
PART
m
he 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 Inheritanc,. 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.
If you indicate a different tax rate, please state your
relationship to decedent:
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
PART
@]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
OF TAX ON ABOVE ASSETCS)
1
2 X
3
4
5
6 X
7
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Computation)
I
$
that the facts I
and belief.
have reported above are true, correc:t and
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