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COMMONWEALTH OF PENNSVLVANIA
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
06500465
09-20-2006
REV-1545A AFP (7-DDl
TYPE OF
ACCOUNT
D SECURITY
[X] SEC ACCT
D S~Q,cK
DBON):JS
....r ,__ ;.J
KAREN J DEIBLER
34 BLAIR MOUNTAIN RD.
DILLSBURG PA 17019
EST. OF ANNE C LARNEY
S.S. NO. 176-32-2941
DATE OF DEATH 08-17-2006 ~
COUNTY CUMBERLAND 0 g;
Co
REMIT PA YKEm::1 AND Foiii> TO;' 'c~
REGISTER OF wtfi~ -I '. /1
CUMBERLAND cO'cOlHn H~SE ,", J
CARLISLE, PA ,~fi~3
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'15. U1
MERRILL LYNCH has provided the Department with the information listed below which has been used irl"'>
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a beneficiary of this asset.
If you feel this information is incorrect, please obtain written correction from the transfer agent, 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. 872-47339
x
276,782.00
20.000
55,356.40
.15
8,303.46
TAXPAYER RESPONSE
To insure proper credit to your al:::cDunt, two
(2) copies of this notice must aC100mpany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, A!;ent".
DOD Valuation
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
NOTE: If tax payments are made within three
(3) months of the decedent's date of death,
you may deduct a 57. 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. ~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 notic:e to obtain
a discount or avoid interest, or you may check box 'IA" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
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 ASSET(S)
If you indicate a different tax rate, please state your
relationship to decedent:
OF
1
2
3
4
5
6
7
x
x
PART
~
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Computation)
~
$
Under penalties of perjury, I declare that the facts I
complete to the b~t of my knowledge and belief.
TA
/1
)
have reported above are true, correct and
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