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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
'* INFOltTION NOTICE
, r.;:C ('~ 'j AND
- R< 'sQ ~W~ ,'~ER RESPONSE
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REV-I54! EX AF;'i9.~~,ii~~) .::"\ 'oj. \" ., ... .,
FILE
ACN
DATE
NO. 21"()(P - J{ytz.
06152642
10-}3-2006
SUSAN N MCNEAR
475 WOODCREST DR
MECHANICSBURG PA 17050
200& DEe -6 PH ~~P.5 OF KATHRYN E HESS
S.S. NO. 066-22-6864
CLOI'lH",,":b~f~ g9~~~F DEA~UH::;~:~~OO.
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
TYPE OF
ACCOUNT
IXJ SAVINGS
o CHECKING
o TRUST
o CERTIF.
MEMBERS 1ST FCU 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 PennsYlvenia. Questions may be answered by galling (717) 787-83Z7.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 224635-05 Date 12-02-2002
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
589.94
50.000
294.97
.045
13.27
TAXPAYER RESPONSE
To insure proper credit to your account, two
(Z) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Reg ister of Wills, Agent".
Tax
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.
PART
!!I
A.''f:II The above information and tax due is correct.
~. 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. r=J Th~ 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. 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
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
PART
[!J
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
OF
1
2
3
4
5
6
7
8
x
TAX ON JOINT/TRUST ACCOUNTS
x
PAYEE
DESCRIPTION
AMOUNT PAID
I
$
and
DATE (~
I
TOTAL (Enter on Line 5 of Tax Computation)
declare that the facts
belief.