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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
-~.-...:...
~.
INFORMATION NOTICE
......,......."..AND
tAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 0, 6)..~ 3
07108417
03-02-2007
AEV-l543 EX AF'P (o9-DD> ,
Z001 M.!\!< -9 lfliH: a~ GLENN E LOVE
S.S. NO. 203-10-2986
CLEH( (JATE OF DEATH 10-14-2006
ORPHf\JYS C~JfflTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECK I NG
o TRUST
. iii CERTIF.
WAL TER LOVE
10960 SPRING RIDGE RD
SHIPPENSBURG PA 17257
C:Li!t
r f"';: " i
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MEHBERS 1ST FCU hIlS provided the Depert.ent with the info~ation 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 info~.tion 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
uf P..nn,OYlvania. QU"btiU"S May b.. answered by "aIling (717) 787-8321.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 250602-42
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
x
Date
Established
204,969.68
50.000
102,484.84
.12
12,298.18
09-07-2004
To insure proper credit to your account, two
(2) copies of this notice Must aCCOMPany your
paY.ent to the Register of Wills. Make check
payable to I "Register of Wills, Agent".
x
NOTEI If tax paYMents are Made within three
(3) Months of the decedent's date of death,
you May deduct a 5X discount of the tax due.
Any inheritance tax due will beCOMe delinquent
nine (9) Months after the date of death.
PART
m
TAXPAYER RESPONSE
[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 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.
B. c=J The 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. c=J The above infor.ation is incorrect and/or debts and deductions were paid by you.
You Must COMPlete PART ~ and/or PART ~ below.
PART If YOU indicate a different tax rate, please state YOUI'
[!I relationShip to decedent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date EstabUshed 1
2. Account Balance 2
3. Percent Taxable 3 X
4. Amount Subject to Tax 4
5. Debts and Deductions 5
6. Amount Taxable 6
7. Tax Rate 7 X
8. Tax Due 8
PART
[!]
DATE PAID
PAYEE
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Llne 5 of Tax Computatlon)
.
Under penaltles of perjury, I declare that the facts I
complete to the best of my knowledge and bellef.
have reported above are true, correct and
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