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COMMONllEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
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nrr. J.N.......F.~RMATION NOTICE
""'.1 ", AND
., JA;cPAYER RESPONSE
FILE
ACN
DATE
NO. 21 07-0098
07108395
03-02-2007
_' 10-.-' I
REV-1543 EX AFP <O9-00l
ZOOl1'1f1R I 2 AH 10: 45
EST. OF FRANK T PALMER
CLECI( (Ie S.S. NO. 185-20-9839
ORP' L~'; 1:"::'\' :~'~.\I If)T, DATE OF DEATH 01-12 - 20 0 7
1 1\., ,J ,)" ,,/ II COlfU'I'V CUMBERLAND
CUt./"'T":"'f'i D\ U&U a
TYPE OF ACCOUNT
o SAVINGS
Iil CHECKING
o TRUST
o CERTIF.
FRANK T PALMER JR
406 STONE HEDGE LN
MECHANICSBURG PA 17055
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CITIZENS BANK OF PA has provided the Depart.ent with the infor.ation listed below which has bun 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 infor.ation is incorrect, please obtain written correction fro. the financial institution, attach a copy
to this fo~ and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co..onwealth
of Penllsl/lvani". QUllstions .ay be answ,,,,"Ll by "alling (1l71 787-6327.
COMPLETE PART 1 BELOW
Account No. 6205255891
II II
II SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Date
Established
07-14-2004
To insure proper credit to your account, two
(2) copies of this notice .ust accoapany your
pay.ent to the Register of Wills. Meke check
payable to I "Register of Wills, Agent".
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
x
87,357.43
50.000
43,678.72
.045
1,965.54
TAXPAYER RESPONSE
NOTE. If tax pay.ents are .ade within three
(3) .onths of the decedent's date of death,
you .ay deduct a 5X discount of the tax due.
Any inheritance tax due will beco.e delinquent
nine (9) .onths after the date of death.
x
PART
[!]
A. c=J The above infor.ation and tax due is correct.
1. You.ay choose to re.it pay.ent to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or yoU .ay check box "A" and return this notice to the Register of
Wills and an official assess.ent will be issued by the PA Depart.ent of Revenue.
[CHECK ]
ONE
BLOCK
ONLY
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 .ust co.plete PART [!] and/or PART ~ below.
PART
[!I
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. 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
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3
4
5
6
7
8
x
x
PAYEE
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
.
facts I have reported above are true, correct and
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