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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. Z8D6Dl
HARRISBURG. PA 171Z8-D6Dl
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INFORMATION NOTICE
/': AND
'~AXPAYER RESPONSE
FILE NO. 21 06-0145
ACN 06001693
DATE 05-02-2006
REY-1545 EXAFP'(D9-DDI
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PH 12:
5~ST. OF DALE A BRITTEN
S.S. NO. 174-16-3944
DATE OF DEATH 02-05-2006
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
o CERTIF.
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REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
MICHAEL BRITTEN
JY12 ~ CRESTMOOR DRIVE
WOODBURY MN 55125
US SERIES EE SAVINGS BONDS has provided the Departsent with the inforsation listed below which has been used in
calculating the potential tex 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 inforsation is incorrect. please obtain written correction fros the financial institution. attach a COpy
to this fors and return it to the above address. This account is taxable in accordance with the Inheritance Tax Lews of the Cossonwealth
of Pennsylvania. Questions .ay be answered by calling (717) 787-83Z7.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. EE/SERIESBONDS Date 03-07-1985
Established
x
45.680.00
50.000
22.840.00
.045
1.027.80
TAXPAYER RESPONSE
To insure proper credit to your account. two
(Z) copies of this notice sust accospany your
paysent to the Register of Wills. Make check
payable to: "Register of Wills. Agent".
Account Balance
Percent Taxable
A.ount Subject to
Tax Rate
Potential Tax Due
x
NOTE: If tax paysents are sade within three
(3) sonths of the decedent's date of death.
you say deduct a 5~ discount of the tax due.
Any inheritance tax due will becose delinquent
nine (9) sonths after the date of death.
Tax
PART
[!]
[CHECK ]
ONE
BLOCK
ONLY
A. 0 The above inforsation and tax due is correct.
1. You say choose to resit paysent to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest. or you say check box "A" and return this notice to the Register of
Wills and an official assessaent will be issued by the PA Departsent of Revenue.
B. ~e above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
~ t~ be filed by the decedant's representative.
C. 0 The above inforsation is incorrect and/or debts and deductions were paid by you.
You sust cosplete PART ~ and/or PART ~ below.
If you indicate a different tax rate. please state your
relationship to decedent:
PART
~
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established 1
2. Account Balance 2
3. Percent Taxable 3 X
4. A.ount Subject to Tax 4
5. Debts and Deductions 5
6. A.ount Taxable 6
7. Tax Rate 7 X
8. Tax Due 8
PART
~
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
$
I
TOTAL (Enter on Line 5 of Tax Co.putation)
~ I declare that the facts I
.y knowledge and belief.
have reported above are true. correct
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