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COMMONWEAL TH OF PENNSYlVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG, PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 0'" Ll5~
07119698
05-03-2007
1lEY-1S4S EX oR> (89-to)
OR,~;
1(' '-::"
IU, 'EST. OF PAUL l FASOLD
5.5. NO. 193-18-3323
DATE OF DEATH 03-09-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
iii CHECKING
D TRUST
D CERTIF.
, "U 9
r~', ..j~ '!I' _. t...
~ ; ~'i f
** JODY A SHIVELL
8 TEABERRY DR
CARLISLE PA 17013-9041
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 been used in
calculating the potential tax due. Their records indicate that at the death of the above dec.dent. 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 for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Co..onwealth
of Pennsylvania. Questions.ay be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 6214353175
Date
Established
03-14-2006
To insure proper credit to your account. two
(2) copies of this notice .ust accoepany your
pay.ent to the Register of Wills. Make check
payable to. "Register of Wills. Agent".
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
x
.00
100.00
.00
.045
.00
TAXPAYER RESPONSE
NOTE. If tax pay.ents are .ade within three
(3) .onths of the decedent's date of death.
you .ay deduct a 5% discount of the tax due.
Any inheritance tax due will beco.e delinquent
nine (9) .onths after the date of death.
x
PART
[!]
The above inforeation 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. [] 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. [] The above infor.ation is incorrect and/or debts and deductions were paid by you.
You .ust co.plete PART ~ and/or PART ~ below.
x
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
PART
~
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
.
Under penalties of perjury. I declare that the facts I
complete to the best of my knowledge and belief.
TAXPAYER SIGNATURE
have reported above are true. correct and
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