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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUEr,-'
BUREAU OF INDIVIDUAL'fAxES
DEPT. 280601 - -' -
HARRISBURG. PA 171Za'~0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 06-1163
07108416
03-02-2007
REV-1S~S EX MP C09- 00>
'J ''[7 r 'I' \I lOP; 'I' I?'. L. I
':.;", t,j; I I l,....~ i
EST. OF SUSAN C BREWER
S.S. NO. 181-38-9086
DATE OF DEATH 11-13-2006
COUNTY CUMBERLAND
TVPE OF ACCOUNT
o SAVINGS
[i] CHECK I NG
o TRUST
D CERTIF.
RICHARD VARLET
1195 KINGSLEY RD
CAMP HILL PA 17011
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MEMBERS 1ST FCU has provided the Depart.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...ation is incorrect. please obtain written correction fro. the financial institution. attach a copy
to this fa... and return it to the above address. This account is taxable in accordance with the Inheritance Tax L.vs of the Cu..onwealth
-- --.-
_.. a____.'1......""':~""'------__.L"I.----.......lL-------- .
GENERAL INFORMATION
1. FAI LURE TO RESPOND WI LL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable inte...est based on info...ntion
sub.itted by the financial institution.
2. Inhe...itance tax beco.es delinquent nine .onths afte... the decedent's date of death.
3. A joint account is taxable even though the decedent's na.e was added as a .atte... of convenience.
4. Accounts (including those held between husband and wife) which the decedent put in joint na.es within one yea... p...io... to
death a...e fully taxable as t...ansf....s.
5. Accounts established jointly betw.en husband and wife .o...e than one yea... p...io... to d.ath a...e not taxable.
6. Accounts held by a deced.nt "in t...ust fo..... anothe... 0... oth....s a...e taxable fully.
REPORTING INSTRUCTIONS
PART
1
TAXPAYER RESPONSE
1. BLOCK A - If the info....ation and co.putation in the notice a...e co......ect and deductions a.... not being clai.ed, place an '~..
in block "A" of Pa...t 1 of the "Taxpaye... Response" s.ction. Sign two copies and sub.it the. with you... check fo... the a.ount of
tax to the Registe... of Wills of the county indicated. The PA oepa...t.ent of Revenue will issue an official assessment
(Fo.... REV-1548 EX) upon ...eceipt of the ...etu...n f...o. the Registe... of Wills.
2. BLOCK B - If the asset sp.cified on this notice has been 0... will be ...epo...ted and tax paid with the PennsYlvania Inhe...itance
Tax Retu...n filed by the decedent's ...ep...esentative, place an "X" in block "B" of Pa...t I of the "Taxpaye... Response" section. Sign one
copy and ...etu...n to the PA Depa...tment of Revenue, Bu...eau of Individual Taxes, Dept 280601, Ha......isbu...g, PA 17128-0601 in the
env.lope p...ovided.
3. BLOCK C - If the notice info....ation is inco......ect and/o... deductions a...e being clai.ed, check block "C" and cOMPlete Pa...ts 2 and 3
acco...ding to the inst...uctions below. Sign two copies and sub.it the. with you... check fo... the a.ount of tax payable to the Registe...
of Wills of the county indicated. The PA Depa...t.ent of Revenue will issue an official assess.ent (Fo.... REV-1548 EX) upon ...eceipt
of the ...etu...n f...o. the Registe... of Wills. - _ ......._ '1111'
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