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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
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INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 07-0022
ACN 07105604
DATE 02-13-2007
(i"-llf;'I-1S43 ~'AFI' (09-00)
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EST. OF DOROTHEA J DEAN
S.S. NO. 178-20-6734
DATE OF DEATH 12-24-2006
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
D CHECK I NG
D TRUST
lXJ CERTIF.
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
WILLIAM M DEAN
3 FOX FIELD CT
HECHANICSBURG PA 17050
SOVEREIGN BANK has provided the Departllent with the inforution 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 infor.ation is incorrect, please obtain written correction frail 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 COllllonwealth
nf PennsYlv~nia. Ques~ions .ay be answerad by c;lling {717l 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 2335129462
Date 11 - 02- 1994
Established
To insure proper credit to your account, two
(2J copies of this notice lIust aCCOIIPany 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
12,177.90
X 50.000
6,088.95
X .15
913.34
TAXPAYER RESPONSE
NOTE: If tax pay.ents are lIade within three
(3J 1I0nths of the decedent's date of death,
you lIay deduct a 5X discount of the tax due.
Any inheritance tax due will becolle delinquent
nine (9J _onths after the date of death.
PART
[!J
A.
[ CHECK ]
ONE
BLOCK B.
ONLY
c.
c=J The above inforllation and tax due is correct.
1. You lIay choose to re.it payllent to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you lIay 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.
~ 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=J The above inforBlation is incorrect andlor debts and deductions were paid by you.
You Blust co.plete PART ~ and/or PART ~ below.
Tax Rate
X
If you indicate a different tax rate, please state your
relationship to decedent:
PART
~
TAX RETURN - COMPUTATION
LINE 1. Date Established
Amount Taxable
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3
4
5
6
7
8
x
2. Account Balance
3.
4.
5.
6.
7.
Percent Taxable
Amount Subject to Tax
Debts and Deductions
8. Tax Due
PART
[!l
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation>
I
.
perjury, I declare that the facts I
my knowledge and belief.
have reported above are true, correct
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