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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 07105601
DATE 02-13-2007
REV-1S43 EX MP <09-00)
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1"".'.,.lU J
EST. OF DOROTHEA J DEAN
S.S. NO. 178-20-6734
DATE OF DEATk 12-24-2006
COUNTY CUMBERLAND
TYPE OF ACCOUNT
[i] SAVINGS
DCHECKING
D TRUST
D CERTIF.
-8 Pl: 3: 25
WIllIAM M DEAN
3 FOX FIELD CT
MECHANICSBURG PA 17050
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
SOVEREIGN BANK has provided the Depart.ent 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 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
Account No. 2331031312
. .
. SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Date
Established
12-15-1982
To insure proper credit to your account, two
(2) copies of this notice .ust acco.pany your
pay.ent to the Register of Wills. Make check
paYab~e to: "Register of Wills, Agent".
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
x
37,001.88
50.000
18,500.94
.15
2,775.14
TAXPAYER RESPONSE
NOTE I 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
[!]
[CHECK ]
ONE
BLOCK
ONLY
A. c=J The above inforMation 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 .IlIY 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.
B. ~e 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.pIete PART 0 and/or PART 0 below.
PART
[!]
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
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
..
perjury, I declare that the facts
my knowledge and belief.
have reported above are true, correct and
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