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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 07105605
DATE 02-13-2007
REV-l54l1 EX ~p <09- 00)
EST. OF DOROTHEA J DEAN
S.S. NO. 178-20-6734
DATE OF DEATH 12-24-2006
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECK! NG
o TRUST
[i] CERTIF.
Z007 HP.R --8 Fh 3: 2S
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 Departaent with the infoMlation 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 inforaation is incorrect, please obtain written correction fro. 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 Coaaonwealth
of PennsYlvania. Questions .ay be answered by calli"g (717} 787-8327.
COMPLETE PART 1 BELOW
Account No. 2475011801
Ii Ii
I: SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Date 02-22-1995
EstabUshed
x
14,818.89
50.000
7,409.45
.15
1,111.42
TAXPAYER RESPONSE
To insure proper credit to your account, two
(2) copies of this notice .ust accoapany 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
NOTE: If tax payaents are aads within three
(3) .onths of the decedent's date of death,
you aay deduct a 5Y. discount of the tax due.
Any inheritance tax due will becoae delinquent
nine (9) .onths after the date of death.
PART
[!I
[CHECK ]
ONE
BLOCK
ONLY
A. c=J The above infor.ation and tax due is correct.
1. You .ay choose to reait payaent 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.
B. ~ 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. r=J The above info....ation is incorrect and/or debts and deductions were paid by you.
You aust coaplete PART ~ and/or PART ~ below.
x
If you indicate a d1fferent tax rate, please state your
relationship to decedent:
PART
[!I
TAX RETURN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deduct10ns
6. Amount Taxable
7. Tax Rate
8. Tax Due
TAX ON JOINT/TRUST ACCOUNTS
OF
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)
$
of perjury, I declare that the facts
of my knowledge and belief.
I have reported above are ~e~ correct
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