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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 07105600
DATE 02-13-2007
REV-tSti3 EX AFP (09-00)
2 DO 7 f;:; P. R - 8 P ii 3: 2 5
TYPE OF ACCOUNT
D SAVINGS
Ii] CHECKING
D TRUST
D CERTIF.
EST. OF DOROTHEA J DEAN
S.S. NO. 178-20-6734
DATE OF DEATH 12-24-2006
COUNTY CUMBERLAND
OR ;:\.1/
('Il\t."
VL);:
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.atio~ 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 COMMonwealth
of Pennsylvania. Questions.ay be answered by callin~ (717) 787-8327.
COMPLETE PART 1 BELOW
Account No. 2331025681
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
PART
[!]
. .
. SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Da te 07 - 01 - 1982
Established
To insure proper credit to your account, two
(2) copies of this notice Must aCCOMpany your
paYMent to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
x
49,226.05
50.000
24,613.03
.15
3,691.95
TAXPAYER RESPONSE
NOTE: If tax paYMents are Made within three
(3) Months of the decedent's date of death,
you May deduct a 5X discount of the tax due.
Any inheritance tax due will beCOMe delinquent
nine (9) Months after the date of death.
x
A. c=J The above inforMation and tax due is correct.
1. You .ay choose to reMit paYMent to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you May check box "A" and return this notice to the Register of
Wills and an official asseSSMent will be issued by the PA DepartMent 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 inforMation is incorrect and/or debts and deductions were paid by you.
You Must COMPlete PART 0 and/or PART 0 below.
[CHECK ]
ONE
BLOCK
ONLY
1
2
3 X
4
5
6
7 X
8
If you indicate a different tax rate, please state your
relationship to decedent:
PART
[!]
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE l. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
,. Amount Taxable
7. Tax Rate
8. Tax Due
PART
~
DATE PAID PAYEE
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
.
TOTAL CEnter 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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