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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENlE
BUREAU OF IHDIVIIlJAL TAXES
IIEPT. 280601
HARRISIURSI PA 17128-0601
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INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 0' 3>""2-
ACN 06157540
DATE 11-22-2006
2007 JAN f 0 PM 12: 36
EST. OF ROBERT S RADCLIFFE
S.S. NO. 204-01-3100
DATE OF DEATH 07-28-2006
COUNTY CUMBERLAND
TVPE OF ACCOUNT
lXl SAVINQS
o CHECKING
o TRUST
o CERTIF.
CLERK OF
ORPHAN'S COURT
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LAURA L RADCLIFFE - .. '..
1312 PAXTON CHURCH RD
HBG PA 17110
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PSECU hes pl"Ovided th8 DepertHnt with the info....tion listed belot1 which has been used in
calculating the potential tax due. Their records indicate that at the death of the IIbove deelldantl you were a joint ONner/beneficiary of
this BClCount. If YOU feel this info....tlon is Incarreetl please obtain written correction fro. the fin_iel Institution I attach a copy
to this fore and return it to the above address. This account Is taxable in accordance with the Inheritance Tax L....s of the Co_nwHlth
ofPennQJ..vanl.. Quas.tian... _ ~rlId by cl!I!lUna (717) 7az..13Z7.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 8602992813 Date 06-18-2002
Estllbllshed
x
7,186.87
16.667
1,197.84
.045
53.90
TAXPAYER RESPONSE
To Insure proper credit to your accountl two
(Z) copies of thls notice MIst accDllP8l1Y your
peYllent to the Register of Wills. Make check
payable to: "R8IIlster of Wills1 Agent".
Account Balance
Percent Taxllble
Mount Subject to Tax
Tax Rate
Potential Tax Due
x
HOTE: If tax pay.ants are .lIde within three
(3) eonths of the decedent"s date of d_thl
yoU _y deduct a 5% discount of the tax due.
Any Inheritance tax due wUI bee.e delinquent
nine (9) aooths after the date of d.ath.
PART
[!]
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A.~Th8 ~ve info~tlon and tax dUB is correct.
r. You MY chao.. to r..lt payaent to the Register of Wills with two copl.s of thls notice to obtain
a discount Dr avoid lnterastl or you _y check box "A" and return this notlce to the R8IIlster of
Wills and an official assesSlant will be Issuad by the PA Oepartaent of Revenue.
B. 0 The above asset has been or will be raport8d and tax paid with the PeMsylvania Inheritance Tax return
to be filed bY the decedent"s representative.
C. 0 The above inforatloo is incorrect and/or debts and dllductlons were paid by you.
You aust coepleta PART [!] and/or PART [!) below.
[CHECK ]
ONE
BLOCK
ONLY
If you Indlcete a different tu: rate, pI... state your
relationship to ~cedent:
PART
[!]
TAX RETURN - COMPUTATION OF TAX ON JOINT,TRUST ACCOUNTS
LINE 1. Date Established 1
2. Account BalMCe 2
3. Percent Taxllble 3 X
4. ~t SUbject to Tax 4
S. Debts and Deductions S-
6. Aaount Taxable 6
7. Tax Rate 7 X
8. Tax~ 8
PART
~
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
0'