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COJlIIOHWEALTH OF PENNSYLVANIA
IlEPAR11IENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
IIEPT. 280601
HARRISBURG~ PA l71Z8-060l
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IEV-U45 ~x Af, l.~i; ,-
INFORMATION NOTICE
- rfT':- ,~.- AND
T~~t~yeR RESPONSE
1,.,- ;' " ,: : ,.'~'J
FILE NO. 21 Ot OO'~,.(_
ACN 06157542
DATE 11-22-2006
LAURA L RADCLIFFE
1312 PAXTON CHURCH RD
HBG PA 17110
TYPE OF ACCOUNT
Z007 JA~I 10 PM ~~60F ROBERT S RADCLIFFE 0 SAVIN8S
S. S. NO. 204-01-3100 IX] CHECKING
CLERK OF DATE OF DEATH 07-28-2006 0 TRUST
ORPHAN'S COLSl"UNTY CUMBERLAND D CERTIF.
CUMP:Ti! ('('I r:jl\, REMIT PAYMENT AND FORltS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PSECU has providIKI the DepartHnt with the infoMl1ltlon Usted below whIch has baan used in
calculating the potantlal tax due. Their records indicate that at the death of the above deced..,t~ YOU were a joint owner/beneficiary of
this account. If you feel this infor..tion is incorrect~ please obtain written correction fro. the financial institution~ attach a copy
to this fo,.. and return it to the lIbove address. This account is taxable in accordance with the Inherits1ce Tax Laws of the C08aonwealth
of Pw1nsylvan18.QuHtions II8'Y be1lllSWllred by cIIUl", (717) 787-8'527. '
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 8602992813 o.t. 06-18-2002
Est.bllsMd
\
Account 8e1WtCtt
P.rcent T8X1Ibl.
AIIount Subj.ct to Tex
Tex Ret.
PotenUel Tex Due
x
3,276.06
16.667
546.02
.045
24.57
TAXPAYER RESPONSE
To insure proper credit to your account~ tlllO
(2) copies of this notice BUst accu.peny your
paYlHlf'lt to the Register of Wills. Make check
payable to: "Register of Il1lls~ Agant...
x
NOTE: If tmr paYIIWlts are Bade within three
(!) aonths of the decedent.s dete of death~
you ..ycieduct a 5% discount of the tax due.
Any inherJ tance tax due wUl becOlltl delinquent
nine (9) BunthS after the date of death.
PART
l!l
liIJ1~:;i:tiI~~i:=J;;;~::~~~!:!~~::~~~litljtl~;t~~:~!;~:~~lii~~~~1~7~;~t:~~;J:i~~~r.;~I8;;i~;~1i;;;i:i:~a
A. a The above infoMl1ltion and tax due is correct.
r::IfJ 1. You Bay choose to r_lt paYlHlf'lt to tha Register of WUls Nith tlllO copias of this notice to obtain
a discount or avoid interest~ or yoU BaY check box "A" and return this notice to the Register of
Wills and an official assesSlent Nill be issued by the PA Departaent of Revenue.
8. 0 The above asset has bun or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent.s representative. .
C. 0 The above infor..tion is incorrect and/or debts and deductions were paid by you.
You BUst cOlIPleta PART 0 and/or PART [!] beloN.
[CHECK ]
ONE
BLOCK
ONLY
If you Indlcat. e dlff.rent tax r.te, pl.e.. st.t. your
r.letlonshlp to decedent:
PART
l!I
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Dat. Estebllshed 1
2. Account Selene. 2
3. P.rcent Texebl. 3 X
.... AIIow1t Subj.ct to Tex ...
S. Debts end Deductions S-
6. Aeount Texeb1. 6
1. Tex R.t. 1 X
8. Tex Due 8
PART
~
DATE PAID
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Ent.r on Line S of Tex Co~tetlon)
I
.
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I hey. reported eboy. .r. true, corr-ft end
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