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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
'*
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO.21
07106854
02-27-2007
REV-15li3 EX AFP (09-00)
EST. OF WEIR R WERT
S.S. NO. 204-03-7852
DATE OF DEATH 10-29-2006
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
[i] CHECKING
o TRUST
o CERTIF.
HELEN WERT
300 HOGESTOWN RD
MECHANICSBURG PA 17050
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PNC BANK has provided the Departllent with the inforllation 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 inforllation is incorrect, please obtain written correction froll the financial institution, attach a copy
to this forll and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the COllllonwealth
of Pennsylvania. Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW. . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 5070088549
Date 10-15-2001
Established
To insure proper credit to your account, two
(2) copies of this notice lIust accollpany your
paYllent 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
PART
[!]
6,424.87
X 16.667
1,070.83
X .00
.00
TAXPAYER RESPONSE
NOTE. If tax paYllents are lIade within three
(3) months of the decedent's date of death,
you may deduct a 5% discount of the tax due.
Any inheritance tax due will becolle delinquent
nine (9) 1I0nths after the date of death.
A. ~The above inforllation and tax due is correct.
1. You lIay choose to rellit paYllent 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 assessment will be issued by the PA Departllent of Revenue.
[CHECK ]
ONE
BLOCK
ONLY
B. c=J The 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 ~ and/or PART ~ below.
If you indicate a different tax rate, please state your
relationship to decedent:
RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3 X
4
5
6
7 X
8
PART
~
TAX
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
PART
~
DATE PAID PAYEE
DEDUCTJONS CLAIMED
::U
DESCR I PTI ON
AMOUNT PAID
:.' (.]
~-
ti "-: {"")7
~ 11'
TOTAL
have reported above are true, correct and
CEntllron Linll 5 of Tax Computation)
$
declare that the_ f:acts
and belief.
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