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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601~
HARRISBURG PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO.21 05-0722
07500238
04-04-2007
DENISE L ANOKA
PO BOX 13174
MARINA DEL REY
REV.1543A AFP (7-00'
EST. OF RUTH A ANOKA
5.5. NO. 177-24-5745
DATE OF DEATH 07-18-2005
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SECURITY
[i] SEC ACCT
o STOCK
o BONDS
CA 90295
REMIT PAYMENT AND F~~S TO:
REGISTER OFCWILLS ~
CUMBERLAND CDdOOURT MeUSE
CARLISLE, PA3~7013 ~ .
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C)
SMITH BARNEY has provided the Depart.ent with the infor.ation listed below which hllLlUen usedl"
calculating the potential tax due. Theil" records indicate that at the death of the above decedent, you were ab~iCial"'Y ef-this asset.
If you feel this infor.ation is incorrect, please obtain written correction fro. the transfer agent. attach ~~py to this lor. a~._
return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the C~.onwealth o~ennsylvania.
lIuestions .ay be answered DY calling uD:i la7-lS~ij. .-...-----.-----.-------.---~---
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. L259909
DOD Valuation
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
x
1,867.63
50.000
933.82
.045
42.02
TAXPAYER RESPONSE
To insure propel" credit to your account, two
(2) copies of this notice .ust acco.pany your
pay.ent to the Register of Wills. Make check
payable to. "Register of Wills, Agent".
x
NOTE. If tax pay.ents are .ade within three
(3) Bonths of the decedent's date of death.
you .ay deduct a 5% discount of the tax due.
Any inheritance tax due will beco.~elinquent
nine (9) .onths after the date of death.
PART
[!]
A. DThe above 1nfor.at10n and tax due 1S correct.
1. You .ay choose to re.it pay.ent to the Register of Wills with two copies of this notice to obtain
a discount 01" avoid interest. 01" you Bay 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.
[CHECK ]
ONE
BLOCK
ONLY
B. c=JThe above asset has been or will be reported and tax paid with the Pennsylvania fnheritance Tax return
to be filed bY the decedent's representative.
C. DThe above infor.ation ~ incorrect and/or debts and deductions were paid by you.
You .ust co.!>J..et"e PART 0 and/or PART 0 below.
If you indicate a different tax rate, please state your
relationship to decedent:
PART
[!]
TAX
LINE 1. DOD Valuation
2. Percent Taxable
3. Amount Subject to Tax
4. Debts and Deductions
5. Amount Taxable
6. Tax Rate
7. Tax Due
RETURN - COMPUTATION OF TAX ON ABOVE ASSETCS)
1
2 X
3
4
5
6 X
7
PART DEBTS AND DEDUCTIONS CLAIMED
[!I
DATE PAID
PAYEE
DESCRIPTION
AMOUNT PAID
.
TOTAL (Enter on Line 5 of Tax Computation)
Under penalties of perjury, I declare that the facts I
complete to the best of my knowledge and belief.
have reported above are true, correct and
HOME C )
WORK C )
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