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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
..
INFORMATION NOTICE
T'- AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 01 "Z.-"Z..l
07104408
02-05-2007
REV.1S43 EX AFP (09.80)
"'" - -/
,Ie: I
r'i j g~~~ ~F GRACE M RANEK
S.S. NO. 566-22-4689
1- DATE OF DEATH 12-13-2006
_ _ ., COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
!Xl CERTI F .
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NANCY A LENNINGTON
140 WILSON ST
CARLISLE PA 17013
SOVEREIGN BANK has provided the Department with the inforMation 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 inforMation is incorrect, please obtain written correction frOM the financial institution, attach a copy
to this forM and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the COMMonwealth
of Penn~~lvsnia. QUGstions may be answered by call1ny (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 1675206328
Date 08-11-1997
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 tOI "Register of Wills, Agent".
~If tax paYMents are Made 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 beCOMe delinquent
nine (9) Months after the date of death.
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
22,899.33
X 50.000
11 ,449.67
X .15
1 , 71 7 . 45
TAXPAYER RESPONSE
PART
[!I
[CHECK ]
ONE
BLOCK
ONLY
A. c=l The above inforMation and tax due is correct.
1. You May 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. c=l 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. ~ The above inforMation is incorrect and/or debts and deductions were paid by you.
~ You Must COMPlete PART ~ and/or PART ~ below.
PART If you indicate a different~ta~ ~~~ please state your
I!l relationship to decedent: Q4.1 ~LV
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
~ - It - "I"
2 ,}~"!r'qq .s~
:~1J ~ct. 101
5 -
:~~'1
LINE
1. Date Established
2.
3.
4.
5.
6.
7.
8.
1
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Amount Taxable
Tax Rate
Tax Due
PART
[!]
~ PAID PAYEE
*". 0'1 li'I~l\C<j ht"D1"~
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION AMOUNT PAID
~"~I~Fq.qsg
TOTAL (Enter on Line 5 of Tax Computation) *
perjury, I declare that the facts I have reported above are true, correct and
my knowledg
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