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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 ()1 l'-L-,
07104407
02-05-2007
-'I
,
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TYPE OF
ACCOUNT
o SAVINGS
o CHECKING
o TRUST
!Xl CERTIF,
EST. OF GRACE M RANeK
S.S. NO. 566-22-4689
DATE OF DEATH 12-13-2006
COUNTY CUMBERLAND
REV-1S43 EX AFP (09-00)
:: ,J
I' or
,
ASHLEY E LENNINGTON
140 WILSON ST
CARLISLE PA 17013-2844
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
SOVEREIGN BANK has p..ovided the Depa..tMent with the info....ation listed below which has been used in
calculating the potential tax due. Thei.. ..eco..ds indicate that at the death of the above decedent, you we..e a joint owne../beneficial'Y of
this account. If you feel this info"lIation is inco....ect, please obtain w..itten co....ection f..oll the financial institution, attach a copy
to this fO"1I and ..etu..n it to the above add..ess. This account is taxable in acco..dance with the Inhe..itance Tax Laws of the COllllonwealth
of PennsylViU'da. QlJP~ti_O"C: ",,,y be !!!nsw~red "'... calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 1675206310
Date 08-11-1997
Established
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
15,121.07
X 50.000
7,560.54
X .15
1,134.08
TAXPAYER RESPONSE
PART
m
To insu..e p..ope.. c..edit to you.. account, two
(2) copies of this notice lIust aCCOIIPanY you..
paYllent to the Registe.. of Wills. Make check
payable to: "Registe.. of Wills, Agent".
~If tax paYllents a..e lIade within th..ee
~thS of the decedent's date of death, ~
you lIay deduct a 5X discount of the tax due.
Any inhe..itance tax due will becolle delinquent
nine (9) 1I0nths afte.. the date of death.
A. c=l The above info....ation and tax due is co....ect.
1. You lIay choose to ..e.it paYllent to the Registe.. of Wills with two copies of this notice to obtain
a discount 0.. avoid inte..est, 0.. you .ay check box "A" and ..etu..n this notice to the Registe.. of
Wills and an official assessMent will be issued by the PA Depa..tllent of Revenue.
B. c=l The above asset has been 0.. will be ..epo..ted and tax paid with the Pennsylvania Inhe..itance Tax ..etu..n
to be filed by the decedent's ..ep..esentative.
C. ~ The above info....ation is inco....ect and/o.. debts and deductions we..e paid by you.
~YOU IIUSt cOIIPlete PART ~ and/o.. PART ~ below.
[CHECK ]
ONE
BLOCK
ONLY
PART If you indicate a different
~ relationship to decedent:
TAX RETURN - COMPUTATION OF AX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established 1 }-~ -t~~'1
2. Account Balance 2 ~~~~ D~I{
3. Percent Taxable 3
4. Amount Subject to Tax 4
5. Debts and Deductions 5 -~ ~~4-
6. Amount Taxable 6
7. Tax Rate 7 x~-o~
8. Tax Due 8
DEBTS AND DEDUCTIONS CLAIMED
PART
~
~. PAYEE
*' h\lA.1 L.tnnln~
~.
,. n I5eO;\
TOTAL (Enter on Line 5 of Tax Computation) ·
AMOUNT PAID
~ ~d-~ .~I
of perjury, I declare that the facts I have reported above are true, correct and
my knowledge-and belief.
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