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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG, PA 1712B-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO.21 0-1 o~
07125540
06-08-2007
s-
REV.1S43 ~ AFP (09-00>
TYPE OF
EST. OF EDMUND J KALBFLEISCH
S.S. NO. 069-14-3891
DATE OF DEATH 07-23-2006
COUNTY CUMBERLAND
ACCO
[i] SA
o CH
o TR
o CE
DOROTHY KALBFLEISCH
1214 BENT CREEK BLVD
MECHANICSBURG PA 17055
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
SOVEREIGN BANK has provided the Department with the info...ation 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 ofl
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 Commonweal h
of Pennsylvania. Questions may be answercd by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0774047047
Account Balance
Percent Taxable
Amount SUbject to Tax
Tax Rate
Potential Tax Due
PART
[!J
[CHECK ]
ONE
BLOCK
ONLY
Date 08-27-2002
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 to: "Register of Wills, Agent".
13,577.57
X 16.667
2,262.97
X .00
.00
NOTE: 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.
You may choose to remit payment to the Register of Wills with two copies of ~s,notic~o obt~in
a discount or avoid interest, or you may check box "A" and return this notice.;:tjj)-~he ROlster of
Wills and an official assessment will be issued by the PA Department of Reverriril~:'
.. , ...,....,.~
B. 0 The above asset has been or will be reported and tax paid with the Pennsylvania.. iAil~titanc.2tax return
to be filed by the decedent's representative. :::
c. D The above information is incorrect and/or debts and deductions were paid by you;.
You must complete PART ~ and/or PART ~ below.
P-.)
PART
[!]
TAX
If you indicate a different tax rate, please state your
relationship to decedent:
RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
I
2
3 X
4
5
6
7 X
8
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
DEBTS AND DEDUCTIONS CLAIMED
DESCR I PTI ON
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
.
declare that the facts
and belief.
have reported above are true, correct and
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