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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 11128-0601
*'
FILE
ACN
DATE
NO. 21 t:)\ t>~~
07127102
06-20-2007
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
r<'
C~
REMIT P~ENT AND F~S TO.c' i"'~
REGISTER OF~LS <- ... ';2
CUMBERLAND ~" ~OURT 4:tQUSE;~ '::?J
CARLISLE, P~'\::l~13 r- l. -- S:..~
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PSECU has provided the DepartMent with the inforMation listed below which ~2~n used ~ ,-
calculating the potential tax due. Their records indicate that at the death of the above decedent. you were a 4~nt owner/b~ficiary of;-
this account. If you feel this inforMation is incorrect. please obtain written correction frOM the financial i~stitution. a~h a copy
to this fo,.. and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Coeeonwealth
of PennsYlvania. Questions eay be answered by calling (111) 181-8321.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
LINDA C BEATY
205 W MAIN ST
SHIREMANSTOWN
REY-1543 EX AFP (09-00>
TYPE OF
ACCOUNT
[i] SAVINGS
o CHECKING
o TRUST
o CERTIF.
EST. OF FLORENCE S MONTIJO
5.5. NO. 183-16-9805
DATE OF DEATH 05-03-2007
COUNTY CUMBERLAND
PA 17011
Account No. 0183169805
Date
Established
09-22-1999
To insure proper credit to your account, two
(2) copies of this notice eust accoepany your
payeent 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
x
14,844.63
50.000
NOTE. If tax payeents are eade within three
7,422.32 (3) eonths of the decedent. s date of death,
.045 you eay deduct a 5" discount of the tax due.
dl , Any inheritance tax due will becoee delinquent
334. 00-6'10 ::':~.'W'onine (9) eonths after the date of death.
x
PART
[!]
TAXPAYER RESPONSE
A. r.-I The above inforeation and tax due is correct.
}~ 1. You eay choose to reeit 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 Departeent of Revenue.
[CHECK ]
ONE
BLOCK
ONLY
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. c=l The above inforeation is incorrect and/or debts and deductions were paid by you.
You Must coeplete PART ~ and/or PART ~ below.
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3 X
4
5
6
7 X
8
PART
~
TAX RETURN - COMPUTATION
If you indicate a different tax rate, please state your
relationship to decedent.
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
l!]
DATE PAID PAYEE
I
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
.
~' ,...,.," .f ,.,,",y, 1 d.cl'" .h.' .h. f.c"
omplete to~he st of my knowledge and belief.
..-
_ ____ _ ...__ _.._....'T"lln~
I have repo~d above are true, correct and
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