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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
*'
FILE
ACN
DATE
NO. 21 tll o\tf-\~
07127705
06-20-2007
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
REV.1Sti~ EX AFP <09-00)
TYPE OF ACCOUNT
EST. OF FLORENCE S MONTIJO D SAVINGS
S.S. NO. 183-16-9805 D CHECKING
DATE OF DEATH 05-03-2007 D TRUST
COU"TY CUMBERLAND [Xl CERTIF.
"'"
REGISR:~~T ~~L~ND ~MS TO:,
CUMBERLAND ',~,)l{J RT ~US~/,',
CARLISLE, ~~13 '""
d"7m I -,
U3 5? \0
00
, ~~ Q -rj
-' ::a
PSECU has provided the Depart.ent with the info,..ation listed below whicllc:"asibeen use~in ,
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were~.joint owner~nefici~r.i-~f
this account. If you feel this infor.ation is incorrect, please obtain written correction fro. the financial institution~tach 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 Co..onwealth
of Pennsylvania. Questions .ay be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
LINDA C BEATY
205 W MAIN ST
SHIREMANSTOWN
PA 17011
-0
:!:
Account No. 0183169805
Date
Established
09-22-1999
To insure proper 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".
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
PART
[!]
x
3,106.23
50.000
NOTE. If tax paYMents are .ade within three
1,553.12 (3) .onths of the decedent's date of death,
.045 you .ay deduct a 5% discount of the tax due.
Any inheritance tax due will beco.e delinquent
69.89 - 5'10 ~,t.. 'Ie> nine (9) .onths after the date of death.
TAXPAYER RESPONSE
x
A. r-1 The above infor.ation and tax due is correct.
fJ 1. You.ay choose to re.it 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 assess.ent will be issued by the PA Depart.ent 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 information is incorrect and/or debts and deductions were paid by you.
You Must co.plete 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
~
DATE PAID PAYEE
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
.
TOTAL {Enter on Line 5 of Tax Computation}
perjury, I declare that the facts
knowledge and elief.
~
have reported above are true, correct and
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