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COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B060l
HARRISBURG. PA l7l2B-060l
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 ~\ ek~3
07127706
06-20-2007
REV.1S43 EX AFP (09.00)
EST. OF FLORENCE S MONTIJO
S.S. NO. 183-16-9805
DATE OF DEATH 05-03-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGs
D CHECKING
D TRUsT
!Xl CERTIF.
,...",
REMIT ~YHENT AN@ORHS TOL"
REGISTER QidllILLS -.J T! (i~
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psECU has provided the Oepartment with the information listed below WhiCh:1ijs been LIWl in .. rT1
calculating the potential tax due. Their records indicate that at the death of the above decedent. you we~a Joint own.r/benetitd~ of
this account. If you feel this inforMation is incorrect. please obtain written correction frOM the financrai instituti~ attach a -idpy
to this fo,.. and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws o~he COMMonwealth
of Pennsylvania. Questions May be answered by ca~ling (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
Account No. 0183169805
Date
Established
09-22-1999
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".
Account Balance
Percent Taxable
Amount subject to Tax
Tax Rate
Potential Tax Due
x
1,240.29
50.000
NOTE. If tax paYMents are Made within three
620.15 (3) Months of the decedent's date of death.
.045 you May deduct a 5% discount of the tax due.
Any inheritance tax due will beCOMe delinquent
27.91- S"J,,' Z(,..~ J nine (9) Months after the date of death.
x
PART
[!]
TAXPAYER RESPONSE
A. ~ 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.
[CHECK ]
ONE
BLOCK
ONLY
B. E:J 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. E:J The above infor.ation is incorrect andlor debts and deductions were paid by you.
You Must COMPlete PART ~ andlor 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 I
my k~OWledgcnlU1~'1
have reported above are true, correct and
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