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COMMONWEAL TH OF PENNSYLVANIA -..
OEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES r,'- r.' .r.r~ ., C.D O~ . . . -
DEPT. 2B0601 I~t''.i\ Ill!)'... J
HARRISBURG, PA 17128-0601 r'cr"lc'rr~ n': , ..
t~L\J,j1,J" 'vI ,Vi.,--
REY-1543 EX AFP (09.00)
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO.21 07-0448
07001622
06-07-2007
CLERK OF
QRP1-LA.N'S COURT
CUMBERLN-.t[) CO.. PA
EST. OF MARY C MARCONI
S.S. NO. 177-24-1385
DATE OF DEATH 04-20-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
D CHECKING
D TRUST
!Xl CERTIF.
2001 JON 20 PH 2: '5
** ROBERT MARCONI
218 N ARCH ST
MECHANICSBURG PA 17055
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
HEHBERS 1ST FCU has provided the Depart..nt with the information lishd below which has bun used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If YOU feel this information is incorrect, please obtain written correction from the financial institution, attach 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 Commonwealth
of Pennsylvania. Questions .ay be answered by calling (717) 787-8127.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 260553-41
Date
Established
03-22-2007
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. "Regishr of Wills, Agent".
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
x
7,038.89
100.00
7,038.89
.045
316.75
TAXPAYER RESPONSE
NOTE. If tax payments are made within three
(3) months of the decedent's date of death,
you may deduct a 5X discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
x
PART
ill
[CHECK ]
ONE
BLOCK
ONLY
A. c=l The above information and tax due is correct.
1. You may choose to remit pay.ent 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.
B. ~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. [] The above information is incorrect and/or debts and deductions were paid by you.
You aust coaplete PART ~ and/or PART ~ below.
PART
[!]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
If you indicate a different tax rate, please state YOUI'
relationship to decedent:
PART
~
TAX RETURN - COMPUTATION
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
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3
4
5
6
7
8
x
x
PAYEE
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
.
.
declare that the facts
belief.
have reported above are true, correct and
3~~-'fU~o8
( 7/ 7 )
WORK ( )
TELEPHONE NUMBER
IJ:, - 2LJ -rt> "7
DATE
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