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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG. PA 17128-0601
*'
INFORMATION NOTICE
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TAXPAYER RESPONSE
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[i] CERTIF.
REV-1S43 EX AF'P (09- 00>
READING PA
EST. OF GLADYS B SMEAL
S.S. NO. 160-16-9264
DATE OF DEATH 05-20-2007
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS ~
CUMBERLAND fa. ,A:OURT 1fi)USE.
CARLISLE, P)f'J:l7013:;t;:>-
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C)Q -ry ._
PSECU has provided the Deparbent with the infor.ation listed below which,h~~-Melrri useail . ".
calculating the potential tax due. Their records indicate that at the death of the above decedent. you were a a~t owner/~efic{ary':~~
this account. If you feel this infor.ation is incorrect. please obtain written correction fro. the financial in~ution. ~ach a copy
to this for. and return it to the above address. This account is taxable in accordance with the Inheritance ~ Laws of t~Co..onwealt~
of Pennsylvania. Questions.ay be answered by calling (717) 787-B327. ..~
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
** PRISCIL HETZEL
1110 HETRICK AVE
PALMYRA PA 17078
Account No. 0160169264-50
Date
Established
07-17-2006
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 Ta~
Tax Rate
~otential Tax Due
PART
[!]
x
11 , 039.02
50.000
5,519.51
.045
248.38
TAXPAYER RESPONSE
NOTE: If tax pay.ents are made within three
(3) .onths of the decedent's date of death.
you .ay deduct a 5X discount of the tax due.
Any inheritance tax due will beco.e delinquent
nine (9) .onths after the date of death.
x
[CHECK ]
ONE
BLOCK
ONLY
A. c=J The above infor.ation and tax due is correct.
1. You.ay choose to re.it pay.ent to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest. or you .ay 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.
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. c=J The above infor.ation is incorrect and/or debts and deductions were paid by you.
You .ust co.plete PART ~ and/or PART ~ below.
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3 X
4
5
6
7 X
8
If you indicate a different tax rate, please state your
relati nship to decedent:
PART
~
TAX RETURN f COMPUTATION
LINE 1. Date E~tabl1sh.d
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 DEBTS AND DEDUCTIONS CLAIMED
~
DATE PAID
PAYEE
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
.
facts I have reported above are true, correct and
Under penalties of perjurY, I declare that the
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