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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG. PA 1712B-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO.21 07-0548
07134268
08-10-2007
REV~lSli3 EX AFP C09-00>
TYPE OF ACCOUNT
EST. OF GLADYS B SMEAL 0 SAVINGS
S.S. NO. 160-16-9264 0 CHECKING
DATE OF DEATH 05-20-2007 0 TRUST
COUNTY CUMBERLAND r>-~~ Ii] CERTIF.
REMIT ~~T AND~RMS TO.:
REGISTER OF:)6LLS :::>ace
CUMBERLAND 'eiP.,.'.' .GQUR?OUS.E
CARLISLE, P~-::;:il:1'OI~"'" .
'>g ~
.7': I '-wJ ::-:-.j ;--)
;;3 c;:; :;?-
,
....0 r"
PSECU has p..ovided the Depa..tnnt with the info...ation listed below whic:1lJtl~ been usllll in
calculating the potential tax due. Thei.. ..eco..ds indicate that at the death of the above decedent. you we..~4i joint own~eneficiary of
this account. If you feel this info...ation is inco....ect. please obtain w..itten co....ection f..o. the financial institutio~ttach a coP~
to this fo... and ..etu..n it to the above add..ess. This account is taxable in acco..dance with the Inhe..itance Tax Laws of the Co..oowealth
of PennsYlvania. Questions .ay be answe..ed by calling (717) 7B7-B327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
PRISCILLA HETZEL
1110 HETRICK AVE
PALMYRA PA 17078
Account NO. 0160169264-54
Date
Established
07-17-2006
To insu..e p..ope.. c..edit to you.. account. two
(2) copies of this notice .ust acco.pany you..
pay.ent to the Registe.. of Wills. Make check
payable to. "Registe.. of Wills. Agent".
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
PART
[!]
x
10,104.45
50.000
5,052.23
.045
227.35
TAXPAYER RESPONSE
NOTE. If tax pay.ents a..e .ade within th..ee
(3) .onths of the decedent's date of d.ath.
YOU .ay deduct a 5X discount of the tax due.
Any inhe..itance tax due will beco.. delinquent
nine (9) .onths afte.. the date of death.
x
A. c:J The above info...ation and tax due is co.....ct.
1. You.ay choose to ..e.it pay.ent to the Registe.. of Wills with two copies of this notice to obtain
a discount 0" avoid inte..est. 0.. you .ay check box "A" and ..etu..n this notice to the Registe.. of
Wills and an official assess.ent will be issued by the PA Depa..t.ent of R.venue.
B. ~ The above asset has been 0" will be ..epo..ted and tax paid with the Pennsylvania Inhe..itance Tax ..etu..n
~ to be filed by the decedent's ..ep..esentative.
C. c:J The above info...ation is inco....ect and/o.. debts and deductions we..e paid by you.
You .ust co.plete PART ~ and/o.. PART ~ below.
If you indicate a different tax rate, please state your
relationship to decedent:
RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
I
2
3 X
4
5
6
7 X
8
[CHECK ]
ONE
BLOCK
ONLY
PART
[!]
TAX
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 knowledge and belief.
have reported above are true, correct and
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