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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG, PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 07 -0511
07132248
07-26-2007
REV.1S43 EX AFP (09.00)
JUNE KOONS
10 GLENDALE DR
MECHANICSBURG
TYPE OF ACCOUNT
PA 17055
EST. OF FREDERICK R LEONARD
S.S. NO. 320-30-4824
DATE OF DEATH 03-11-~lJb
COUNTY CUMBERLAND:-':':;:)
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REHIT PAYHEtii~~D
REGISTER OF wti~
CUMBERLAND CO LOOORT
CARLISLE, PA(.1j1JtlI3
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PNC BANK has provided the Depart.ent with the infor.ation listed below which has been 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 infor.ation is incorrect, please obtain written correction fro. the financial institution, attach a copy
to this for. 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 may be answered by ~alling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 5140037609
Date
Established
01-01-1978
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 Ta~ Due
PART
[!]
x
8,969.47
16.667
1,494.94
.045
67.27
TAXPAYER RESPONSE
NOTE: If tax pay.ents are .ade within three
(3) .onths of the decedent's date of death,
you may 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
A. r=J The above infor.ation 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 Depart.ent of Revenue.
[CHECK ]
ONE
BLOCK
ONLY
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. r=J The above infor.ation is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
PART
~
TAX
If you indicate a different tax rate, please state your
relationship to decedent:
RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3 X
4
5
6
7 X
8
LlN€ 1- Date Estab.l.1shed
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)
.
have reported above are true, correct and
perjury, I declare that the facts
my knowledge and belief.
f ib~')
DATE
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