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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 07-0449
07132240
07-26-2007
REY-1S43 EX AFP (09-00)
TYPE OF
ACCOUNT
Ii] SAVINGS
o CHECKING
O-TRUST
~O~RTIF .
EST. OF ANNA LEONARD
S.S. NO. 019-12-2361 ~
DATE OF DEATH 04-11-~07 ~
COUNTY CUMBERLA~~ ~
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REMIT PAYMEKT)AND ~RMS TO;
REGISTER of-'tlIbiLs N
CUMBERLANDCO~~UR~OUSer
CARLISLE, p~~=;B013-o -,
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** JUNE L KOONS
10 GLENDALE DR
MECHANICSBURG PA 17055
W
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PNC BANK has provided the Department with the infoNlation 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 information is incorrect. please obtain written correction from 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 Commonwealth
of Pennsylvania. Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 5004713721
Date 03-27-2007
Established
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
PART
[!]
8,383.52
X 100.00
8,383.52
X .045
377.26
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.
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
8. ~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 must complete PART ~ and/or 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:
L:;:liE 1. i:iate ~.:t"tablisheci
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
[!J
DATE PAID PAYEE
DEBTS AND DEDUCTIONS CLAIMED
DESCR I PTI ON
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
.
)
perjury, I declare that the facts I have reported above are true, correct and
my knowledge and belief.
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