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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280liOl
HARRISBURG, PA 17128-0liOl
'*
FILE NO.
ACN
DATE
21- ol-C(35
07139999
10-09-2007
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
REV-151i5 EX AFP -C090"00>
2007 OCT 24 PH I: 42
TYPE OF ACCOUNT
[i] SAVINGS
o CHECKING
D TRUST
o CERTIF.
EST. OF GEORGE D GULDEN
S.S. NO. 174-20-0793
DATE OF DEATH 07-25-2007
COUNTY CUMBERLAND
CI,.ER~ OF
ORPHt,!'. (r'(j' lRT
CUf'-' . '~""' i I
f..'~:i~"
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
HELEN T GULDEN
1-6' W BYTb.ER ~T
~T 118LLY spr;;~ pA 17965"'(
/ ;f~rLJco-
~ Po 17o/~
PNC BANK has provided the Deparhent 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 fo,.. and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co..onwealth
of Per.r.~ylvcniG. Questions .ay be answerpd by calling C717) 787-!327.
Account No. 5130329966
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
PART
[!]
Date 12 - 0 1 - 1982
Established
To insure proper credit to your account, two
C2} copies of this notice .ust acco.pany your
pay.ent to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
19,552.89
X 16.667
3,258.88
X .00
.00
TAXPAYER RESPONSE
NOTE: If tax pay_ents are .ade 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.
A. Fi7I The above info,..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.
[CHECK ]
ONE
BLOCK
ONLY
B. r=J 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 .ust co.plete PART ~ and/or PART ~ below.
1
2
3 X
4
5
6
7 X
8
If you indicate a different tax rate, please state YOUr
relationship to decedent:
PART
~
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LIM~ 1- Date EstaD~1sn.a
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)
.
Under penalties of perjury, I declare that the facts
complete to the best of my knowledge and belief.
')~ c1 ~~
TAXPAYER SIGNATURE
have reported above are true, correct and
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