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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
REVISED NOTICE * * *
FILE
ACN
DATE
NO.21 07-0778
07142779
11-02-2007
*
REV-1Sli3 EX ~p (09-00)
*
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,-'
TYPE OF
ACCOUNT
D SAVINGS
D CHECKING
D TRUST
iii CERTIF.
1 ')..
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EST. OF LYDIA V FOOSE
S.S. NO. 199-07-3289
DATE OF DEATH 08-07-2007
COUNTY CUMBERLAND
....",. ,
HOWARD L FOOSE
403 BRIAN CT
MECHANICSBURG PA 17050
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PNC BANK has provided the Deparbent with the information 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 form 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. 31800234432 Date 05-14-2003
Established
Account Balance 24,747.42
Percent Taxable X 50.000
Amount Subject to Tax 12,373.71
Tax Rate X .045
Potential Tax Due 556.82
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".
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.
PART
[!]
TAXPAYER RESPONSE
[CHECK ]
ONE
BLOCK
ONLY
A. [J The above information and tax due is correct.
1., You may choose to relli t 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.
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. [J The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
DEBTS AND DEDUCTIONS CLAIMED
PART
[!]
TAX RETURN - COMPUTATION
If YOU indicate a different tax rate, please state your
relationship to decedent:
LINE l. 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
OF TAX ON JOINT/TRUST ACCOUNTS
I
2
3 X
4
5
6
7 X
8
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
$
v
perjury, I declare that the facts
knOWledge and belief.
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