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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
07142780
11- 02-2007
*
REV-15ti3 EX AFP (09-00)
*
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....)L
EST. OF LYDIA V FOOSE
S.S. NO. 199-07-3289
DATE OF DEATH 08-07-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
[i] SAVINGS
D CHECKING
D TRUST
D CERTIF.
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 Departnnt with the inforllation 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 inforllation is incorrect, please obtain written correction froll the financial institution, attach a copy
to this forll and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the COllllonwealth
of Pennsylvania. Questions lIay be answAred by calling (717) 787-8327.
COMPLETE PART 1 BELOW * * . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 5000961939
Date 03-27-1997
Established
To insure proper credit to your account, two
(2) copies of this notice IIUSt accompany your
paYllent 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
9,694.13
X 50.000
4,847.07
X .045
218.12
TAXPAYER RESPONSE
NOTE. If tax paYllents are lIade within three
(3) 1I0nths of the decedent's date of death,
you lIay deduct a 5% discount of the tax due.
Any inheritance tax due will becolle delinquent
nine (9) 1I0nths after the date of death.
PART
ill
[CHECK ]
ONE
BLOCK
ONLY
A. [] The above inforllation and tax due is correct.
1. You may choose to remit paYllent to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you lIay check box "A" and return this notice to the Register of
Wills and an official asses silent will be issued by the PA Departllent of Revenue.
B. ~ The above asset has been Dr will be reported and tax paid with the Pennsylvania Inheritance Tax return
~to be filed by the decedent's representative.
C. [] The above inforllation is incorrect and/or debts and deductions were paid by you.
You IIUSt cOIIPlete PART ~ and/or PART ~ below.
UNE 1- Date Estaillished
2. Account Balance 2
3. Percent Taxable 3
4. Amount Subject to Tax 4
5. Debts and Deductions 5
6. Amount Taxable 6
7. Tax Rate 7
8. Tax Due 8
PART
~
DATE PAID PAYEE
X
PART
~
TAX RETURN - COMPUTATION
If you indicate a different tax rate, please state your
relationship to decedent:
OF TAX ON JOINT/TRUST ACCOUNTS
x
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
$
Under
complete
perjury, I declare that the facts
my knowledge and belief.
DATE
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