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COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG, PA 1712B-0601
'*
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO.21 07-0712
07141082
10-10-2007
REV-1543 EX AFP C09-00)
TYPE OF
ACCOUNT
D SAVINGS
[i] CHECKING
D TRUST
D CERTIF.
EST. OF RUSSELL L POTTEIGER
5.5. NO. 206-10-8173
DATE OF DEATH 07-15-2007
COUNTY CUMBERLAND
ROBERT L POTTEIGER
339 N LOCUST PINT RD
MECHANICSBURG PA 17050
REMIT PAYMENT AND FDRMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
FULTON BANK has provided the Departllent 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 information is incorrect, please obtain written correction froll 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 answarcd by calling (717) 787-8327.
COMPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 3219-05438
Date 08-28-1992
Established
To insure proper credit to your account, two
(2) copies of this not!fe lIust acco~ny your
paYllent to the Regist~~f Wills. Make check
payable to: "Register of. ~ls, Agent".
:.~~~) C'__.)
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
8,391.73
X 50.000
4,195.87
X .15
629.38
,,-..
NOTE. If tax payments a~~.~~ wit6i4 three
(3) 1I0nths of the decedent.;~ ,dflte oF-,jeath,
you may deduct a 5% discou;..tof the. t"" due.
Any inheritance tax duewn::ri:iecolle 'irelinquent
nine (9) months after the"dat~ of d~h.
. ~ -- --J
PART
[!]
[CHECK ]
ONE
BLOCK
ONLY
A. [] The above inforllation 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 assessllent 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. [] The above information is incorrect and/or debts and deductions were paid by you.
You must cOIIPlete PART ~ and/or PART ~ below.
PART
[!J
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
LINE 1. 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
DEBTS AND DEDUCTIONS CLAIMED
DESCR I PTI ON
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
.
declare that the facts
and belief.
have reported above are true, correct and
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