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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
'*
/ ~ -~-/q -/1
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO.
ACN
DATE
21 0/-3/7
01113815
03-14-2001
REV-1545 EX AFP <09-001
C2.-
EST. OF EDWIN L SARRETT
S.S. NO. 204-26-9699
DATE OF DEATH 07-01-2000
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
[i] CHECKING
o TRUST
o CERTlF.
AMELIA J SARRETT
4320 ALLEN RD
CAMP HILL PA 17011
REMIT PAYMENT AND FORMS TO:
RESISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
AllFIRST FINANCIAL SERVICES has provided the Departllent 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 inforaation is incorrect, please obtain written correction froa 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 Co..onwealth
nf Pennsylva~ia- ~J8~tions .ay be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0010262431 Date 0~-23-1992
Established
Account Balance
Percent Taxable
Allount Subject to
Tax Rate
Potential Tax Due
9,817.57
50.000
4,908.79
.15
736.32
TAXPAYER RESPONSE
x
Tax
x
PART
[!]
A.
[ CHECK ]
ONE
BLOCK B.
ONLY
c.
To insure proper credit to your account, two
(2) copies of this notice .ust accoapany your
pay.ent to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
NOTE: If tax pay.ents are aade within three
(3) .onths of the decedent's date of death,
you .ay deduct a 57. discount of the tax due.
Any inheritance tax due will beco.e delinquent
nine (9) .onths after the date of death.
o The above inforaation and tax due is correct.
1. You .ay choose to reeit 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 assessaent will be issued by the PA Depart.ent of Revenue.
[] 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.
~ The above inforaation is incorrect and/or debts and deductions were paid by you.
You .ust coeplete PART ~ and/or PART ~ below.
If you indicate a different ta~ate~ please state your
relationship to decedent: .s as
PART
~
TAX RETURN - COMPUTATION
lINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Allount Subject to Tax
S. Debts and Deductions
6. Allount Taxable
7. Tax Rate
8. Tax Due
OF
1
2
3
4
5
6
7
8
x
x
PART
[!]
DATE
PAYEE
DESCRIPTION
AMOUNT PAID
(Enter on line 5 of Tax COlIPutation)
PAID
Al/tJ
I
TOTAL
I
$
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
cOllplete to the best of IIY knowledge and belief.
~C}.~
TAXPAYER SISNAT~E
HOME (
f.b~ (1J7 ) 111./110
TELEPHONE NUMBER
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