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PENNSYLVANIA INHERITANCE TAX
• INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21~-~ .~,~!d~'3
PD eax zao6ol - TAXPAYER RESPONSE ACN 08163191
HARRISBURG PA 17128-0601 ~ _ ,
DATE 12-22-2008
REV-1543 E% AFP (08-0®)
TYPE OF ACCOUNT
"~~ v3 Ft~a ~;~ ~~~ ~. ~~ EST. OF RUTH M SWARTZ ^ SAVIN
SSN 222-05-5506 ^ CHECK
~, ~~-;~. ;-.r DATE OF DEATH 11-30-2008 ^ TRUST
COUNTY CUMBERLAND ~ CERTI
O~~H~ ~ ..,,~ 1l~z
C,` - `, ~~ ~ ~ REMIT PAYMENT AND FORMS T0:
PATRICIA YOUNG ~'~~ REGISTER OF WILLS
812 W KELLER ST CUMBERLAND CO COURT HOUSE
MECHANICSBURG PA 17055-4028 CARLISLE, PA 17013
PNC BANK NA provided the Department with the information below, which has been used in calculating the
potential tax due. Records indicate that at the death of the above-named decedent, you were a point owner/beneficiary of this account.
If you feel the 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. Please call C717) 78~-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
GS
ING
F.
Account No. 000031900238813 Date 02-14-2004 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance 22, 708.94 payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 50.000
11 , 354.47 NOTE: If tax payments are made within three
Amount Subject to Tax $ months of the decedent's date of death,
Tax Rate X .045 deduct a 5 percent discount on the tax due.
5 1 0 .9 5 Any Inheritance Tax due will become delinquent
Potential Tax Due $ nine months after the date of death.
P~T TAXPAYER RESPONSE
1
- URE TO R POND WILL RESULT I~I AN OFFICIAL ~I'AJC ASSESSMENT
A. ^ The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
CHECK a discount or avoid interest, or check box "A" and return this notice to the Register of
0 N E Wills and an official assessment will be issued by the PA Department of Revenue.
B L 0 C K ~ B. ® The above asset has been ar will be reported and tax paid with the Pennsylvania Inheritance Tax return
ONLY to be filed by the as#ata~+epr+esentatiw. Joint Owner
C. ^ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART 3^ below.
PART If indicating a different tax rate, please state
relationship to decedent:
TAX RETURN - COMPUTATION
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
OF TAX ON JDINT/TRUST ACCOUNTS
2
3 X
4
5
6
7 X
8
OFFICIAL USE ONLY ^ RAF
PA DEPARTMENT OF REVENUE
PAD
3
4 ,
5
6
7
8
PART DEBTS AND DEDUCTIONS CLAIMED
0
IUTAL ctnier on Line 5 of Tax Computation) $
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
com etc to the best o my knowledge and belief . HOME ( ) 766-1363
WORK W 1 ~ ) ~ ~f
TAXPAYER SIGNATURE TELEPHONE NUMBER DA
DATE PAID PAYEE DESCRIPTION AMOUNT PAID