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'~ BUREAU OF INDIVIDUAL TAXES
PO 80X 288601
HARRISBURG PA 17128-0601
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
_- - AND
TAXPAYER RESPONSE
REV-1543 EX I1FP (OB-OB)
FILE N0. 21 y V/~
ACN 08163193~~
DATE 12-22-2008
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PATRICIA A YOUNG
811 W KELLER ST
MECHANICSBURG PA 17055-4028
EST. OF RUTH M SWARTZ
SSN 222-05-5506
DATE OF DEATH 11-30-2008
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
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 tali 1717) 787-532; will) questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 000005030007601 Date 02-02-2006 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance 12, 761.19 payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 6,380.60 months of the decedent's date of death,
TaX Rate X .045 deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax Due $ 287.13 nine months after the date of death.
PART TAXPAYER RESPONSE
AILtIRE TO SPOMD WILL R~SULT ~H A~ OFFICIAL TAX MENT
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
Wills and an official assessment will be issued by the PA Department of Revenue.
C ONE
BLOCK B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
ONLY to be filed by the~atete-represent$ki+ae. Joint Owner
C. ~ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART ~ below.
PART If indicating a different tax rate, please state (I lAL U DNS Y ~ AA E
relationship to decedent:
PA DEPARTMENT OF REVENUE
TAX RE TURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD
LINE i. Data Established 1 1
2. Account Balance 2 $ 2
3. Percent Taxable 3 X 3
4. Amount Subject to Tax 4 $ 4
5. Debts and Deductions 5 5
6. Amount Taxable 6 $ 6
7. Tax Rate 7 X 7
8. Tax Due 8 $ ~ a
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
comgX~£e to the best of my knowledge and belief. unMr x717 ~ 7hE,-1 ~h~
TOTAL CEnter on Line 5 of Tax Computation) 6