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PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES _ .-, 1^" ;,~ AND
Po Box zao6ol `- _ '". "'~~~~ `'` TAXPAYER RESPONSE
HARRISBURG PE 17128-0601 ~ ~.,. ;-, -- s ~' ~~
REV~1$43`~X~~AFP t08-OB) ~
FILE N0. 21-- ~V-~~ ~~
ACN 09174576
DATE 11-27-2009
LORETTA JONES
APT 405
208 SENATE AVE
CAMP HILL PA 17011
EST. OF LOUIS E PARKTON
SSN 182-22-5242
DATE OF DEATH 07-21-2009
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
INTEGRIT Y BANK 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 joint 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
Penn~~lvania. Plesse call C717) 787x8327 witi~ queotu-a.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 206001889 Date 02-07-2007 To ensure proper credit to the account, two
Established copies of this notice must accompany
payment to the Register of Wills. Make check
Account Balance $ 1, 343.59 payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 671 • 80 months of the decedent's date of death,
Tex Rate X ~ 15 deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax Due $ 100.77 nine months after the date of death.
PART TAXPAYER RESPONSE
/ ! / ~uN :%
Under penalties of perjury, I declare that the facts I have reported above are trucCe, correct and
c plate to t best of my knowledge and belief . HOME C ~ 17 ) ~ ~ J'- ~~~
~6rZ L-~ r-e ~'P~ WORK C
YER I N E TELEPHONE NUMBER DATE
TOTAL CEnter on Line 5 of Tax Computation) S