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PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
6UREAU OF IND VIDUAL TAXES AND FILE N0. 2r-~~- QZ j)~
Po Box 2so6o1
FIARRISBURG PA • `~
17128-8601 ..,',Gi;` ~ ~.~~-n PON
1 `,;'~ ACN 10111560
( ,~ ~ ' , ~~i fit" REVISED NOTICE * * * DATE 03-15-2010
TYPE OF ACCOUN'
201Q AUG '~i PM IZ` ~~ EST. OF ROBERT D DUNKLEBER4ER ^ SAVIN
SSN 194-60-0911 ® CHECK
~~ (~ DATE.. OF DEATH 02-10-2010 ^ TRUST
~~'~ COUNTY CUMBERLAND ^ CERTI
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'YL/ t'~I'1 [~11 REMIT PAYMENT AND FORMS T0:
VllMC1G~f~
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ROBE ,
.
T D DUNKLEBERGER
REGISTER OF WILLS
151 HUGART RD 1 COURTHOUSE SQUARE
CARL ISLE PA~17013 CARLISLE PA 17013
FARMERS 8 ME CHANTS TRUST CO provided the Departaent with the inforaation below, which has boon used ini calculative the
potential tax d •. Records indicate that at the death of the above-naaed decedent, you wer• a ioint owner/banafici~ry of this account.
If you foal the inforaation is incorrect, please obtain written correction froa the financisl institution, attach al copy to this fora
and return it t the above address. This account is taxable in accordance with the Inheritaoc• Tax laws of the CoaMenMSalth of
Pennsylvania. lease call C717) 787-8327 with questions.
COMPLE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUC IONS
Account o. 33-08820 Data 09-27-1996 To ensure proper credit to the account, two
Established copies of this notice oust ~ccoaparry
Account 87 payaant to the Reeistar of Wilia. Make check
slants 10
043
,
.
vayable to "Register of Wilds, Agent°.
Percent axable X 50.000
Aaount S NOTE: If tax payaents era ado within throe
bjeet to Tax ~` 5
021
94
~
,
.
aonths of the decedent's da
e of death,
Tax Rata X .045 deduct a 5 Dercant discount on the toot duo.
Potentia 225.99 Any Inheritance Taos duo wil~ becoae dalingwnt
Tax Duo
nine aonths after the dsta f drsth.
P
T TAXPAYER RESPONSE
a
1
A. ~I Tha above inforaation and tax dw is cornet. ',
~QI Raait payaant to the Rapister of Wills with two copies of this notice to obtain
CHECK a discount or avoid interest, or chock box "A" and return this notice to the Register of
C ONE ~ Wills and an official assessaant will b• issued by the PA Departaent of Revenue.',
BLOCK B. ^ Tha above asset has boon or will be reported and tax paid with the Pennsylvania Inheritanu Tax return
ONLY to b• filed by the aststa representative.
C. ^ Tha above inforaa ion is incorrect and/or debts and deductions ware paid.
Coaplate PART 2~ and/or PART 3^ below.
PART If i dicatinp a different tax rata, please state
rela lonship to dacadant:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Data Established 1
2. Aeeo rat Balance 2 ~
3. Part rat Taxable 3 X
4. Aaou t Subject to Tax 4
5. Debt and Deductions 5 -
6. Aaou t Taxable 6 ~
7. Tax eta 7 X
8. Tax ue B ~
PART DEBTS AND DEDUCTIONS CLAIMED
a
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL CEnter on Lin• 5 of Tax Coaputation) t
Under pan lties of perjury, I declare that the facts I have reported above era true, eorre t and
coaplet• o the bast of my knowledge and belief. HOME t )
WORK C )
AXPAYER
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