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PENNSYLVANIA INHERITANCE TAX'
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES [ AND FILE NO, 21-~~'O!-3D
Po Box 28oso1 ,~f"?'{~j~j(p~pYER RESPONSE ACN 11103254
HARRISBURG PA 17128-0601
REY-1545 EX ~FP (t6-R 6) ~ ~ ~" '~~i~. ~. DATE 01 -18-2011
BRENDA G JONES
30 LAY RD
NEWVILLE
EST. OF PAUL L HOCKEN~ERRY
vtCRi{( OF 5SN 209-28-967
vt.C DATE OF DEATH 07-16-~OIO
rr +~ C/O/'~yyU~~Ri COUNTY CUMBERLAN
L~~ 4t1., ~; REMIT PAYMENT AND FORMS T0:
PA 17241-8624
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
PSECU provided the Departunt with the inforration below, which has bear
potential tax due. Records indicate that at the death of the above-need decedont, you were a joint owner/I
If you feel the inforration is incorrect, please obtain written correction fror the financial institution,
and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of
Pennrilvania. Please call C717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT TNs
account No. 0209289667-S4 Data 03-26-1986
Established
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
r /'1R 1
$ 1,493.81
X 16.667
$ 248.97
X .045
$ 11.20
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
I in calculating the
iciary of this account.
h a copy to this forr
Corronwealth of
CTIONS
To ensure proper cro it'to the account, two
copies of this notic rWSt aecorpal)y
payrent to the Regis •r'of Wills. Nske check
payable to "Register of Wills, Agent".
NOTE: If tax payren s are rade within three
ronths of the decade is date of death,
deduct a 5 percent d scaunt on the tax due.
Argr Inheritance Tax ue will become delinquent
nine ronths after th date of death.
A. ~ The above inforration and tax des fs correct.
Resit payrent to the Register of Wills with two copies of this notice to
CHECK a discount or avoid interest, or check box "A" and return this notice to
0 N E Wills and an official assessrent will be issued by the PA Departrent of I
BLOCK ~ B. ~ The above asset has Deen or will be reported and tax paid with the Pen
0 NL Y to be filed by the estate representative. nrilvai
C. ~ The above inforR~ation is incorre t 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 OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established -- }- ___
2. Account Balance 2 ~
3. Percent Taxable 3 X
4. Asount Subject to Tax 4 ~
5. Debts and Deductions 5
6. Amount Taxable 6
7. Tax Rate 7 X
8. Tax Due g $
PART DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE DESCRIPTION
TOTAL CEnter on Line 5 of Tax Ce.n((*.*i....t
Under penalties of perjury, I declare that the facts I have reported above are true, ~
complete to the best of my knowrledge and belief.
~ln~v, I ~ )1 WORK C ~ ~7 ~ S3D(y~'
~crnvr,r ~ ~ ra,er)~oE i. .,. ~.~ ~ .....~ ~ 7
!/ rr, r
r of
Inheritance Tax return
AMOUNT PAID
-_..,_
rrut and '
76D
DA'f E -