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BUREAU oF INDIVIDUAL 7AXES Pennsylvania lnheritance Tax DEPARTMENT OF REVENUE
PD B�X Z8�6�1 Information Notice . RE�-,54,EX DocEXEC (OB-12)
HARRISBURG PA 17128-0601
And Taxpayer Response FILE NO.2114-0610
RE�'0 ��n 4FF��'� �F ACN 14146054
DATE 08-18-2014
2D14 RUG 28 P�1 3 09 Type of Account
Estate of VASILIKE CHIANOS Savings
�L�i`;it �� SSN 001-22-8728 X Checking
Trust
QRPHANS' GflU�� CountyCUMBERLAND14 Certificate
FRANK W CHIANOS �'�M�����l.�� �{�.� �fa
1705 LAUREL RD
HARRISBURG PA 17112-9660
PNC BANK NA provided the department with the information below indicating that at the death of the
above-named decedent you were a joint owner or beneficiary of the account identified.
Remit Payment and Forms to:
Account No.5140247294 REGISTER OF WILLS
Date Established 01-12-2009 1 COURTHOUSE SGIUARE
Account Balance $46,621.69 CARLISLE PA 17013
Percent Taxable X 50
Amount Subject to Tax $23,310.85
Tax Rate X 0.045 NOTE�: If tax payments are made within three months of the
Potential Tax Due $1,048.99 decedenYs date of death,deduct a 5 percent discount on the tax
With 5%Discount(Tax x 0.95) $(see NOTE�) due. Any inheritance tax due will become delinquent nine months
after the date of death.
PART Step 1 : Please check the appropriate boxes below.
1
A �No tax is due. I am the spouse of the deceased or I am the parent of a decedent who was
21 years old or younger at date of death.
Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount
shown above as Potentia/Tax Due.
g �The information is The above information is correct, no deductions are being taken,and payment will be sent
correct. with my response.
Proceed to Step 2 on reverse. Do not check any other boxes.
C �The tax rate is incorrect. � 4.5% I am a lineal beneficiary (parent,child,grandchild, etc.) of the deceased.
(Select correct tax rate at
right, and complete Part � 12% I am a sibling of the deceased. .
3 on reverse.)
� 15% All other relationships (including none).
p �Changes or deductions The inf Complete Part 2 and part 3 as appropr ate o n the back of th s forl m.
listed.
Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax
E �inheritance tax form Return filed by the estate representative.
REV-1500. Proceed to Step 2 on reverse. Do not check any other boxes. ,
Please sign and date the back of the form when finished.