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COMMONWEALTH OF PENMSYLVANIA
OEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
*'
INFORMATION NOTICE
AND
m~~~ESPONSE
p f"',
II < .-
FILE
ACN
DATE
NO. 21 OS- - Ol..olo.g
05500359
06-09-2005
IfEV-154,u AFP a-Do>
'I" ""''"
",l;;9~a qF HAROLD E FRANTZ
5.5. NO. 179-07-7888
(.~9.~ .T,iPF DEATH 03-12-2005
CQy~ CUMBERLAND
TYPE OF ACCOUNT
o SECURITY
[XJ SEC ACCT
o STOCK
o BONDS
JOANNE F HOLLAND
3 KIMBERLY CIRCLE
DRYDEN NY 13053
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
A G EDWARDS has providad tha Dapartmant with tha infor.ation listed balow which has baan usad in
celculating tha Potantial tax dUa. Thair racords indicata that at tha daath of tha above dacedent, YOU were a beneficiary of this asset.
If YOU feel this infor.ation is incorract, plaasa obtain written correction fro. tha transfer agant, attach a copy to this for. and
return it to tha abova address. This account is taxable in accordanca with the Inheritance Tax Laws of tha Com.onwaalth of PennsYlvania.
Questions may bB answBrgd by calling (717) 7~7-8~?7.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR
Account No. 684036238
FILING AND PAYMENT INSTRUCTIONS
DOD Valuation
Percent Taxable
Amount Subject to Tax
Tax Rate
Potantial Tax Due
x
130,796.59
50.000
65,398.30
.15
9,809.75
TAXPAYER RESPONSE
To insure proper crvdit to your account, two
(2) copies of this notice Must accompany your
pay.ent to the Register o~ Wills. Make check
payable to: ""Register of Wills" Agent".
x
NOTE: If tax paY_ants are made within three
(3J months of the decedent"s date of death,
you may deduct a 5% discount of the tax due.
Any inheritance tax due will beca.. delinquent
nine (9) _onths after the date of death.
PART
[!J
A. c=J The above information and tax due is correct.
1. You .ay choose to remit paY_snt to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Rsgister of
Wills and an official assessment will be issued by the PA Depart_ent of Revenue.
B. ~ The above asset has baen or will be reported and tax paid with tha Pennsylvania Inheritance Tax return
to be filed by the decedent"s representativs.
c. c=J The above infor.atian is incorrect and/or debts and deductions were paid by YOu.
You must complete PART ~ and/or PART ~ below.
[CHECK ]
ONE
BLOCK
ONLY
PART If you indicate a differant tax rate, pl.esa state your
@] relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON ABOVE ASSEHS)
LINE 1. DOD Valuation 1
2. Percent Taxable 2 X
3. Amount Subject to Tax 3
4. Debts and Deductions 4
S. Amount Taxable 5
6. Tax Rete 6 X
7. Tax Due 7
PART
f!1
DATE PAID
PAYEE
Under penalties of perjury, I declare that the facts I
complete to the best of my knowledge and beliaf.
.~~
I
TOTAL (Enter on Line 5 of Tax Computation)
DESCRIPTION
AMOUNT PAID
I
$
have reported above are true~ correct
HOME (~O 7-> '?'-i4 -40,3
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DATE