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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
....~.... .>.
'IIaI'.
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 05-0818
ACN 05152270
DATE 11-25-2005
REV-15fiS EX AFP (09-00>
.v
EST. OF KAY F HOOVER
S.S. NO. 195-32-1773
DATE OF DEATH 08-12-2005
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
[XJ CHECKING
D TRUST
D CERTIF .
~ ., r . ~ ....
WILLIAM P IRVIN
512 ELDORADO DR
RED LION PA 17356
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE~ PA 17013
CITIZENS BANK OF PA has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a ioint owner/beneficiary of
this account. If you feel this 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 Pennsylvania. Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 6100791823 Date 09-06-1988
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
1,992.68
50.000
996.34
.15
149.45
TAXPAYER RESPONSE
:';jjCilllV'
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
x
NOTE: If tax payments are made within three
(3) months of the decedent"s date of death,
you may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
Tax
PART
[!J
[CHECK ]
ONE
BLOCK
ONLY
A. D The above information and tax due is correct.
1. You may choose to remit payment 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 Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
B. D The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent"s representative.
C. I\i(The above information is incorrect and/or debts and deductions were paid by you.
~You must complete PART ~ and/or PART ~ below.
PART
[!]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
If you indicate a different ~r~, ~e, ~~ease state your
relationship to decedent: L ''\ \\ -., e-y'
PART
~
TAX RETURN - COMPUTATION OF TAX,ON/~O~~T:TRUST ACCOUNTS
LINE 1. Date Established 1 ~- b J 1 ~ ~
2. Account Balance 2 t Iq<t ~ J 1~
3. Percent Taxable 3 X :2:" ~~~
4. Allount Subject to Tax 4 4J cj q b, 3 L)
5. Debts and Deductions 5 ,..Jt::.
6. Allount Taxable 6 ~ 1~ 3J
7. Tax Rate 7~ ~.S. v
8. Tax Due 8---lt 4~\g1./
PAYEE
DESCRIPTION
AMOUNT PAID
I
$
TOTAL (Enter on Line 5 of Tax Computation)
Under penalties of perjury~ I declare that the facts I
complete t~.,~e bes rf~ kn~Wl~dge and belief.
I!v-/ iA-- .-/ ~
TAXPAYER SIGNATU E
correct and
d. r~~-d
DATE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
IRVIN WILLIAM PAUL
51 2 EL DORADO DRIVE
RED LION, PA 17356
-------- fold
ESTATE INFORMATION: SSN: 195-32-1773
FILE NUMBER: 2105-0818
DECEDENT NAME: HOOVER KAY F
DATE OF PAYMENT: 03/03/2006
POSTMARK DATE: 03/03/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 08/12/2005
NO. CD 006395
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $44.84
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$44.84
REMARKS:
CHECK# 3771
SEAL
INITIALS: MG
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS