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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
'*
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21
ACN 06131006
DATE 06-30-2006
REV-1545 EX AFP (09-00)
EST. OF LOUISE COTTO
S.S. NO. 195-32-2293
DATE OF DEATH 04-15-2006
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
[XJ CERTIF.
RUTH A LONG
200 SULPHUR SPRING RD
CARLISLE PA 17013-8729
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
(~.~2
1_\ \~ ,,)
SOVEREIGN BANK has provided the Department with the information listed below which has ~ used(1D
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a ioirit::owner/beneficiary .of'
this account. If you feel this information is incorrect, please obtain written correction from the financial ins.titl.l!)on, atjlach a copy',::
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax U.WCs', of ttii:t:ommonwealth
of Pennsylvania. Questions may be answered by calling (717) 787-8327. ,~--' ,-;
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT IN$iRUCTI~S
. " l .)
Account No. 1695215119 Date 07- 08 -19 91 To insure proper credi ~ to your acco'ul?t, two
Established (2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
x
10,017.18
50.000
5,008.59
.15
751. 29
TAXPAYER RESPONSE
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.
Account Balance
Percent Taxable
Anount Subject to
Tax Rate
Potential Tax Due
x
Tax
PART
[!]
A.
[ CHECK ]
ONE
BLOCK B.
ONLY
c.
[] 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 Dr avoid interest, Dr 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.
[] The above asset has been Dr will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
~The above information is incorrect and/or debts and deductions were paid by you.
~You must complete PART ~ and/or PART ~ below.
x
ON JOI.~ Tf/ RUST
7/ f? _fl
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t)D
500 51 . 3-1
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,,'t) 0 g, s-9
,~
.:2;)'s' 3 9
DEBTS AND DEDUCTIONS CLAIMED
ACCOUNTS
If you indicate a different tax rate, p~e state your
relationship to decedent: ,Y111? e.....-
PART
[!J
TAX RETURN - COMPUTATION
LINE 1. Date Estabiishea
2. Account Balance
3. Percent Taxable
4. Anount Subject to Tax
5. Debts and Deductions
6. Anount Taxable
7. Tax Rate
8. Tax Due
TAX
OF
1
2
3
4
5
6
7
8
x
PART
@J
DATE PAID
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Conputationl
Under penalties of perjury, I declare that the facts I
conplete to the best of ny knowledge and belief.
J~~.()_ ~~
TAXPAYER SIGNATURE ~
I
$
have reported above
HOME (71 7 )
WORK ( )
TELEPHONE NUMBER
are true, correct and
:2-1' 3 -c:'?"2 7
lo/"u It) ~
DATEI