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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
~ INFORMATION NOTICE
~"RgD~~,,:N~ES~ONSE
IEV-1S45 EX AFP i';V;.~ I tPi : ;- (.
e.,. ,
FILE
ACN
DATE
NO. 21 cJ.o q~
06154036
10-25-2006
.. CATHERI SHELLENBERGER
811 EAST ST
LEWISBERRV PA 17339
TVPE OF ACCOUNT
1D05 NaV -3 PM 1~S52 OF MER~E N BISH D SAVINGS
S . S . NO. 1190 - 2 0 - 37 0 7 D CHECKING
CLERK OF DATE OF DEAIpI 09-23-2006 D TRUST
cu~~WMggR~OUIITY CUMBR~~:~~YHENT AND FORMS TO~ CERTIF.
~' EGISTER OF WILLS
UMBER LAND CO COURT HOUSE
ARLISLE, fA 17013
"EHlERS 1ST FCU has provided the Deparblent with the info...ation listed below which has been used in
CIIlculatlng the potential tax due. Their records indicate that at the death of the above decedent. you were a joint owner/beneficiary of
this account. If you feel this infor..tion is incorrect. please obtain written correction fr~ the financial institution. attach 8 COpy
to this fol"ll and return it to the above IIddress. This account is taxable in accordance with the Inheritance Tax Laws of the Cossonwealth
of Pennsylvania. Questions..y be answered by calling (711) 187-8327. I
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING lAND PAYMENT INSTRUCTIONS
Account No. 273597-46 o.te 10-26-2005
Established
Account 88lence
Percent Taxable
Mount Subject to T.x
Tax R.te
Pot....ti.l Tax Due
x
.00
100.00
.00
.045
.00
TAXPAYER RESPONSE
TO~insure proper credit to your account. two
(2 copies of this notice .ust acc~pany your
pa .ent to the Register of Wills. Hake check
pa able to: "Register of Wills. Agent".
x
I
NOtE: If tax paysents are .ade within thr_
(3l eonths of the decedent"s date of death.
yolll ..y deduct a 5X discount of the tax due.
An* inheritance tlIx due wUl b.c~e delinquent
ni. (9) .onths after the date of death.
PART
[!J
ThlI above infor..Uon and tax due is correct.
I. You .ay choose to r..it pay..nt to the Register of WUlls with two copies of this notice to obtain
a discount or avoid interest. or you .ay check box "A" ~nd return this notiell to the Register of
Wills and an official asses.ent will be issued by the PA Deparblent of Revenue.
B. 0 The above asset has b_n or will be reported and tax paid ~ith the PeMsylvania Inheritance Tax return
to be filed by the decedent"s representative.
C. 0 The above inforsation is incorrect and/or debts and deductions were paid by you.
You BUst coeplete PART 0 and/or PART @] below.
[CHECK ]
ONE
BLOCK
ONLY
If you indic.te . different tax rat., ple.se state your
rel.tionship to decedent:
PART
~
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. o.te Established 1
2. Account BalMce 2
3. Percent Taxable 3 X
4. '-aunt Subject to T.x 4
s. Debts Md Deductions 5-
6. Mount Taxable 6
7. T.x R.te 7 X
8. T.x Due 8
PART
[!J
DATE PAID
PAVEE
DESCRIPTION
"AMOUNT PAID
I
i
TOTAL (Enter on Line 5 of Tax tel IlPUt.tion) .
Under pen.lties of perjury~ I declare t~t the f.cts I h.ve r~rted 8bove .re true, correct and
v-
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