Form 3460009101 - Estate Information Sheet-Pennsylvania Department Of Revenue Page 2
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1
23460009201
REV-346 EX
)
(03-09
Decedent’s Social Security Number
Decedent’s Name:
Co-Executor/Administrator
Social Security Number
Telephone Number
Last Name
Suffix
First Name
MI
First Line of Address
Second Line of Address
ENTER ZIP + 4
City or Post Office
State
ZIP Code
Co-Executor/Administrator
Social Security Number
Telephone Number
First Name
Last Name
Suffix
MI
First Line of Address
Second Line of Address
ENTER ZIP + 4
City or Post Office
State
ZIP Code
General Instructions:
This form should be filed with the Register of Wills of the county of which the decedent was a resident at death.
Please be aware the correspondent identified will receive all correspondence from the department. It is the responsibility of the
personal representative to notify the department if the correspondent contact information changes.
The department is authorized by law, 42 U.S.C. §405 (c)(2)(C)(i), to require disclosure of Social Security numbers in connection
with administering state tax laws. The department uses the Social Security number to identify the decedent and personal repre-
sentatives of the estate. The commonwealth may also use the information in exchange-of-tax-information agreements with fed-
eral and local taxing authorities. State law prohibits commonwealth personnel from disclosing confidential tax information except
for official purposes.
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Parent category: Financial