REV-346 EX (8-92)
FOR REGISTER'S OFFICE USE ONLY
PA DEPARTMENT OF REVENUE
ESTATE INFORMATION SHEET
County Code Year File Number
DECEDENT INFORMATION: Enter data as it will appear on all documents submitted to the department.
Name (Last) (First) (Middle)
Decedent's Social Security Number Date of Death Date of Birth
TYPE FILING: Enter check (T) mark to indicate the nature of the return to be filed with the department.
Probate Return Joint Assets Only Estate Tax Only Litigation Purposes (No Other Assets)
LETTERS GRANTED: Enter check (T) mark to indicate the nature of the proceedings at the Register of Wills Office.
(Attach additional sheets if explanation is necessary.)
Testamentary Administration No Letters Other (Please Explain)
ATTORNEY/CORRESPONDENT: Enter all data concerning the attorney or other individual to receive all tax information and
correspondence.
Name (Last) (First) (Middle) Supreme Court I.D. No.
Street Address
City State Zip Code Telephone Number
PERSONAL REPRESENTATIVE Enter all data concerning the personal representative(s) of the estate authorized by the
INFORMATION: Register of Wills
Executor/Administrator
Name (Last) (First) (Middle) Social Security Number
Street Address
City State Zip Code Telephone Number
Co-Executor/Administrator
Name (Last) (First) (Middle) Social Security Number
Street Address
City State Zip Code Telephone Number
Co-Executor/Administrator
Name (Last) (First) (Middle) Social Security Number
Street Address
City State Zip Code Telephone Number
Prepared By
Date
rev. 10.13.06
