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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
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REV~1545' ~x AF~ 1'9~DDI
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INFORMATION NOTICE
r,r- AND
~AXPAYER RESPONSE
FILE NO. 21 06-0370
ACN 06122109
DATE 05-18-2006
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TYPE OF ACCOUNT
PH \2: 10 EST. OF MARY J HAWCO D SAVINGS
S.S. NO. 100-20-7545 D CHECKING
DATE OF DEATH 01-30-2006 D TRUST
COUNTY CUMBERLAND IX] CERTIF.
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CATHERINE M HAWCO
81 LEE ANN CT
ENOLA PA 17025
MEMBERS 1ST FCU has p..ovided the Depa..t.ent with the info.....tion listed below which has been used in
calculating the potential tax due. Thei.. ..eco..ds indicate that at the death of the above decedent, you we..e a joint owne../beneficia..y of
this account. If you fe.l this info...ation is inco....ect, please obtain w..itten co.....ction f..o. the financial institution, attach a copy
to this fo... and ..etu..n it to the above add..ess. This account is taxable in acco..dance with the Inhe..itance Tax L..ws of the Co..onwealth
of P.nnsylvani... Questions .ay bg answp..ed by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 156471-42 Date 02-01-1996
Established
x
5,105.39
50.000
2,552.70
.12
306.32
TAXPAYER RESPONSE
To insu..e p..ope.. c..edit to you.. account, two
[Z) copies of this notice .ust accoap..ny you..
payaent to the Registe.. of Wills. Meke check
payable to: "Registe.. of Wills, Ag.nt".
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
NOTE: If tax payaents a..e aade within th..ee
[3) .onths of the decedent.s date of d.ath,
you aay deduct a 5X discount of the tax du..
Any inhe..itance tax due will becoa. d.linqu.nt
nine [9) aonths afte.. the date of daath.
Tax
PART
ill
The above info..aation and tax due is co....ect.
1. You aay choose to ..eait payaent to the Registe.. of Wills with two copies of this notice to obtain
a discount 0.. avoid inte..est, 0" you .ay check box "A" and ..etu..n this notice to the Registe.. of
Wills and an official assess.ent will be issued by the PA Depa..t.ent of Revenue.
[CHECK ]
ONE
BLOCK
ONLY
B. r=J The above asset has been 0.. will be ..epo..ted and tax paid with the PennsYlvania Inhe..itance Tax ..etu..n
to be filed by the decedent's ..ep..esentative.
C. r=J The above info..mation is inco....ect and/o.. debts and deductions we..e paid by you.
You .ust coaplete PART ~ and/o.. PART ~ below.
If you indicate a different tax rate, please state your
relationship to decedent:
PART
[!]
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established 1
2. Account Balance 2
3. Percent Taxable 3 X
4. Amount Subject to Tax 4
S. Debts and Deductions 5
6. Amount Taxable 6
7. Tax Rate 7 X
8. Tax Due 8
PART
~
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Computation)
I
$
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best of my knowledge and belief.
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