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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
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~~FORMATION NOTICE
,}- AND
~AXPAYER RESPONSE
FILE NO. 21 06-0370
ACN 06122108
DATE 05-18-2006
REY-1S45 Ex ,"" 109-DBl
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Pi; \2: 09
EST. OF MARY J HAWCO
5.5. NO. 100-20-7545
DATE OF DEATH 01-30-2006
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
D CHECKING
D TRUST
OCI CERTIF .
REHIT PAYHENT AND FORHS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CATHERINE M HAWCO
81 LEE ANN CT
ENOLA PA 17025
HEHBERS 1ST FCU has p..ovided the Depa..t.ent with the info...ation 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 feel this info...ation is inco....ect, please obtain w..itten co..rection 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 Laws of the C~~nwealth
of Pennsylvania. OUBstions.ay be answe..ed by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 156471-43 Date 02-16-2002
Established
x
5,509.38
50.000
2,754.69
.12
330.56
TAXPAYER RESPONSE
To insu..e p..ope.. c..edit to you.. account, two
(2) copies of this notice .ust acco.pany you..
pay.ent to the Registe.. of Wills. Make check
payable to: "Registe.. of Wills, Agent".
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
NOTE: If tax pay.ents a..e .ade within th..ee
(3) .onths of the decedent's date of death,
you .ay deduct a 5X discount of the tax due.
Any inhe..itance tax due will beco.e delinquent
nine [9) .onths afte.. the date of death.
Tax
PART
[!]
The above info...ation and tax due is co....ect.
1. You .ay choose to ..e.it pay.ent 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. [] 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. [] The above info...ation is inco....ect and/o.. debts and deductions we..e paid by you.
You .ust co~lete PART ~ and/o.. PART ~ below.
x
If you indicate a different tax rate, please state your
relationship to decedent:
PART
~
TAX RETURN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
TAX ON JOINT/TRUST ACCOUNTS
OF
1
2
3
4
5
6
7
8
x
PART
~
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
$
I
TOTAL (Enter on Line 5 of Tax Computation)
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. HOME ( )
WORK ( )
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