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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG, PA 17128-0601
INFORMATION NOTICE
r-,!"U:c AND
.0' h-tJLTAXPAYER RESPONSE
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REV.1S4[ ~!w~.a' ,. "j~'i:.. ,.\~
FILE
ACN
DATE
NO. 21 Cfl 05<1S-
07125510
06-08-2007
TYPE OF ACCOUNT
o SAVINGS
[i] CHECKING
o TRUST
o CERTIF.
PH I: I ~ST. OF DONALD L FITE
S.S. NO. 167-40-1756
DATE OF DEATH 04-28-2007
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
SANDRA K ROBERTS
203 POTATO RD
CARLISLE PA 17013
,
MEMBERS 1ST FCU has providedi the Deparbent with the infoNlation listed below which has been used in
calculating the potential tax due. Their records indifate that at the death of the above decedent, YOU were a joint owner/beneficiary of
this account. If you feel this inforMation is incorre~t, please obtain written correction frOM the financial institution, attach a copy
to this fONl and return it to the above address. Thi$ account is taxable in accordance with the Inheritance Tax Laws of the COMMonwealth
of Pennsylvania. Questions May be answered by ~dll~n (717) 787.8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 223010-11
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
PART
[!]
[CHECK ]
ONE
BLOCK
ONLY
Date 01-16-2004
Established
To insure proper credit to your account, two
(2) copies of this notice Must aCCOMPany your
paYMent to the Register of Wills. Make check
payable to. "Register of Wills, Agent".
1,069.55
X 50.000
534.78
X .15
80.22
NOTE. If tax paYMents are .ade within three
(3) Months of the decedent's date of death,
yoU May deduct a 5% discount of the tax due.
Any inheritance tax due will beCOMe delinquent
nine (9) Months after the date of death.
The above inforMation nd tax due is correct.
1. You May choose to eMit payMent to the Register of Wills with two copies of this notice to obtain
a discount or avoi interest, or you May check box "A" and return this notice to the Register of
Wills and an offic al asseSSMent will be issued by the PA DepartMent of Revenue.
B. [] The above asset has be n or will be reported and tax paid with the PennSYlvania Inheritance Tax return
to be filed by the dec dent's representative.
C. [] The above inforMation .s incorrect and/or debts and deductions were paid by you.
You Must COMPlete PART ,~and/or PART [!] below.
OF TAX ON
1
2
3
4
5
6
7
8
PART
[!]
TAX RETURN - COMPUTATION
If you indicate a different tax rat , please state your
relationship to decedent:
LINE l. 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
PART
[!J
DATE PAID PAYEE
x
JOINT/TRUST
I
I
ACCOUNTS
D ITS AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
TOT L (Enter on Line 5 of Tax Computation>
.
TAXPAYER
facts I
have reported above are trfe, c~rect and
HOME (111) 11'::f.- ~3lp
WORK () ~_Iq~
TELEPHONE NUMBER DATE
r
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1162 EX(11-96)
PENNSYLVANIA
INHlRITANCE AND ESTATE TAX
OFFICIAL RECEIPT
I
RECEIVED FROM:
ROBERTS SANDRA K
203 POT A TO RD
CARLISLE, PA 17015
__u__ fold ----------
ESTATE INFORMATION: SSN: 167-40-1756
FILE NUMBER: 2107-0595
DECEDENT NAME: FITE DONALD L
DATE OF PAYMENT: 06/20/2007
POSTMARK DATE: 06/20/2007
COUNTY: CUMBERLAND
DATE OF DEATH: 04/28/2007 I
I
NO. CD 008308
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
07125510 I $80.22
I
I
I
I
I
I
I
I
OTAL AMOUNT PAID:
REMARKS:
CHECK# 825
I ITIALS: JA
$80.22
SEAL GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
EGISTER OF WILLS