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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEKENT~ ALLONANCE OR DISALLONANCE
OF DEDUCTION~, AND ASSESS KENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REY-1548 EX AFP (12-00)
GARY A MICULITA
APT A
103 FORGE RD
BOILING SPRINGS PA 17007
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
09-03-2001
MICULITA
04-20-2000
21 01-0401
CUMBERLAND
207-07-6749
01111742
LUBI
D
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REfV:i5~8-E3f-Af:p--fi1f:oo)------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 09-03-2001
ESTATE OF MICULITA
LUBI
D DATE OF DEATH 04-20-2000
COUNTY
CUMBERLAND
FILE NO. 21 01-0401
TAX RETURN WAS:
S.S/D.C. NO. 207-07-6749
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
01111742
FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICE
ACCOUNT NO.
0060088338
TYPE OF ACCOUNT:
DATE ESTABLISHED
(~ SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE
04-28-1968
x
1,657.17
0.500
828.59
6,102.60
.00
.06
.00
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
x
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. *
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRl, YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. 1
~- cQ~~-- 7
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
F I L E NO. 21 ---0 I -' -r'.c' /
ACN 01111742
DATE 03-08-2001
REY-1543 EX AFP (09-00)
EST. OF LUBI D MICULITA
S.S. NO. 207-07-6749
DATE OF DEATH 04-20-2000
COUNTY CUMBERLAND
TYPE OF ACCOUNT
[X] SAVINGS
o CHECKING
D TRUST
o CERTIF.
GARY A MICULITA
APT A
103 FORGE RD
BOILING SPRINGS PA 17007
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
ALLFIRST FINANCIAL SERVICE has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Peron5ylvania. Questioro~ may be anSwered by calling (717) 737-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0060088338 Date 04-28-1968
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
1,657.17
50.000
828.59
.15
124.29
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".
x
NOTE: If tax payments are made within three
(3) months of the decedent's date of death,
you may deduct a 51. discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
Tax
~~ TAXPAYER RESPONSE
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[CHECK ]
ONE
BLOCK
ONLY
A. [] The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
C. ~ The above information is incorrect and/or debts and deductions were paid by you.
~ You must complete PART ~ and/or PART ~ below.
PART
@J
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 jO...I'T /TRUST
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ACCOUNTS
If you indicate a different tax rate, please state your
relationship to decedent:
OF
1
2
3
4
5
6
7
8
x
x
PART
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DATE PAID
01/1J'i/;.tJ(.>O
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
IT"';" E,/i.B1I ,If",-,- ;i;.tJ<#,J.L ~I
TOTAL (Enter on Line 5 of Tax Computation)
DESCRIPTION
rutVe/cLl ~e/l$e5
I
$
AMOUNT PAID
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perjury, I declare that the facts I
nowledge and belief. HOME
correct and
DATE