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COMMONWEALTH OF PENNSYLVANIA
DEP ARTM ENT OF REVENU E
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX{11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
TEWELL BRENDA C
326 CANDLELIGHT DRIVE
MECHANICSBURG, PA 17055
__u_u_ fold
ESTATE INFORMATION: SSN:
FILE NUMBER: 2108-0255
DECEDENT NAME: GAWRONSKI WINNONA WELS~
DATE OF PAYMENT: 05/19/2008
POSTMARK DATE: 05/17/2008
COUNTY: CUMBERLAND
DATE OF DEATH: 03/04/2008
NO. CD 009755
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
08120019 I $79.93
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$79.93
REMARKS:
CHECK# 2931
SEAL
INITIALS: CJ
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
~-
.~,~
n INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO.21 08-0255
08120019
05-12-2008
REV~lS43 EX AFP (09-00)
200BMAY 19 PH I: 34
CLER}< OF
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EST. OF WINNONA GAWRONSKI
S.S. NO.
DATE OF DEATH 03-04-2008
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
IX] CERTIF.
BRENDA C TEWELL
326 CANDLELIGHT DR
MECHANICSBURG PA 17055
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MEMBERS 1 ST FCU has p..ovided the Depa..tment with the info..mation 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..mation is inco....ect, please obtain w..itten co....ection f..om the financial institution, attach a cOpy
to this fo..m and ..etu..n it to the above add..ess. This account is taxable in acco..dance with the Inhe..itance Tax Laws of the Commonwealth
of P~nnsylvania. Quastions may be answe..ed by calling (717) 7~7-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 200142-41
Date 12-27-2000
Established
To insure proper credit to you~ account, two
(2) copies of this notice must accompany you..
payment to the Registe.. of Wills. Make check
payable to: "Registe.. of Wills, Agent".
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
11,218.25
X 16.667
1,869.75
X .045
84.14
TAXPAYER RESPONSE
NOTE: If tax payments a..e made within th..ee
(3) months of the decedent's date of death,
yoU may deduct a 5% discount of the tax due.
Any inhe..itance tax due will become delinquent
nine (9) months afte.. the date of death.
PART
[!]
The above info..mation and tax due is co....ect.
1. You may choose to ..emit payment to the Registe.. of Wills with two copies of this notice to obtain
a discount 0.. avoid inte..est, 0.. you may check box "A" and ..etu..n this notice to the Registe.. of
Wills and an official assessment will be issued bY the PA Depa..tment 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. c=J The above info..mation is inco....ect and/o.. debts and deductions we..e paid by you.
You must complete PART ~ and/o.. PART ~ below.
X
PART
[!l
TAX
If you indicate a different tax rate, please state your
relationship to decedent:
RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date E.stablished
2. Account Balance 2
3. Percent Taxable 3
4. Amount Subject to Tax 4
S. Debts and Deductions 5
6. Amount Taxable 6
7. Tax Rate 7
8. Tax Due 8
PART
[!j
DATE PAID PAYEE
x
DEBTS AND DEDUCTIONS CLAIMED
DESCR I PTI ON
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
$
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facts I have ..eported above are true.