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Home My WebLink About10-07-08 (2)COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REYENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 INFORMATION NOTICE AND ,~;-!,.;'~ TAXPAYER RESPONSE FILE N0. 21 O$ - ~(~ ~ ACN 08115005 DATE 04-10-2008 2~0~ OCT -7 A~ 8~ 58 CLEF4r~ fu `~ OrRPN~f~'S ~ ~~;)RT CUP,"" (" Ir~, ~~~ PAUL DLUGOLECKI 303 MONROE ST MECHANICSBURG PA 17055 TYPE OF ACCOUNT EST. OF PAUL S DLUGOLECKI ^ SAVINGS S.$. N0. ^ CHECKING DATE OF DEATH 01-06-2008 ^ TRUST COUNTY CUMBERLAND ® CERTIF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has provided the Department with the information listed below which has bean 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 Pennsylvania. Cuestions may be answered by calling C717) 787-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 7502-45 Date 09-01-1964 To insure proper credit to your account, two Established C2) copies of this notice must accompany your Account Balance 6,567.86 payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". Percent Taxable X 5.000 NOTE: If tax payments era ^ade within three Amount Subject t0 TeX 328.39 (3) months of the decedent's date of death, Tax Rate X . 045 you way deduct a 5X discount of the tax due. Anv inheritance tax due will become delinquent Potential Tax Due 14 • 78 nine C9) months after the date of death. PART TAXPAYER RESPONSE :a4:#Ekizs€WaiBi~e;~.r"'~'`s'`e~i~~:iYi~rl~~aiiiii:u;: .a;,a~::~:iie<+'e~i~8,7e::~::i?ad:::,::m3i`i:~?:~#~hE+~r:~ 1.:~s~:'rhFE:i:~:fid:):k<8x~rae .. ,, h,,. -~::.:: : ,y~i. . :_._.. _ _ .,:~?s.,[~~:isB•3ei~:isWi:iu,.:sa~ef~5}f€€i;:,.:.:.,,, ~i,,... 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 CHECK 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. C 0 N E ~ BLOCK B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y 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 2^ and/or PART ^ below. PART If you indicate a different tax rate, please state your ~~"~ti •'~~~'• ~;`` ~' ~'' "`" ~ "'~"'''' •. R ~~' ~ ~ ~ ~ ^ 2 relationship to decedent: ~ , ~~~ ``,~`:=~~ ~p.N .:; ,, 'f ' ~' TAX RETURN - COMPUTATION LINE 1. Dat® 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 OF TAX ON JOINT/TRUST ACCOUNTS 1. 2 3 X 4 5 - 6 7 X 8 PART DEBTS AND DEDUCTIONS CLAIMED a DATE PAID PAYEE DESCRIPTION AMOUNT PATn Under penalties of perjury, I declare that the facts I have reported above re true corDre and ~e plate the bespt~ o~~jmy knowledge and belief. HOME C ) ~ ~~ ~~ 7 " ~Q.~~~ ~-1-"v'~ ` WORK C'~l7 ) 7 ' L /~s~7/e TOTAL CEnter on Line 5 of Tax Computation) # COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-961 NO. CD 010368 DLUGOLECKI PAUL 303 MONROE ST MECHANICSBURG, PA 17055 fold ESTATE INFORMATION: FILE NUMBER: 2108-0496 DECEDENT NAME: DLUGOLECKI PAUL S DATE OF PAYMENT: 10/07/2008 POSTMARK DATE: 10/07/2008 COUNTY: CUMBERLAND DATE OF DEATH: 01 /06/2008 REMARKS: SEAL CHECK# 2727 ACN ASSESSMENT CONTROL NUMBER AMOUNT 08115005 ~ 514.78 TOTAL AMOUNT PAID: 514.78 INITIALS: JN RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS