HomeMy WebLinkAbout10-07-08 (3)COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT REVENUE ~.W F QJjtM~AT I O N NOTICE F I L E No . 21 C7$ L} q(~
BUREAU INDIVIDUAL TAXES .- ,.'AND
DEPT. 2BB6o1 '- ~ `" ACN 08115013
WIRRISBURG, PA nlzs-oeol ! .~ TgXPA1fER RESPONSE
-~ DATE 04-10-2008
REV-1543 IX AiP C09-00)
~~~~ ~C~ _~ A~ g~ Q3 TYPE OF ACCOUNT
EST. OF PAUL S DLUGOLECKI ^ SAVINGS
(~ rGr t6±r:S. N0. ^ CHECKING
t"`~~`~~!'" OF DEATH 01-06-2008 ^ TRUST
CUMBERLAND ® CERTIF.
REMIT PAYMENT AND FORMS T0:
PAUL DLUGOLECKI REGISTER OF WILLS
303 MONROE ST CUMBERLAND CO COURT HOUSE
MECHANICSBURG PA 17055 CARLISLE, PA 17013
MEMBERS 1ST FCU has provided the Department with the information listed below which has been used in
calculating the Dotential tax due. Their records indicate that at the death of the above decadent, you were a ioint owner/beneficiary of
this account. If you foal this information is incorrect, please obtain written correction fros 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 Pannsylvanie. Questions may be answered by calling 0717) 787-8327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 7502-40 Date 11-08-2003 To insure prover credit to your account, two
Established C2) copies of this notice must accompargr your
Account BalBnee 20,400.59 Dayment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Percent Taxable X 5.000
NOTE: If tax payments are made within three
Amount Subject to Tax 1,020.03 C3) months of the decedent's data of death,
Tax Rate X . 045 you ^ay deduct a 5X discount of the tax duo.
Any inheritance tax due will become delinquent
Potential TaX Due 45.90 nine (9) months after the date of death.
PART TAXPAYER RESPONSE
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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 chock 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 ONE
B L 0 C K 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 ware paid by you.
You must complete PART ^ and/or PART ^ below.
PART If you indicate a different tax rate, please state your
Q relationship to decedent:
TAX RETURN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxably
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
^H
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL CEnter on Line 5 of Tax Computation) $
Under p alties of perjury, I declare that the facts I have reportedn above a e t ua,,t~orrjct and
co~m etn~ t bes o my knowledge and belief. HOME C?~ / ) ~ ~~ ~~ ( G 79
~1 Or Y ~ ~ WORK C ~ )
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 EXI11-961
NO. CD 010371
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:
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
08115013 ~ 545.90
TOTAL AMOUNT PAID:
545.90
CHECK# 2729
INITIALS: JN
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS