HomeMy WebLinkAbout10-07-08 (4)COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
INFORMATION NOTICE
.- .~ n,{-r ~r '~. ~ ANA
- 7A~P~1fER RESPONSE
wev-1543 IX 11FF (09-OOj"
FILE N0. 21 ~~ ~~ "t ~
ACN 08115001
DATE 04-10-2008
~~~~ ~~T ..7 EST. OF PAUL S DLUGOLECKI
$.S. N0.
Q+ ~~ ~r~ ~
' ~ ~ OF DEATH 01-06-2008
Q~i~i`~r~`~ ~~ ~~~y CUMBERLAND
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
® CERTIF.
C~~',~, "- 4' 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 potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/baneficiarv of
this account. If you feel this information is incorrect, Dlease 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. Ouestians ^ay be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 7502-46 Date 11-15-2006 To insure proper credit to your account, two
' Established (2) copies of this notice roust accomparN your
paywent to the Register of Wills. Make check
Account Balance 50,552.11 payable to( "Register of wills, A6ent".
Percent Taxable X 5.000
NOTE: If tax payments are wade within three
Amount Subject t0 Tax 2, 527 • 61 (3) wonths of the decedent's date of death,
Tax Rata X .045 you way deduct a 5Y. discount of the tax due.
Any inheritance tax due will becowe delinquent
Potential Tax Due 113 • 74 nine C9) months after the date of death.
PART TAXPAYER RESPONSE
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A. ~ The above information and tax due is correct.
1. Yau may choose to rewit payment to the Register of Wills with two copies of this notice to obtain
CHECK a discount or avoid interact, or You way check box "A" and return this notice to the Register of
Wills and an official assesswent will be issued by the PA Department of Revenue.
C ONE
B L 0 C K B. ~ The above asset has bean or will be reported and tax paid with the Pennsylvania Inheritance Tax return
ONLY to be filed by the decedent's representative.
C. ~ The above information is incorrect and/or debts and deductions were paid by you.
You suet complete PART 2^ and/or PART 3^ below.
PART It You indicate a different tax rate, please state your r~;~+~r~;~i ~ '~' h, ~~ ;.' ' ':
Z relationship to decedent: ;:.,; •~ .• '' ,~'''~'~ ~~ Y~~=;'~' •'`~~
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS ~ ~~•~~°'''s'~~'~`""•' ~"'"~'•'''~'''~'~""''~'`' ''~''~" ~'1~~''~'''~~'.
4 ~,''~ "y'i:,' :i'.'`: if.:';' ~ , :4i S" ,'i44 d„ e~i;e' i; ti"ti
LINE 1 . Data Estab113hed 1 ~~w~. "~~'~,'"'~'~ "~ 'y" •~ '~ B~~S', v~ :' '~ ~
:s;~ ~~,''rt,3~'''~w`14~14~~:..a ~ d~:;,;r;~''~:~,!:a": :~~~~ b
2. Account Balance 2 ;E;:6°€ti;r, ~;ih~!~w~;'~•~'4',,,,i,,;,~, ,v., ,;;;,;,'
:;r.~:,~::v5;~~,,,p, ~;~~~~44~~~~;~;,: i;i~kkR;~;,~~'?ksc•~,,;,w; ;;k:'az~~;'i;~,~,
3. Percent Taxable 3 X ^'_~~~, "~ '•' .,~," ", ~~,,. ~, ~
:;~~?, ~ '. r~ y; t .`_,;~;;;~.l:::i:~:~i4~z ~^ '''"~'''~z~4E•'7: =s~~a,,,,,,',,~:
4. Amount Subject to Tax 4 '`'~Ri'~ ~~."''"'~ _ ~ ~ •~'
5. Debts and Deductions 5 - _
"':•_^.:G~, 3...i~~~ ~•iT•i5; ;!;Y;ie yi';'y'' i'~~,•• ;'~ i{;~ •4"4 r;=:~~,,v~,~;,~ ''''''x:~ 2;; 4,",';
6. Amount Taxable 6 ..., '~+, s ~,r,::,:,€=~s~i~.,, ,.::,::.,:,,'~'~~ ~..' ,,:,~,,
;i2;;i~;:yiy~v~ """u':,- ~^,si ~ ,y' , ' : , . 5i"ix}Y ,~ '~ ,':'e,.., .. re ,''
yifve; ~ , 4' ;;2i:. ;~.~;:, a ~'u':y:° ~';'~,'z; r~ fir: ,S;,g i 4~'.•.:~ ''~'Ye' ..- ,:~
7 . Tax Rate 'x,; : ~ :a rti i'€`s" ''a:~.:::::::::~ ,'.~•.ir.~': ,
,i .... ....:..:.::. x:
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PaRr DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL CEnter On L1ne 7 or iax wmpucacivn~ v
Under penalties of perjury, I declare that the facts I have reported above are t~rsue, correct and
~CBlplete to best of my knowledge and belief. HOME ( ) ~-`~ ~ r ~ 3
~fL ~ WORK C~! ~ ~ - SLL Z
TAXPAYER SIG A E TELEPHONE NUMBER D E
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
REV-1162 EX111-96)
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
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
NO. CD 010369
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
081 15001 ~ S 1 13.74
TOTAL AMOUNT PAID:
REMARKS:
S 1 13.74
CHECK# 2732
INITIALS: JN
sEaL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS