HomeMy WebLinkAbout10-07-08 (5)COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, Pa nlza-osol
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REY-1543 OI 11FP Cb9r~03)I
INFORMATION NOTICE
AND
. ~.,:T~X~p1i4YER RESPONSE
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FILE
ACN
DATE
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08115019
04-10-2008
TYPE OF ACCOUNT
~~~~ OCT '"~ AP'~ r4~'ieJ~F PAUL S DLUGOLECKI ^ SAVINGS
$.$. N0. ® CHECKING
11 e^i-~/ ^~ DATE OF DEATH 01-06-2008
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Ji ^ TRUST
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~~Nt!ra;,`'y ~'yv~~~~~UNTY CUMBERLAND ^ CERTIF.
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REMIT PAYMEN
T 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 point 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. Questions may be answered by calling C717) 7B7-8327.
COMPLETE PART 1 BELOW * ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 7502-11 Date 08-09-1984
To insure proper credit to your account, two
Established C2) copies of this notice must accompany your
Account Balance 5, 300
31 payment to the Register of Wills. Make check
. payable to, "Register of Wills, Agent°.
Percent Taxable X 5.000
Amount Subject to Tax 2 6 5
0 2 NOTE: If tax payments are wade within three
. (3) months of the decedent's date of death,
Tax Rate X .045 you may deduct a 5Y. discount of the tax due.
Potential Tax Due 1 1
9 3 Any inheritance tax due will become delinquent
. nine (9) aonths 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 check bo x "A" and return this notice to the Register of
0 N E Wills and an official assessment will ba issued by the PA Department of Revenue.
[ B L ~ 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 2^ and/or PART ^ below.
PART If You indicate a different tax rate, please state your ^~°~'i!''~ '~' '~~ '''~'~"• '~'~°'r'
2 relationship to decedent: i::,:!a?!,!:~~::-!=~_~.._-~;';~~:::~~ :.,..:.. ,:a.: w~_____________ _!
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
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3 x
4
5
6
7 X
8
--
PART DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID n PAYEE _ DESCRIPTION AMOUNT PAID
TOTAL CEnter on Line 5 of Tax Computation) ~
Under penalties of perjury, I declare that the facts I have reported above are true, cor ect and
omp to to he best of my knowledge and belief. HOME C~l? ) ~,^ R~s
WORK C'7/'1 ) ~14~').. ~S'LsjL_ / ~s~ ~'b
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
REV-1162 EX(11-96)
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 010370
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# 2730
AMOUNT
ACN
ASSESSMENT
CONTROL
NUMBER
081 15019 ~ 51 1.95
TOTAL AMOUNT PAID:
511.95
INITIALS: JN
RECEIVED BY: GLENDA EARNER STRA~RnI Ir,N
REGISTER OF WILLS
REGISTER OF WILLS