HomeMy WebLinkAbout10-07-08 (6)COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES FILE NO. 21 ~ ~ ~(~ (~
DEPT. 280601 ' ', T. AND ACN 08115023
HARRISBURG, PA laze-o6o1 _ TJ4XPAYER RESPONSE
+ ~ DATE 04-10-2008
~v-:sti,sku+e iaa~uo:` rj
,~j TYPE OF ACCOUNT
~~~~ ~~T -' ~~ 9' EST. OF PAUL S DLUGOLECKI ®savlNGs
S.S. N0. ~ CHECKING
VLF~"~~; ~~i DATE OF DEATH 01-06-2008 ~ TRUST
LR 5 COUNTY CUMBERLAND ~ CERTIF.
O~Pi=~~,i d ~ ~':t
' ~' . Pr+
Cl;i; ~ ' ~ 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 Departaent with the infonation 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/beneficiary of
this account. If you feel this infaraation is incorrect, please obtain written correction frog the financial institution, attach a copy
to this fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Coaaonwealth
of Pennsylvania. Questions ^ay be answered by calling C717) 787-8327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 7502-00 Date 09-01-1964 To insure proper credit to vaur account, two
Establl5hed C2) copies of this notice gust accoaparar your
74,677.58 payaent to the Register of Wills. Make chock
Account Balance payable to: "Register of Wills, Agent".
Percent Taxable X 5.000
3, 733.88 NOTE: If tax pavaents are Bade within three
Amount Subject to TBX C3) months of the decedent's date of death,
Tax Rate X , 04~j you may deduct a 5X discount of the tax due.
168.02 Any inheritance tax due will becoaa delinquent
Potential TaX Due nine (9) aonths after the date of death.
PART TAXPAYE R
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A. ~ The above inforaation and tax due is correct.
I. You may choose to resit payaent to the Register of Wills with two copies of this notice to obtain
CHECK a discount or avoid interest, or you aay check box "A" and return this notice to the Register of
ONE Wills and an official assessaent will be issued by the PA Departaent of Revenue.
BLOCK ~ B. ~ The above asset has been 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 inforaation is incorrect and/or debts and deductions were paid by you.
You gust coaplete PART ~ and/or PART 3^ below.
PART If you indicate a different tax rate your 'k~~'~+~~~o;~,;"''a,: °°'~rp s ~' •~•
PlaeSe state ;t;;p ,i"'':'.!: ya'~y5' ~~ ~` '~~ 'n :,~~,~~ :
relationshi to decedent: ,~??;~'': ~' ~~''i': !
air';;..: . ~4 '~a • ~,,;, ,'} ~~~y' ' ~~~+: ~:_:,~~,: ;`;~, : ~'`''~' ~ ,:':
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS ~~~s,=-3 ~ ~:'';?:p~;;;;•~~~ ~°•~~'~~~~'~~ '~'S
j~ $~.. ... :: :
''4'`_: yhy'fs.•i'rxE'''.`x+':'i5's:~;: ~r;:i;f4'+~ i~4SS.54 i'';~ 2:~;y~i~~eST`i`S'';.f' ,'';e ,': '~;'i~vl,~i44Y
LING 1 . Data Estabiishad 1 iy~~'~ :: : ~', ., , ,i'~„ ,~.., ~.,,., z ~~';;~';'~''" .,,,"E';','
~'.a:is~ n~;:~;i:.'au, ..~ 4,4~_. ~::~;' ;5?i'2i:4 4:p7; :;:;a ~r ,a:;yaye;i
2. Account Balance ~ _.a ~E~S~,. ~e~a~i',~+€~::€:yi~~~~4~ti'~` -,''~p~'a:: pp~r~.a'ip;~;;,:;:-i
'~;~e'''i~e:~,!-'v:r;iiS a5,.4~..~v u ~y,,`;~~pi4!e~yi':i~`u:.i 'e4'~ a ii':'r',~:i2'~i'i'ri:45::;.;';45~::5'''.:'+'i2i~
3. Percent Taxable 3 X Sesa'i; ~: '~.~ : .:: 'ei4'e ;4' x~~,',',
4. Amount Subject to Tax 4 ; ~~== ;~ `~~',:'„''?;_~:'i' b=.~:.: "i,;,;:~;,;,~,:aii`'G:p~' :~_,?:':+ap:.,',i':;:,~,+i
5' ~ 5
, ,4 a a:' ti :'~, c :!i7~i i' :, ~4'q ^ *:y".:''', y: ~',i i4 a' ~''4 '~4'''y' .
5 . D a b t s and Deductions 5 - ~~~~~'+~~+~;'':w:s= ~{ '~~,v'i~ ,4 ~~~p~',` ~ r:~z;~a„ ', .. '~,~;~~;
gyp.. ~~~
''-.L ~4'4:~.r;~;i;;€. ::~~p•:;:,:.i `:ca 4,;'fi~''','yi,y''"~, +r'~+ 5, ~'.:''~~'~
6. Amount Taxable 6 '.;•yt~ti:,s~;a._ ...a,,,.p;€'a,':'r,'v+~t;s.'~~~~s,~+~,:;:,,yl;::~i~€:;:,:';'X,. ~ :;:'r'g~''~;+y:;y€,'4,
a~;~~r~,~,°:~•.:,apps'•"rCa:;~;:p~'..g,~~,Cs'` :;'~;''•'k~;2E';, ~. ~ ,~,,,y,,,~,,,::,.:;.:
;?ve
7 . Tax Rate 7 X =;i;i?:,.; . ,.. , ..,.... ~ .:._.~;_ .. -;€;: .,.: ~a'p:' k•
'~''p4;~:;!i,~'k~~~~a~;~'~~a~'~;~~5e'iSeap~~~+e•'~ ~;€'i:?i:;~~''u - x p~+I;,i
8. Tax Due 8
__--
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION eMniiur Darn
WORK C ~ ~) 7~..
~~iA~ inncer on une s of Tax Computation) S
Under penalties of perjury, I declare that the facts I have reported above are trpu~, corprect and
' mp -e to h best qfC my knowledge and belief. HOME C~~~ ) ~~"'_{L~
A n ~l.
COMMONWEALTH OF PENNSYLVANIA REV-1162 EXI11-961
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 010372
DLUGOLECKI PAUL
303 MONROE ST
MECHANICSBURG, PA 17055
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
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
081 15023 ~ $168.02
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 2731
S 168.02
INITIALS: JN
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS