HomeMy WebLinkAbout10-07-08 (7)COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE INFORMATION NOTICE L
BUREAU OF INDIVIDUAL TAXES FILE NO. 21 ~~ (~~
DEPT. 280601 i ~ ,,- AND ACN 08115009
HARRISBURG, PA nlza-BSgI --•1`dX~AYER RESPONSE
' DATE 04-10-2008
REV-1545 IX ~FP C09-00) ....t J~
TYPE OF ACCOUNT
Z~Q~ C~CT "7 {~' ~ PAUL S DLUGOLECKI ^ SAVINGS
$.$. N0. ^ CHECKING
(;I ~~: GATE OF DEATH 01-06-2008 ^ TRUST
QRF~I-'~-~i'~ ~ t;tQQJ~TY CUMBERLAND ®CERTIF.
r , i r,, ..
C~ GIs - 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 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 decadent, you were a joint owner/beneficiary of
this account. If you foal 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) 787-8327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 7502-43 Date 06-09-1997 To insure proper credit to your account, two
Estab115hed C2) copies of this notice must accompary your
Account Balance 24,331.70 payment to the Register of Wills. Make check
payable to) "Register of Wills, Agent".
Percent Taxable X 5.000
NOTE: If tax payments era ^ada within three
Amount Subject to TeX 1,216.59 C3) months of the decedent's data of death,
Tax Rate X .045 you may deduct a 5X discount of the tax due.
54.75 Any inheritance tax due will become delinquent
Potential Tax Due nine C9) months after the date of death.
PART E ON
RESP SE
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A. ^ The above information and tax due is correct. ~ R~
1. You may choose to remit Dayment 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
C ONE ~ Wills and an official assessment will be issued by the PA Department of Revenue.
BLOCK B. ^ The above asset has bean or will be reported and tax paid with the Pennsylvania Inheritance Tax return
ONLY to ba 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 3^ below.
PART If you indicate a different tax rata '~s'~ d`;.;'''~i'"''' '
Please state your ; y~ "~ ~ v
relationship to decedent: a ~;~~;'''y`!~9~`a;;,,, ,,,a,.p'r,, ~ r ~ ~'
~,,'' ~ ;':,!i;,4'''' v.e ,y,; ,~,' Y,i,S;; v'; Y.i;!e ,',,4~'.r:, ~,~,~~, ' 24; '~~~~,
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS ~;~'~ti~~+~~ 2...'„.~,;,,;'~'',',;M, y~f;~; ~' '-~~;~' ~;',~r,'a,
LINE 1. Date Established 1 ;5~~~~k '': ~"~4~"'`~'„',y:~~ ~ ~:,?~';'~''~ ,y '.'a; ~~$ ~;
~:~~~~~ y;i~,~',~4 iv'Ss~a'';;Titi'c 4'a,cy~, ,;,;!ti ~''~',''4„'S'~'''' '''4• 1,' ~'
2. Account Balance ~~ ,, ~~' : '~`~[u rP',':~s:'~,,;, ' ~ -,,!,,,,~;,;~
+~ii iii i!:a;:!u;i'i e!::s`';; ._.,a_~, ,,'r::::a:::'tii;s''' ie44iiii!'c, "` ., 4,
3. Percent Taxable 3 X r'~€~€s~~ .__._ ;..~,.$::::.!,;a'a:=;x:c ... '; 3 :... ;.,
1y e'c.-, ~~1
4. Amount Sub eat to T ~~~~~~~~,g'~a''•=~'~S,p;n`;~?y ~ry;;~a'>< 1 a~`a•;,:~,;r~r':;.;,; a~,o,'S,Wy'`;'a,; ~;~
5' ~.: s
j ax 4 ~ y~ .:: -: ~ . ;. g=;;'~,a'r;4!s:s~ r'a!x.,,;;;a.,`.=.s. s„
5. Debts and Deductions 5 - ~=~:?~i~iR~'`;;#ti';y,~a,, t5 ~~..~''y;,~ ;;~`~''`~' °~'g:~~~~~";v°.
;~,,2y;'~;&'.,i~a~d'v"4k3''T~'',~*~,^~a"!fa5,'~i'~h'~,4i°''S ~!a~;'','h''r3 ;,~~.
6. Amount Taxable 6 :;,ti'=44:, ~ .+; ;€.: , ., '-;x;~. ,;~;~ r
:;'r!'ri.4',;,'V~~z;.'?; s~;~:;a~';!i;~,,';;~4,4 ' reY'r~'', x; ~;ti;;4~'',4'~' o;y!,, •iiYy' ;y;y~3~ , ~'
7. Tax Rate c, ~ RAH. ~ ~ `` '' ,
8 ;~h~';~;'€;iea:>>,'~4 ~~R~,~;~~'r,~~,:W~i~;w;~;'s~Ls,s~'~~'°~~ ~;~;~r; ~ i!!r,;;~'~~~;ti,~?~~, '
8. Tax Due ~'•;;: „•,;, ,,,,,; ,,,~
;i?;ee'yi~ !S ;~" 4 _ ' x'iS4t,5i,'e!e!e!'•_'P!e!~,vR v ! ~•v! i;'2i!i4!,!:S4;y,..•-.
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID n ~ A ~-YEE ~ DESCRIPTION AMOUNT PAID
TOTAL CEnter on Line 5 of Tax Computation) #
U or penalties of perjury, I declare that the facts I have reported above a truGe~ ~co r t and
omp a to best of knowledge and belief. HOME C~/~ ) ~ ~~ W
WORK 7 "1 )'7 ~ ems'
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 010373
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
AMOUNT
ACN
ASSESSMENT
CONTROL
NUMBER
08115009 ~ 554.75
TOTAL AMOUNT PAID:
REMARKS:
554.75
CHECK# 2728
INITIALS: JN
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS