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PENNSYLVANIA INHERITANCE TAX
''" °.=~. ,.,: INFORMATION NOTICE Z(-!I`Id
6UREAU 0~'fNDIVIDWI TAXES r' `~k ~U~ ~~ AND FILE N0. `-
PO ox 260601 v AXPAYER RESPONSE AC~1 10140848
HA~ISaUR6 PA 17128-0601 ~~ tr~~~,. DAfiE 07-16-2010
NEY-1563 EX P (t6-t0)
MICHAEL RDKSANDICH
13 VILLAGE COURT
MECHANICSBURG PA 17050
MEMBERS 1ST FCU provided the Departaent wfth the infonation below, which has boon us
potential tax due. Records indicate that at the death of the above-pawed decedent, you ware a ioint owner/ben~
If you feel the intonation is incorrect, vlsase obtain written correction free the financial institution, att.
end return it to the above address. This account 3s taxable in accordance with tho_Inheritanea:Tax laws of'th
F6nnsiilvania. Please call 0717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INStTi
Account No. 107284-00 Dat• 03-18-1989 To ensure proper crddi
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rata
Potential Tax Du•
l/L~CRK ~~
:r6ERLANC ~ ?_ ~°
~~~~ _~ P~ ~. f II TYPE OF ACCOUNT
Established
$ 3,129.65
X 50.000
~ 1,564.83
.12
.7$
copies of this notid• i
payaent to the Regi$to
payable to ^Reaister o
NOTE: If tax paerwerlts
aonths of the deeedOnt
deduct a 5 percent dis
Ary Inheritance Tax 'du
nine aonths after the
C7~ ` .~-~
„~ '"C7
,r
--i W t,_
`~
in calcu atfng the
:iary of this account.
a copy to this forty
oraonwealth of
IONS
to the account, two
;t accoapany
of Wills. Make check
Wills, A4ent^.
rte aade xithin throe
',date of death,
qnt on the tax due.
rill becoae delinquent
t,• of death.
P~T TAXPAYER RESPONSE
1
A. ~ The above intonation and tax duo is corset.
Resit payaent to the Register of Wills with two envies of this notice to ob alp
CHECK a discount or avoid fntesst, or chock box "A^ and return this notice to ,the Register of
Wills and an official assessaent will be issued by the PA Departaent of Rov nue.
C ONE
BLOCK B. ^ Tha above asset has been or will ba reported and tax paid with the Pennsylvania Iryheritance lax return
0 N L Y to b• filed by the estate roprosentativo.
C. ^ The above info ion is ineorr t and/or debts and deductions wore paid. i
Coaplet• PART 2 and/or PART ~ below.
I
PART Ir indicating a asrrerent tax rate, please state
relationship to docadant:
TA_X RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LIRE I.~Date Established ~ l~ ~ _~~
2. Account Balance 2
3. Percent Taxable 3 X
4. Aaount Subject to Tax 4
5. Debts and Deductions 5 -
6. Amount Taxable 6 $
7. Tax Rate 7 X
B. Tax Duo 8 ~
PA~RT
L" I
DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL CEnter on Line 5 of Tax Computation) i
Under penalties of perjury, I declare that the facts I
a to the best of m knowledge and belief.'
compla
t
AA
~ have reported above are true, co
HOME C ) nett and
~
/
~nJ
./oYj~. pT iuti.-- L~~.t /t/ ~ WORK C 7/ 7 ) ~G ~ 7
TAXPAYER SIGNATURE TELEPHONE NU BER DATE
EST. OF MILDRED NYE ® SAVINGS
SSN 168 - 26 - 7427', ^ cHECKINs
DATE OF DEATH 0 6- 0 9- 2 0 ~ ^ TRUST
COUNTY CUMBERLAND -- ~ ~tTIF.
~
REMIT PAYMENT AND FORMS T0: ~"'
X>~ r-r~ ~
~~ £~
REGISTER OF WILLS ~ ~~ ~ ~`~`
1 COURTHOUSE SQUARE
~
~ ~~ ~'~
'~~"' `~
CARLISLE PA 17013 ~