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TYPE OF l~CC4UPtT
ES.ri~. t7F' RUSSELL i~f EIa~.EY ~ St~u.Pa6S
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I3A°!'u v~ t3~A'i'a3 10-2b-9~a TRSiST
COt7Ta"I'X CL'~4HERLAf~~ ~ CS~ FILATE
P@E AYkE~ ANF9 F~ 7A
;;+~~LE ~'~~;° REGIST ':OF 4tILL5 c~~ b'
~, ~c.;..:- ~~? CUMDE@~lNn CO -~DUR l ~-lt"~SE
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rLLT~>; ,';,:~?;;e~ ^•.z ;:rrvidwd the ,:operta:cant with the inforaation listed Aslow which has iy,~{'alculFtin~-7s~e
as±nntl~l tax d:ln. ih-air rncc r-;u indite to that at tfis dsatfi of the above decadent, you were s joint fi,~ry of this seeount.
Zf yea fFSl this .inEar.aaticn is incorrect, plvesa obtain written correction ties the financial lnstitutlon, attach s copy to Utiis fors
and rg!ur~ It t~~ tns ~+•.: ±:%dr,ns~. 7hls aceetnft S4 taxable in ar:cardsrxa with tfis Yn'.leritenca Tsx L~+s of t!w-.Coswmnwaeth of Pennsylvania.
M.emrYS5++i..~3 say bs anawa~ ed by c»..lein;9,pp07171 787-8~3n2yy1. r~.
4m~~~`T Dw>"~ ~~:f",i ~. ai~M°f.,~Ji4 $~ ~ ~' .T 6:~ Y~~B bR~~ .~bGir CV86 ~IL ~S. ifV41 Air r'A9{'IF.f~1T iiV.~T~VVT 4017
!~-.....,._r+.,i ~.. ~'re. x.~.. ..~'.' ~' N~;~ a~-2a-92 io inFUra proper credit to your acoa<.an4, two
f'75"€A191.'d g~94fi t1.) oepies of this rrotics east accospany your
P°j"H0"t to tM Register of MSlls. 3Fs7ss chick
s.r.a'-~sr;: ~a?.a:-ca~ 5 002.35
, payable to: "'Rogi.star of Nills, l6gsnt^.
~*~orr,~~aD; T1*;c:^,?:k~ ?f 50.000
1ATE: Yf tax payaants era cads within three
.f,~t,, ,.°,': '>csi: is _ . ..~ ; 2€.r, z,J~'~.. ~ ~ ,31 sontfia of the decedent's deto of dmath,
TF!X "n S!{SD .k,' ~. Q V you a:aY diduct~ a ~ di9cOUnt Of the tax dua.
Rny inheritance tax due will bacosDa dslinoxDent
3'n{c.rv$i:e7. Ttax ~'~i.r~ 150 • 07 nine (9) Aonths after the date of death.
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.,. "-; Thr~ a.evo~ infara~atirn and tax due is correct.
-- 1. 'f+±i~ teat' ctraa.ze to resit payrosnY to tiro Register of U121s with two copies of thls rxotleo to obtain
:v 41sco•.n: or avoid intmrast, or you eiay ah,scic box ^R^ and retsarn this notice to tM Rmglstsr of
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REV-1643 EX AFP (8-94~
COMMD°~iNEbl'~H *F PIENNSYLVANIA
DEPART-KENT OF REt~ENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISIURG, PA 17128-0601
~ ..
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE N0. 21 /,~~~
ACN 95102011
DATE 01-31-95
TYPE OF ACCOUNT
ESTATE OF RUSSELL W EISLEY ^ SAVINGS
S . S . NO . 716 - O 1- 5148 {^~ cNECKINc
DATE OF DEATH 10-26-94 LJ TRUST
COUNTY CUMBERLAND ® CERTIFICATE
RE ~yAYMENT AND FORM~TO:
VIOLET HOPP REGIST~ WIdd.S ~~
22 CIRCLE DR CUMBERL ~~II~D CO ~( URT E
CARLISLE PA .17013 CARLISLE, PA 17013
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W
FULTON 6ANK has provided the Department with the information listed below which has be6nU;ad inlculati'p`pItfie
potential tax due. Their records indicate that at the death of the above decedent, you were a joint ownerlpenefic y of th9r3 count.
If you Fuel this ihformation is incorrect, please obtain written correction frog the financial institu{~iiattacli-a copy to tF~'3 fors
and return it to the above address. This account is taxable in accordance with the Inheritance Tax La the Coponwealth of Pennsylvania.
:restiors Iraq be ans:eered by calling 0717; 797-8327.
COMPLETE PART 1 BELOW ~ ~ x SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 251-052119 Dat• 11-20-91 To insure proper credit to your account, two
Established C2) copies of this notice must accompany your
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rats
Potential Tax Due
5,002.35
x 50.000
2,501.18
x .06
150.07
payment to the Register of wills. Make check
payable to: ^Register of Wills, Agent^..
NOTE: If tax payments era made within three
C3) months of the dece~nt's date of death,
you may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine C9) months after the date of death.
PART TAXPAYER RESPONSE
::::....
1 :::,.:..:,:::, :::.::........ ....:................................:...........:........ ... ............:............:.....: . . ............: . ....:.:~ ::~::::~:,.:;:..,
....
A. ^ The above information and tax due is correct.
1. You may chooso 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 box ^A^ and return this notice to the Register of
C 0 NE ~ wills and an official assossment will be issued by the PA Dfpartment of Revenue.
BLOCK B. ^ The above asset has boon 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 oust complete PART 2^ and/or PART 3^ below.
PART Ifi you indicat• a differ
relationship to decedent:
TAx PETURN - COMP~!TATIO!f!
LINE 1. Dat• Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rat•
8. Tax Due
please state your
OF ?Q.X ~JN .lOINT.i?RUS'* AGCOlaMTS ~#
1 ~! -~ ~i f
4 .a . s o L• ~f
7 X
8 ~ !~!~s
DEBTS AND DEDUCTIONS CLAIMED
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PA
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TOTAL (Enter on Line 5 of Tax Computation) 5
Under penalties of perjury, I declare that the fiac~s I have reported abov® ors true, correct and
complete to the best of my knowledge and belief . HOME ( 7 / 7 ) o< ~~'- ~C~ Z_
~~ WORK C ) ,~ }.
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