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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT DF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
*'
7NFORMAT70N NOT7CE
"'. ~'''~.-
TAXPAYE~RlSRONSE
FILE NO. 21 05-0084
ACN 05117971
DATE 05-31-2005
EY-1!iUEXAFP (09-10)
TYPE OF
ACCOUNT
o SAVINGS
IX] CHECKING
o TRUST
o CERTIF.
L
I' .'~;} , ,...." "-', '_' A ....'
','<EST.v OF i14Al.:coIlM G HARRO
S.S. NO. 188-09-5937
I!llrn<O!'=DEATH 12-11-2004
ORl;Q~1(f CUMBERLAND
Cl
REHIT PAYHENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
WAYNE S GAMMON
'9?6. C::4.YRV rT
KALE!!" ur ?7'll
;;L1:l."f ~1ft'?€.YA WAr
/'1 A I? lEE -r-r A/ <9A"3 ()()(., '7
(CHANGe
\:Al>.PR.ESS
01
PSECU has provided the Departllent with the infonlation listed below which has been used in
calculating the potential tax due. Their records indicate that at thB dBath of th8 above dllCedent, you were e joint owner/beneficiary of
this account. If YOU feel this inforAtion is incorrect, please obtain written correction frOll thB financial institution, attach a cOPy
to this for. and return it to the above address. This account is taxablB in accordance with the Inheritance Tax Laws of the CCJmIonwnlth
of Pennsylvani.. Questions ..y be answered by calling (717) 787-8327,
COMPLETE PART 1 BELOW . .
Account No. 018809593754
. SEE REVERSE SIDE FOR
Dat. 01-22-1993
Est....lished
FILING AND PAYMENT INSTRUCTIONS
Account Balenc. 846.20
P.rcent Tax....l. X 25.000
Amount SUJj.ct to T.x 211. 55
Tax R.t. X .045
Potential Tax Due 9 . 52
~RT TAXPAYER RESPONSE
[TI 11"",~_-,,",""'.',",",i""!!-I-~...-_-',' ,t_,."ili:-I-I'!.'~.".,."':7""..'_.l!i"'I~I~.~~.-I.~-~..'.~-.".~.'-.ia".".' ";~~..---.'Oi\, ;~.,r.'~-II'JiilIOIiiiWiI.. :.:~lIitii.I.''''''il-I!~-.
-'.....1......1""."..
S!;!;~!Ut~2;~S;~~~~lEa~;~;~;~'rr"'l;:i:~~~~i~;I;;~~==;~~~~~;;ii~W!;!::.J1!l~I~~i~~~~
To insure proper credit to your acco...,t, two
(2) copies of this notice IIUst accOllpany your
paS'.ent to the Register of Mills. Make check
payablB to: "Register of Wills, Agent".
NOTE: If tax paY8lll1ts Bre llade wi thin thrH
(3) .onths of the decedent's date of death,
you IR!!IY deduct a 5:iC dIscount of the tax due.
Any inhsritanca tax due will blltCDlUI delinquent
nine (9) .onths after the date of death.
[CHECK ]
ONE
BLOCK
ONLY
A. ~ The above inforllBtion and tax dUll Is correct.
I. You .BS' choose to re.lt pay..nt to the Register of Mills Idth two copies of this notice to obtain
a discount or avoid interest, or YOU .ay check box nAn and return this notice to the Register of
Wills and an official asses~ent will be issued by the PA Depart.ent of RsvenuB.
B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inhsritanca Tax return
to be filed by the decedent"s representative.
c. D The above infor.ation is incorrBct and/or debts and deductions were paid by you.
Vou .ust collplete PART 0 and/or PART @] below.
If you indicate 8 different tax rate, please state your
rel.tionshlp to decedent:
PART
~
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LDIE 1. Dltt. Eatab1ishecl 1
2. Account Balance 2
3. Percent Taxable 3 X
1.\. AIto...-.t Subject to Tax 1.\
S. Debts and Deductions S
6. Anount Taxable 6
7. Tax Rate 7 X
8. Tax Du. 8
PART
[!]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
.
. . ').
I
TOTAL (Enter on Line S of Tax eo.putation)
of perjury, I decl..... that the facts I htlve ....ported above a....
of my knowledge ~ belief.
-
zooS-
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT,280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
GAMMON WAYNE S
2929 TORREYA WAY
MARIETTA, GA 30067
nnun fold
ESTATE INFORMATION: SSN: 188-09-5937
FILE NUMBER: 2105-0084
DECEDENT NAME: HARRO MALCOLM G
DATE OF PAYMENT: 06/10/2005
POSTMARK DATE: 06/07/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 12/11/2004
NO. CD 005418
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
05117971 I $9.52
I
I
I
I
I
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I
TOTAL AMOUNT PAID:
$9.52
REMARKS:
CHECK# 2549
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS