HomeMy WebLinkAbout11-21-05 (2)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL T~~ _
DEPT. Z8060l
HARRISBURG, PA l71Z8-050l
"= (, ~-
.'W'l'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 J'\::l S - \~'<...~
05146817
10-04-2005
'REV-15~S EX AFP 109-00l I
r', ,
'...;',-1
TYPE OF
EST. OF FLORENCE J WESOLOSKIE
5.5. NO. 195-16-5463
DATE OF DEATH 07-27-2005
COUNTY CUMBERLAND
ACCOUNT
IX] SAVINGS
o CHECKING
o TRUST
o CERTIF.
j r'. ,
-','
DANIEL R WESOLOSKIE
636 ASPEN LN
LEBANON PA 17042-9069
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PSECU 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 decedent, YOU were a joint owner/beneficiary of
this account. If yOU feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this for. and return it to the above address. This account is taxable in accordance with the lnheritc'nce Tax Laws of tile Commonwealth
of PsnnsYlvonia. Questions Nay be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0191700971 Date 02-26-1996
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
78.39
16.667
13.07
.045
.59
TAXPAYER RESPONSE
To insure proper credit to your account, two
(Z) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Tax
x
NOTE: If tax payments are made within three
(3) months of the decedent's date of death,
you may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
PART
[!]
A. [J The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or yoU may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
[CHECK ]
ONE
BLOCK
ONLY
B. [J The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
C. [J The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
If you indicate a different tax rate, please state your
relationship to decedent:
PART
~
TAX RETURN - COMPUTATION
LINE 1. Date Established
2, Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
PART
@J
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
OF
1
2
3
4
5
6
7
8
x
TAX ON JOINT/TRUST ACCOUNTS
x
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Computation)
I
$
Under penalties of perjury, I declare that the facts I have reported above are true, correct and ^~
complete to the best of my knowledge and belief. HOME () . \~
WORK ( )
TAXPAYER SIGNATURE TELEPHONE NUMBER DATE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
f--f'.', "-, ---
'*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 ~ <:'l S - '\\))..Q
05146819
10-04-2005
REY-1543 EX AFP C09-00l
.'>'. ~
,.~ .
I. .
1.: J: ~
TYPE
EST. OF FLORENCE J WESOLOSKIE
S.S. NO. 195-16-5463
DATE OF DEATH 07-27-2005
COUNTY CUMBERLAND
OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
[Xl CERTIF.
"
DANIEL R WESOLOSKIE
636 ASPEN LN
LEBANON PA 17042-9069
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PSECU 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 decedent, you Were a joint owner/beneficiary of
this account. If you feel 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 PGnnSylVDnia. Questions lIay b6 answ8i-ed by c8IllillY {ill) 7a7-a3l7.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0191700971 Date 02-26-1996
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
8,161.70
16.667
1,360.31
.045
61. 21
TAXPAYER RESPONSE
To insure proper credit to your accountl two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
x
NOTE: If tax payments are made within three
(3) months of the decedent's date of death,
you may deduct a 57. discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
Tax
PART
m
A.
[ CHECK ]
ONE
BLOCK B.
ONLY
c.
[] The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
[] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
[] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
If you indicate a different tax rate, please state your
relationship to decedent:
PART
~
TAX RETURN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4, Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
PART
[!J
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
OF
I
2
3
4
5
6
7
8
x
TAX ON JOINT/TRUST ACCOUNTS
x
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Computation)
I
$
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best of my knowledge and belief.
HOME (
WORK (
TELEPHONE
)
)
NUMBER
~r-
TAXPAYER SIGNATURE
DATE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAliTAlfE~'
DEPT. 280601. .
HARRISBURG, PA 17128-0601
I
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21'~, ~ - \""~\:;
05146821
10-04-2005
REV-1543 EX AFP 'D9-DDl
{~ ,~
l ~
~.-.i ;
r', "
I
, . ;I.
U ....1
TYPE OF
EST. OF FLORENCE J WESOLOSKIE
S.S. NO. 195-16-5463
DATE OF DEATH 07-27-2005
COUNTY CUMBERLAND
ACCOUNT
o SAVINGS
D CHECKING
o TRUST
[Xl CERTIF.
(,. .--..,/
c'
-~T
II
DANIEL R WESOLOSKIE
636 ASPEN LN
LEBANON PA 17042-9069
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
PSECU 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 decedent, YOU were a joint owner/beneficiary of
this account. If you feel 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 answerea by calling (717) 787-6327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0191700971 Date 02-26-1996
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
7.225.47
16.667
1.204.27
.045
54.19
TAXPAYER RESPONSE
Ta insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
x
NOTE: If tax payments are made within three
(3) months of the decedent's date of death,
you may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
Tax
PART
[!]
A.
[ CHECK ]
ONE
BLOCK B.
ONLY
c.
[] The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
[] The above asset has been or will be reported and tax paid with the PennSYlvania Inheritance Tax return
to be filed by the decedent's representative.
[] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
If you indicate a different tax rate. please state your
relationship to decedent:
PART
[!J
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PART
@]
TAX RETURN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF
1
2
3
4
5
6
7
8
x
TAX ON JOINT/TRUST ACCOUNTS
x
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Computation)
I
$
Under penalties of perjury. I declare that the facts I have reported above are true. correct and
complete to the best of my knOWledge and belief.
HOME (
WORK (
TELEPHONE
)
)
NUMBER
~K
TAXPAYER SIGNATURE
DATE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TA)<ES.
DEPT. 280601
HARRISBURG, PA 17128~0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 - ~ ~ - \ ~ '(. ~
05146823
10-04-2005
REY'154S EX AFP lU9-00l I
l._ i
, I j
]:j
TYPE OF
EST. OF FLORENCE J WESOLOSKIE
S.S. NO. 195-16-5463
DATE OF DEATH 07-27-2005
COUNTY CUMBERLAND
ACCOUNT
o SAVINGS
o CHECKING
o TRUST
IX] CERTIF.
(' ,""
r,-j
DANIEL R WESOLOSKIE
636 ASPEN LN
LEBANON PA 17042-9069
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PSECU 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 decedent, YOU were a joint owner/beneficiary of
this account. If you feel 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 (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0191700971 Date 02-26-1996
Established
.~
Account Balance
Percent Taxable
Anount Subject to
Tax Rate
Potential Tax Due
x
1,362.77
16.667
227.13
.045
10.22
TAXPAYER RESPONSE
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Tax
x
NOTE: If tax payments are made within three
(3) months of the decedent's date of death,
yoU may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
PART
[!J
A.
[ CHECK ]
ONE
BLOCK B.
ONLY
c.
[J The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
[J The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent.s representative.
[J The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
If you indicate a different tax rate, please state your
relationship to decedent:
PART
@J
TAX RETURN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Anount Subject to Tax
5. Debts and Deductions
6. Anount Taxable
7, Tax Rate
8. Tax Due
PART
@J
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
OF
1
2
3
4
5
6
7
8
x
TAX ON JOINT/TRUST ACCOUNTS
x
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Conputation)
I
$
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
conplete to the best of ny knowledge and belief.
HOME (
WORK (
TELEPHONE
)
)
NUMBER
r<K
TAXPAYER SIGNATURE
DATE