HomeMy WebLinkAbout01-05-06 (3)
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
PECUKONIS JUNE A
610 HILDA CT
MECHANICSBURG, PA 17055
hhn__ fold
ESTATE INFORMATION: SSN: 216-01-1884
FILE NUMBER: 2106-0011
DECEDENT NAME: MACDONALD HELEN M
DA TE OF PAYMENT: 01/05/2006
POSTMARK DATE; 01/04/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 09/04/2005
NO. CD 006174
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
05157510 I $119.97
I
I
I
I
I
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TOTAL AMOUNT PAID:
REMARKS:
JUNE PECUKONIS
CHECK# 348
SEAL
INITIALS: RSK
RECEIVED BY:
REGISTER OF WILLS
$119.97
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21
05157510
12-27-2005
REV-1545 EX AFP 'B9oBBl I
EST. OF HELEN M MACDONALD
S.S. NO. 216-01-1884
DATE OF DEATH 09-04-2005
COUNTY CUMBERLAND
TYPE OF ACCOUNT
[iJ SAVINGS
o CHECKING
o TRUST
o CERTIF.
JUNE A PECUKONIS
610 HILDA CT
MECHANICSBURG PA 17055
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MEMBERS 1ST FCU has p..ovided the Depa..tment with the info..mationlisted below which has been used in
calculating the potential tax due. Thei.. ..eco..ds indicate that at the death of the above decedent, YOU we..e a joint owne../beneficia..y of
this account. If you feel this info..mation is inco....ect, please obtain w..itten co....ection f..OM the financial institution, attach a copy
to this fo... and ..etu..n it to the above add..ess. This eccount is taxable in acco..dance with the Inhe..itance Tax Laws of the COM.onwealth
of PennsYlvania. Questions may be answe..ed by calling (717) 787-8327.
COMPLETE PART 1 BELOW · . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 228600-05 Date 04-05-2003
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
5,332.15
50.000
2,666.08
,045
119.97
TAXPAYER RESPONSE
To insu..e p..ope.. c..edit to you.. account, two
(2) copies of this notice must accompany you..
payment to the Registe.. of Wills. Make check
payable to: "Registe.. of Wills, Agent".
Tax
x
NOTE: If tax paYMents a..e Made within th..ee
(3) months of the decedent.s date of death,
you may deduct a 5% discount of the tax due.
Any inhe..itance tax due will become delinquent
nine (9) months afte.. the date of death.
PART
ill
A.
[ CHECK ]
ONE
BLOCK B.
ONLY
c.
~ The above info..mation and tax due is co....ect.
~l. You May choose to ..emit payment to the Registe.. of Wills with two copies of this notice to obtain
a discount 0" avoid inte..est, 0" YOU may check box "A" and ..etu..n this notice to the Registe.. of
Wills and an official assesSMent will be issued by the PA Depa..tment of Revenue.
[] The above asset has been 0.. will be ..epo..ted and tax paid with the Pennsylvania Inhe..itance Tax ..etu..n
to be filed by the decedent's ..ep..esentative.
If yOU indicate a different tax rate, please state your
relationship to decedent:
[] The above info..mation is inco....ect and/o.. debts and deductions we..e paid by you.
You Must complete PART ~ and/o.. PART ~ below.
PART
@J
TAX RETURN - COMPUTATION OF
LINE 1. Date Established 1
2. Account Balance 2
3. Percent Taxable 3
4. Amount Subject to Tax 4
5. Debts and Deductions 5
6. Amount Taxable 6
7. Tax Rate 7
8. Tax Due 8
PART
[!J
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
TAX ON JOINT/TRUST ACCOUNTS
x
x
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL CEnter on Line 5 of Tax Computation)
I
$
of perjury, I declare that the facts I
of my knowledge and belief.
have reported above are true, correct and
HOME (1/1) t;q,~ It 1 t:,
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TELEPHONE NUMBER DATE
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