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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
____un fold
ESTATE INFORMATION: SSN: 216-01-1884
FILE NUMBER: 2106-0011
DECEDENT NAME: MACDONALD HELEN M
DATE OF PAYMENT: 01/05/2006
POSTMARK DATE: 01/04/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 09/04/2005
NO. CD 006177
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
05157511 I $92.66
I
I
I
I
I
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TOTAL AMOUNT PAID:
REMARKS:
JUNE PECUKONIS
CHECK# 347
SEAL
INITIALS: RSK
RECEIVED BY:
REGISTER OF WILLS
$92.66
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 - ~\, -~~ \\
05157511
12-27-2005
REY-1543 EX AFP 109-00l
EST. OF HELEN M MACDONALD
S.S. NO. 216-01-1884
DATE OF DEATH 09-04-2005
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
[X] CHECKING
o TRUST
o CERTIF.
JUNE A PECUKONIS
610 HILDA CT
MECHANICSBURG PA 17055
REHIT PAYHENT AND FORHS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
HEHBERS 1ST FCU has p..ovided the Depa..tment with the infol"llation listed 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..m and ..etu..n it to the above add..ess. This account is taxable in acco..dance with the Inhe..itance Tax Laws of the Commonwealth
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. 228600-11 Date 04-05-2003
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
4,118.41
50.000
2,059.21
.045
92.66
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) manths of the decedent's date of death,
yoU may deduct a 5% discount of the tax due.
Any inhe..itance tax due will became delinquent
nine (9) months afte.. the date of death.
PART
[!]
A.
[ CHECK ]
ONE
BLOCK B.
ONLY
c.
rin The above info..mation and tax due is co....ect.
~ 1. You may choose to ..emit payment to the Registe.. af Wills with two copies of this notice to obtain
a discount 0.. avoid inte..est, 0" you may check box "A" and ..eturn this notice to the Registe.. of
Wills and an official assessment will be issued by the PA Depa..tment of Revenue.
c=J The above asset has been a.. will be ..epo..ted and tax paid with the Pennsylvania Inhe..itance Tax ..etu..n
to be filed by the decedent's ..ep..esentative.
c=J 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.
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
~
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
TOTAL (Enter on Line 5 of Tax Computation)
I
$
perjury, I declare that the facts I
my knowledge and belief.
have reported above are true, 70rrect
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