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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAxes
DEPT. 280601
HARRISQURG, PA 17128-0601
'*
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 . ~\; -~~,,~
06100956
01-06-2006
REV-154! EX AFP (09-001
f" ~ 5 U
EST. OF STEVE HOWRYLAK
S.S. NO. 181-14-2688
DATE OF DEATH 09-13-2005
COUNTY CUMBERLAND
TYPE OF ACCOUNT
fil SAVINGS
o CHECKING
o TRUST
o CERTIF.
STEPHEN F HOWRYLAK
6402 CANNON DR
MECHANICSBURG PA 17050-1907
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 ware a ioint owner/beneficiary of
this account. If yOU fael this information is incorrect, pleasa obtain writtan correction from the financial institution, attach a copy
to this form and raturn it to tha above addrass. This account is taxable in accordanca with the Inharitance 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. 8608084680 Date 04-05-2002
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
10,060.35
50.000
5,030.18
.045
226.36
TAXPAYER RESPONSE
To insure proper cradit to your account, two
(2) copies of this notice BUst accompany your
payment to the Registar of Wills. Maka check
payable to: "Register of Wills, Agent".
Tax
x
NOTE: If tax payments ara made within three
(3) months of tha decedent's date of death,
yoU may deduct a S7. discount of tha tax due.
Any inheritance tax due will become delinquant
nine (9) "months aftar the date of death.
PART
ill
A.
[ CHECK ]
ONE
BLOCK B.
ONLY
c.
~ Tha above information and tax due is corract.
~ 1. You may choosa to ramit paymant to the Ragistar of Wills with two capias of this notice to obtain
a discount or avoid intarast, or YOU may check box "A" and raturn this notica to the Registar of
Wills and an official assessmant will be issuad by the PA Department of Revenua.
If you indicate a different tax rate, please state your
relationship to decedent:
[J The above asset has bean or will ba raported and tax paid with the PannsYlvania Inheritance Tax return
to ba filed by the dacedant's representative.
[J The abova information is incorrect and/or debts and daductions wera paid by you.
You Bust completa PART ~ and/or PART ~ balow.
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
Under penalties of
o ~"e~?*, of
? //c;zt74
T^VD^ ~D C:TQll^TIID~
I
TOTAL (Enter on line 5 of Tax Computation)
AMOUNT PAID
I
$
ry I declare that the facts I
ledge and belief.
1-/2 -o{,-,
n^T~
have reported above are true, ~orrect
HOME (71 7 ) 7 q 1- (/3 ? 0
WORK (7/1) 7~7- ? 27
T~I ~Dunt.J~ t.Jlnnl~D
and
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
HOWRYLAK STEPHEN F
6402 CANNON DRIVE
MECHANICSBURG, PA 17050-1907
___n_n fold
ESTATE INFORMATION: SSN: 181-14-2688
FILE NUMBER: 2106-0048
DECEDENT NAME: HOWRYLAK STEVE
DATE OF PAYMENT: 01/17/2006
POSTMARK DATE: 01/13/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 09/13/2005
NO. CD 006222
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
06100956 I $226.36
I
I
,
I
I
,
I
I
TOTAL AMOUNT PAID:
REMARKS:
STEPHEN F HOWRYLAK
CHECK#1588
SEAL
INITIALS: RSK
RECEIVED BY:
REGISTER OF WILLS
$226.36
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS