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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG~ PA 17128-0601
..,~....
-'W'l'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 Olp 02."4-
ACN 06113535
DATE 03-21-2006
REV-1543 EX AFP (09-00)
EST. OF FRANK OHARA
S.S. NO. 171-14-2873
DATE OF DEATH 12-30-2005
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
[X] CHECKING
D TRUST
D CERTIF.
-" :?8
DORA E OHARA
302 ASBURY DR
MECHANICSBURG PA 17055-4305
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. 0171142873 Date 10-05-1992
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
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 Wi11s~ Agent".
x
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
[CHECK ]
ONE
BLOCK
ONLY
A. 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.
B. [] 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. [] 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
LINE
RETURN - COMPUTATION
1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
S. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3 X
4
S
6
7 X
8
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PART
~
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line S of Tax Computation)
I
$
Under penalties of perjury, I declare that the facts I
complete to the best of my knowledge and belief.
. ~~X~R ~I~it~
have reported above are true, correct and
HOME ('111) ~.- [;.;.
WORK ( ) JJ JA
TELEPHONE NUMBE~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG.. PA 17128-0601
'.
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 Olo 02.~'1
ACN 06113537
DATE 03-21-2006
REY-1545 EX AFP (09-00)
EST. OF FRANK OHARA
5.5. NO. 171-14-2873
DATE OF DEATH 12-30-2005
COUNTY CUMBERLAND
TYPE OF ACCOUNT
[X] SAVINGS
D CHECKING
D TRUST
D CERTIF .
'L.B
DORA E OHARA
302 ASBURY DR
MECHANICSBURG PA 17055-4305
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 calli~g (717) 787-$327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0171142873 Date 10-05-1992
Established
Tax
17,364.29
16.667
2,894.11
.00
.00
TAXPAYER RESPONSE
;' . ;1i~~~~~~RlslWlT~~~!~!~N~~~!ANm~a~lJ!c!J!AL~~~~L'.;.. ;
..............................................................................................................................-.................... ....................... ...................................-................
.................................................................-...".....-....................................................................... ..........................................-.............................................
....................-..........................................................................................................................................................................................................................................................
. ..... . ..... . .... ... . .. ... . .... . ...... .... .... . ........ .
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".
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
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.
x
PART
[!] Ililllll~~gllll!!19illlll!I;:;;;;:..
[CHECK ]
ONE
BLOCK
ONLY
A. 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.
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. [] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
PART If you indicate a different tax rate, please state your
~ relationship to decedent:
TAX TAX ON JOINT/TRUST ACCOUNTS
LINE
x
RETURN - COMPUTATION OF
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
x
PART
[!]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
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 ( 1 J ?) 'l~t,q.- O~ 4tJ3
WORK ( ) IV ) It
TELEPHONE NUMBER
,~&JDt
ATE
-19 ~L I (9'kL~
TAXPAYER SIGNATURE
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