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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INOIVIOUAL TAXES
DEPT. 2B0601
HARRISBURG, PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 - O(P~ ~
06124964
06-02-2006
REV-1545 EX AFP (09-001 I
EST. OF GERTRUDE I COLLINS
S.S. NO. 199-07-1999
DATE OF DEATH 01-08-2006
COUNTY CUMBERLAND
TYPE OF ACCOUNT
!XJ SAVINGS
o CHECKING
o TRUST
o CERTIF.
CRYSTAL JST6ttER
5251 STRATHMORE DR
MECHANICSBURG PA
'5:t- OnrCr Kol..j
17050
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MEMBERS 1ST FCU has provided the Deparblent with the information listed below which has be";' used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/bereficiar~-af
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, ~ttach a copy
to this forll and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the COllmonwealth
of PennsYlvania. Questions may be a...s..e...ed by c!!Illing (717) 787-8327. ' . _. _ ~
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCT~.QNS
Account No. 179403-00 Date 10-17-1998
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
2,041.52
50.000
1,020.76
.045
45.93
TAXPAYER RESPONSE
To insure proper credi t. to 'your aCCOllAt, two
(2) copies of this notice must acco~~y your
payment to the Register of Wills. ~ke check
payable to: "Register of Wills, Agent".
Tax
x
NOTE: If tax payments are made within three
(3) 1I0nths 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.
The above information and tax due is correct.
'T- 1. You lIay choose to remit paYllent to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or YOU lIay 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.
If you indicate a different tax rate, please state your
relationship to decedent:
c=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.
r\i The above inforllation is incorrect and/or debts and deductions were paid by you.
~You must complete PART ~ and/or PART ~ below.
PART
@J
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
x
-,;,> 0 t-i / ...... ~
5n?o
/ n <~r? '7 {L/
~~?;D5u
qJ
(Jf
OF TAX ON JOINT/TR~S~.CCOUNTS
1 /()-/'7- 9
2
3
4
5
6
7
8
x
PART DEBTS AND DEDUCTIONS CLAIMED
[!J
DATE PAID PAYEE DESCRIPTION
t,f&4~~'; ~;~~~~r}~~;.;<Yl::(}:+<'~"
TOTAL CEnter on Line 5 of Tax Computation)
facts I
AMOUNT PAID
~ ~~ :~
.'~ ~ ;-,t7'
$ S 2, ;2.,/) , ~-V
Cr ;;~ - 0&
DATE