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COMMONWEALTH OF PENNSYL VANIA
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
HAWCO CATHERINE M
909 ACRI RD
MECHANICSBURG, PA 17055
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ESTATE INFORMATION: SSN: 000-00-0000
FILE NUMBER: 2106-0370
DECEDENT NAME: HAWCO MARY J
DA TE OF PAYMENT: 05/30/2006
POSTMARK DATE: OS/23/2006
COUNTY: CUMBERLAND
DA TE OF DEATH: 00/00/0000
NO. CD 006753
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
06122103 I $120.66
I
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I
I
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TOTAL AMOUNT PAID:
$120.66
REMARKS:
CHECI(# 568
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
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 06-0370
06122103
05-18-2006
REV-1543 EX "AFP <0"9-00)"
EST. OF MARY J HAWCO
S.S. NO. 100-20-7545
DATE OF DEATH 01-30-2006
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
[X] CHECKING
o TRUST
o CERTIF.
CATHERINE M HAWCO
81 LEE ANN CT
ENOLA PA 17025
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MEMBERS 1ST FCU 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) 78?-B32?~
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 198689-11 Date 11-13-2000
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
2,010.98
50.000
1,005.49
.12
120.66
TAXPAYER RESPONSE
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".
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
PART
[!]
above information and tax due is correct.
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.
[CHECK ]
ONE
BLOCK
ONLY
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.
PART
~
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
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
OF
I
2
3
4
5
6
7
8
x
TAX ON JOINT/TRUST ACCOUNTS
x
PAYEE
DESCRIPTION
AMOUNT PAID
I
$
TOTAL (Enter on Line 5 of Tax Computation)
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.
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TAXPAYER SIGNATURE