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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
06122105
05-18-2006
REV-1543 EX AFP (09-00)
EST. OF'MARY J HAWCO
S.S. NO. 100-20-7545
DATE OF DEATH 01-30-2006
COUNTY CUMBERLAND
TYPE OF ACCOUNT
[X] SAVINGS
o 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 prDvided the Department with the infDrmatiDn listed belDw which has been used in
calculating the pDtential tax due. Their recDrds indicate that at the death Df the abDve decedent, YDU were a jDint Dwner/beneficiary Df
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
tD this fDrm and return it tD the abDve address. This accDunt is taxable in accDrdance with the Inheritance Tax Laws Df the CDmmDnwealth
of Pen~~ylv~~ia. Que~tion~ ~ay ba 3~sM~:ed by ~al1i~~ (7l7) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 198682-05 Date 02-16-2002
Established
x
19,884.97
50.000
9,942.49
.12
1,193.10
TAXPAYER RESPONSE
To insure proper credit to your account, two
(2) cDpies Df this nDtice must aCCDmpany YDur
payment tD the Register Df Wills. Make check
payable tD: "Register Df Wills, Agent".
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
NOTE: If tax payments are made within three
(3) mDnths Df the decedent's date Df death,
YDU may deduct a 57. discDunt Df the tax due.
Any inheritance tax due will becDme delinquent
nine (9) mDnths after the date Df death.
Tax
PART
[!]
A. ~ The above information and tax due is correct.
1. YDU may chDDse tD remit payment tD the Register Df Wills with tWD cDpies Df this nDtice tD Dbtain
a discount or avoid interest.. or you may check box "A" and return this notice to the Register of
Wills and an Dfficial assessment will be issued by the PA Department Df Revenue.
[CHECK ]
ONE
BLOCK
ONLY
B. [] The abDve asset has been Dr will be repDrted and tax paid with the Pennsylvania Inheritance Tax return
tD be filed by the decedent's representative.
C. [] The abDve infDrmatiDn is incDrrect and/Dr debts and deductiDns were paid by YDU.
YDU must cDmplete PART ~ and/Dr PART ~ belDw.
x
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
TAX ON JOINT/TRUST ACCOUNTS
OF
1
2
3
4
5
6
7
8
x
PART
[!]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
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. HOME ( )
WORK ( )
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