HomeMy WebLinkAbout94-00174
rUYoU43 EX AFP (10911.
COH>r";EAL1H Df PENNSYLYAHIA
.... tI.:P,:,' TlEtH OF REYENUE
BURElU Of IHDIYIDUAl lms
OEPI. /tOBOI
fIAAAJS8lJAQ, PA 1712'.0601
/</ /rJ~~./:~
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21. 'i '/
94105674
02-19-94
11,/
ESTATE OF BELICIC
S.S. NO. 179-10-5923
DATE OF DEATH 08-06-93
COUNTY CUMBERLAND
TYPE OF ACCOUNT
KATHERINE R ~ SAVINOS
CHECKINO
THUU
CERTIFICATE
REHIT PAYMENT ANa FORMS TO I
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MOSE
148 HERMAN AVE
LEMOYNE
KATHERINE R
PA 17043
HARRIS SAVINGS DANf( hu proylded thl Olpartunt with thll Jnforotlon IlItld below which has b..fl uud In calculltJno the
potlnU,1 tll( due. Their r.cord, Indlcatll that at th, death of thl abolll dlCldent, yoU wlr. a joint owner/beneficiary of thh account.
If yoU fI,1 thh Infor..tlon h lnoorr.,', ~h... obtain wrJth,~ corr,ctlon 'rol th'l flnanolal lottltullon, nttach II copy to 'hll for.
""lO4 ""+'11'" It t.. t~.. _"I'ItllI ,tldrn., Thl.. IIn('nllnt \" t"vlIlnl" I,. ""('n'rt~",." with th.- rnh"rltJln,.. hlt I "W'l "f Ih. r.oll.nnwllftlth nf P'nnrvl",,,,...l"
Quutlon, ..y b. an,.,er.d by clll1ng (717) 741.8117,
COMPLETE PART 1 BELOW M M M SEE REYERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Aooount No. 01-00037609 Doto 12-04-69
E.tablhhod
10,629.93
16.667
1,771.69
.15
265.75
TAXPAYER RESPONSE
~AILURI TO RISPOND WILL RESULT IN AN OFFICIAL TAX ASSESSNENT IASID ON THIS NOTICI
Aooount Dolono.
Poroont To..bb
A.ount SUbjoot to ro.
To. Rota
Potontlol To. Duo
x---
To Imur. prop.r crldlt to VQur !Iccount, two
IZI copl.. of thlt notlc. "u.t Meo'pany your
Plty'.nt to th. R.gl'hr of Willi, Mak. ch.ck
payabl. tal "R."hter of Willi, A"lnt".
x
HOTEl 1f tal( paY.lntl lIrt lIad. within thru
t31 fIlonth, Of the dleld.nt', dati of duth,
YOU fIlay dlduct 1I S% dhcount of thl hl( du..
Any Inhfllrltllncl hl( dUI will blco.. d.1Jnqu.nt
nln. (91 lonthl "Iter the d"t. of duth.
PART
m
[CHECK ]
ONE
BLOCK
ONLY
A. [] Th. above l,.,for..tlon and taw dUI I, corr.ot.
1. Vou "ay choo" to r..lt pay..nt to the R,ght" of Willi, with two cop II' of thl, notlc. to obhln
a dhco\.lnt or avoid Intlr..t, or YOU IllY ch.ck bOl( "1\" and '1turn thil notlo. to th, Rtghter of
WJlll nnd nn official a.9.....nt will bt I',uld hy th. PA O.part.'nt of Rlvlnu..
PART
~
TAli
LINE
If you Indlooto 0 dlff.ront t~roto,trl&o.o .toto your
roloUonohlp to dooodont I --It.Ll.l.. ~_ A' ~ .
1Ct.IUMN . \;UI'lI'UIA"lIUN U~ IliA UN "UUIIlIHUl>1 IlIOIOUUI'I,:I
I. Doto E.tablishod I /,)' <./ _ (.,0,
2. Aooount 801.noo 2 II) I iD :). iT. q ~
3, PlrCllnt ra)(.bll 3 )( It, !,.,Il''7
4. A.ount Subj.ct 10 To. 4 I I 7 I. I, II
5. Dobts ond D.duotlon. 5
6. A.ounl To.obb 6
7. To. Roto 7 X
e. To. Duo e
B. 0 Th. above "'It' hall bun or will b, reporttd llnd tal( pnld with thl Ptr.nlylVllnla Inherlhnct TalC return
to b, fU.d by the d,cld.nt's rtprtuntatlv..
,(
c. @Tht nboVII Infor.aUon II Incorrect and/or d.btl and deductl.,ns Nllre paid by YOU.
Vou .u.t cOlplttt PA~T IZlllnd/or PA~T f3l below. 0 _
L.:J l..:.J l.l . '11
~ F I CIA"; USE "(it[ \' 0 AAF
PA UEPARTH~T OF REYENUE
1,1
PAil
1
2
3
4
I ~ .,)
'"
-
,
PART
[!]
DATE
5 'i,j,
~,'
'II! u' <I 6
0(., 7
1M" ~() 8
DEBTS AND DEDUCTIONS CLAIMED
..,',
PAID
PAYEE
DESCRIPTION
AMOUNT PAID
TOTAL (Enhr on L1no 5 of To. Co.p"btlon I I
IItPl~lr Pln.ltte. of Plrjury, I dlClhrl thlt thl flClh I havI r.PClrt.d Ibov. are truI, ClorrlClt Ind
oo~(; 10 th. b..t of ( kIlQWlb~. ond boUof. HOME (1..u.) 1/(,. 3 -1/ {I ~~
TA'xI;Alth~:fb~u J.. I )7 <''''C_ W~~~EP~ONE N~MBER -:. ~
GENERAL INFORMATION
1. FAILURE TO RES~OND WILL RESULT IN AN OFFICIAL TA~ ASSESSMENT with appllool1lo Intorn! ..... on InfomUon
.ubl1tt,d b~ thl ftnanol.1 In.tUutlon.
Z. lnherltene. t.1C beaOlKl' dlllnqu.nt nine .onth. 1ft., thl dlced,nt', dati of dtlth,
5, " Joint ICOount 1. taMIOI'lv," though the dlc.dent', na.. WI' added a. , .attar of conv.nl.nc..
_, Account. (Including tho., held b.twI." hu.blnd and wi'.) which the dle.d.nt put In Joint n.... within on. VI.r prior to
d,.th Ir. fully t.~~l. II trln,f,r,.
5, Aooount. ..tltblhhed Jolntlv bit".." hu.b.nd and w1f1 lor. than on. YlIllr prior to dutn Irl not t8Mlbl"
6. Acoounh held by . dlc.d.nt "In tru.t for" anoth.r or other. IIr. t'lClbl. fulh.
'-'.~.r . -
REPDRTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE
1. BlOr.l(. - If thl Infer..tlcn and COllflutatlon In the notJcl ar. corr.et IInd dlduction. ar. not bllng ol,I.'d, plao. .n "X"
In block "A" of P.rt 1 of thl "Tup.y.r R..pon.... IIctlon. Sign two copl11 end .ub"lt th.. with your chick for the llIOu"t of
till to thl Rlohtlr of Will. of the county Indlc.ted. Th. I)lpart..nt of R.v.nuI will h.uI en (lfflc1lL e.......nt
(For. R~V.IS41 EK) upon rlcllpt of thl Rlturn frol thl Regl.tlr 0' Wlll..
2. aLOCK a . If thl ....t ,plclfllld on thlt noUcl h.. hun or w111 bl reported and t,U( paid with thl P.nn'Ylvanla Inh.rlt.ncI
TIM Rtturn fUtd by thl d.cld.ntl. rtpr..lntlltlvl, plecl an ")C" In block "a" 0' Part 1 0' thl "TaMp.y.r R..pon.... 'Ictlon. Sign ana
COpy .nd rlturn to the PA C.part.lnt 0' Rlvlnu.., aurtau 0' Indlvldu.1 TIMII, CIPt 2110601, Hlrrltburv, PA 171211-0601 In the
envllopl provld.d.
~. "lOCI( r ~ " thll "ntlCI In'nr...tJfltl It lnoorrlllct and/or dlductlon. are .,.lM clallld, ch.ck block "COO and colpht. Part. 2 .nd S
Iccordlng to thl In.truotlon. bllow. Sign two COP.lIl and .ub.lt thll with your chick for thl ..aunt 0' tlM ply.bll to the Rftgltt"
of Willi of thl county Indlcltld. Thl PA O.putl.nt 0' R.VlnUI will lllu. an official as....l\lnt (Fora REV-1541 E)c1 upon rlcolpt
of the return frol thl AIglthr of will..
TAX RETURN - PART 2
TAX COMPUTATION
LINE
1. Enter thl date thl ,.ccouot orlglnaUY wa. established or tltlad in the .Inll.r IlChUng It dat. of d."th.
HOTEl For a dlud.nt dYing aft.r 12/IUIIZI Account. IIlhtch the dac.dlnt put In Jotnt nal.. within on. (1) Yllr 0' llllth Irl
hKlble fully II tran.flre. Howlv.r, therl I. an uclu.lon not to uClld H,OOO per tran.flr.. rlgerdl... of th. vllul 0'
the ICCOunt or thl n\lab.r of Iccount. h.ld.
If. double ..t"lIk (M_) appltr. b.fore your flr.t na.. In th. addrell portion of thlt notlct, thl U,OOO IMclu.lon
.lrlltly hll bltn dlducted frol the account balancl as tlpottad by th. fln.nclal In.tltutlon.
2. Entlr the totll blhne. c, the account Including Int.rllt lIccruld to th. d.tt of dtlth.
5. Thl perc.nt of the account th.t I. tnMabl1 for tach survivor I. detarllnld n. follow'l
A. The porclnt tllClbl. for j~lnt ....t. I.tabll.hld .or. than on. 'lIar prior to thl d.e.dtnt'. d.athl
1 DIYIDEO 8Y lDlAL HUHBER Of UIYIOED BY
JOINT OWNERS
EMINIPIII A joint all.t rtghtttad .In tht n.s.. (If
TOTAL HUHIIER OF )( 100 . PERCENT TA)cABLE
SURVIVIHG JOINT OWNERS
thl d.c.dlnt and two oth.r Plrscn..
I DIVIDED BV S (JOINT OWNERS) DIVIDED ftV 2 (SURVIVORS) . .167 X 100 . 16.n: (UXABLE FOR EACtl SURVIVOR)
I. The parcent hubl. 'or as..t. crllt.d within on. ynr of the d.c.d.nt'. dlllth or lIecountl ollln.d by thl d,cldtnt but hlld
In tru.t for Inothar Indlvldulll.) (trust bllllflchrl..11
I DIVIOED av TOTAL HUH!ER OF SURVIVING JOIHT
OWMERS ~ TRUtT aEHEFICIAnIES
)( 100 . PERCENT TA~A!lE
EMMP1., Joint ICCO...,t r.glstarld In th. Ill... of the dlcldlr,t and two other p.rlon. .nd ..hbU.h.d within on. y..r of dllth by
the d'Cldent.
1 DIYIDED BY 2 IIURYIYORS) . .50 X 100 . SD% llAXIBLE FOR CIC" SURYIYORl
~, The Noullt .ubjlct to tlM Ulna 41 It d.terlln.d by .ultlplylng th. account bllanct <1ln. 2) by th. pltctnt talClbll Uln. S),
S, \;;ntar tl'll total of the dlbt. InCl d.ductlon. It.t,d In Plrt ~.
6, Thlllount tllCabl, lllne 6) It d.tar.lntd by .ubtractlng the d.bh and d.duotlon. (IIn. 5) fro. th. alount .ubj.ct to tlX UJnl 4).
1. Ent" the approprllt. tlM rata 111n. 7) II d.t"lln.d below.
A. Trtn.fI" to Itn..l duclndlnh lnoludlng ,.thlt, lother, hu.band, wlf., .on, deught.r, grendchl111"n, .0n~ln'1a'l,
dtughtar~ln.AtW, .t.pchlld and th.lr I..u. atl hlCab1l at 11M Pltc.nt (6%>.
I. Tran.fl" to .11 oth.,. Including brother, .ltter, uncl., aunt, n.ph.w and nile. art ta)labla at flltun perunt <15iO.
C. If you chlnge th. t'M rlt., pl.... ,plclfy your rllltlon.hlp to the d.cldlnt In th. ar.. ptovld.d.
I. Th. .aount of tax 00. (Iln. 8) It d.tlr.ln.el by Iultlplylng the ft~Dunt tllMabl. (lint 6) by the tl)( rllt. <1 In. 7),
CLAIMED DEDUCTIONS - PART 3
DEBTS AND DEDUCTIONS CLAIMED
Allow.bl. d.bt. and d.ductlon. arl d.t.rtln.d a. follow'l
A. Vou I'VIIlY .ra rllPon.lbll for payltnt, or the ..tata IllbJlot to IId.lnl.trllltlon by a p.rlonll tlPr...ntatlv. It In.ufflcl.nt
to p.y thl d,duotlbl. It....
I. Vou 'otul1lY paid thl dtbt. .'t.r dl.th of the d.cldtnt and cln furnl.h proof 0' pay..nt.
C. C.bt. b.lng ollllld IU.t bl ltuhld fully In Pllrt 3. If lIddJtlon.i llpac. 11 natd.d, us. phln PIP.r e 112" II 11". Proof of
p'Ylant 11'1 b. n",,,.t.d by thl PA D.plttllnt of R.v.nuI.
TAXPAYER ASSISTANCE
IF YOU NEED FURTHER INFORMATION OR ASSISTANCE, CONTACT ANV
REGISTER OF WILLS, PA DEPARTMENT OF P.EVENUE DISTRICT OFFICE
OR CALL THE BUREAU OF INDIYIDUAL TAXES, TAXPAVER INQUIRY UNIT IN
~ARRISBURG AT (717) 787-8327,
RI!Y-1543 I!X AFP (1-911 *
COMHO~;"'AL TH Of J'EHNSYlYAHIA
.. Dl~l'~ ,-iUll .OF REVENUE
BUReAU DF IHDIYIOUAl TAX'S
DEPT. /&0601
IlARRtSlURO, PA 11126-0601
INFORMATION NOTICE
AND
TAXPAY~R RESPONSE
FILE NO. 21
ACN 94105673
DATI! 02-19-94
ESTATE OF BELIr.IC
S.S. NO. 179-10-5923
DATE OF DEATH OB-06-93
COUNTY CUMBERLAND
KATHERINE
TYPE OF ACCOUNT
R ~ SAVINOS
CHECKINO
TRUST
CERTIFICATE
BELICIC
148 HERMAN AVE
LEMOYNE PA 17043
~~l~J ~\ l;v f-
I' 'HV\ ~/e ~C 1.'7,'1~)
HARRIS SAVINOS RANK hu provld.d the Dlpart.. with thl InfJutlnn 1 htld below which hu blln ulld In calculaUng the
pot,nUtl hI( dUI. Thtlr r.card. Indlcatu that .t tt>> nth of the aboy, dle,d,nt, you wlr. a joint ownlr/btntf1clary of thlt lecount.
If you fHI thh Infar..Ucn It lnoorr.ct, pin.. oahln wrlttln corr.otlon frol the financial In.titutlon, athch a copy to thll for.
and r,tllrn It tn th_ I'lhflYlt luiclr..... Th\" lIocrount \. tlllC~hl" In IIr.r.nrnllnr.,. with tn_ lnh.rltl'l"'''. T'"1 1.....1" tk. i"n"."~I,,.~l.h..., 0.,.."\.....1"".,1..,
Qu"tlon. 'IY bt an.war.d by cIlllng (117) lal-B5~1.
COHPLI!TI! PART 1 BI!LOW M M M SEE REVERSE SIDI! FOR FILINO AND PAYHI!NT INSTRUCTIONS
Aooounl No. 01-00031609 0.1. 12-04"69
Eahblhh.d
Aocounl Bol.nc. 10,629.93
Porc.nl T...bh X 16 . 667
AMounl SubJ.ol Ie To. 1,771.69
To. Ral. X .15
Pohnllll T.. Dua 265.75
PART TAXPAYER RESPONSE
[01 FAILURI! TO RI!SPOND WILL RESULT IN AN UFFICIAL TAX ASSI!SSHENT BASED ON THIS NOTICI
..
M
J
REHIT PAYMENT AND FORHS TO I
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
To Inlur. prop.r cr.dit to your lIocount, two
(2l cop I.. of thll notlc. IIUlt !Iccollpllny vour
pllyunt to the R,gllter of Willi. Hllkl check
pllyabh tal "RIlIllhr of Wtlh, Aglnt...
HOTEl If talC paY'lntl arl IIbCG within thr..
(5) lonth. of th. dlcedlnt'. dati of d.ath,
vou .IIY d.duot II ~% dllcount of thl tlllC du..
Any Inherltanc. taw due will b.co.e d.llnquent
nln. (9) 1I0nthll lifter thl date of dnth.
[CHECK ]
ONE
BLOCK
ONLY
o The abov. InforllaUon IInd talC due it corr.ot.
1. Vou uy chao.. to ,.lIlt plIYII.nt to thl Righter of 141111, with two copl.. of thlt notice to obtain
II dltcount or "void Internt, or you .1lY chick bolC "An and return thll notlcl to the Rlglttar tlf
willi and an 01flcl111 o......ent wlll bl I..uld by the PA nlpartlllnt of Revlnul.
B. 0 The abovI nut hili beln or will bl report.d llnd tOlC paId with thl PennlylVllnla Inherlhnt'1 TalC return
to bl flied by the d'cldlnt'l rlpr..entlltlve.
C. ~ abov. Inforutlon 11 Incorrlct end/or d.bt. and dlductionl wire paid by you.
Vou IU.t cOllplete PART ~ end/or PARl [!] bilow,
If you indloal. . dlffaranl In ral., pi.." ahh your
rllatlon.hip to dlcedlntl--IJ..~.IA ~ ... ~
X
OFFICIAl. USE ONLY 0 AAF
f'AU IPA ~~RTHEI~! OF ~;~NUE
2
3
4
S
6
7
8
DEBTS AND DEDUCTIONS CLAIMED
-
PART
[3]
l"Ai( R~T"iili - (;url~UII\Hui'l
LINE I. Dala Eatobll.h.d
2, Account Balance
3. Plrclnt T.~lble
4. Anounl SubJaol 10 T..
S. Dabh .nd DaduoHona
6. Anount T..abl.
7. To. R.I.
8. To, Due
11\~ u~ ~uli'lI/TRUbl A~~uUN1~
u~
I
2
3. X
4
S
6
7
8
I ~ !
CT'
~,l
',<I
,..
'.
~I'" ,._
PART
[!]
DATE PAID PAVEE
: f
DESCRIPTION
AMOUNT PAID
I
TOTAL IEnlar on Llna S of T.. Co"pulallon)
I-
t
~
Unda. pen.IU.. of parjury, I daoJere Ihal Ihe faola I
conpl.l. 10 Ih. ha.1 of ny knowledga and bellaf.
~40~
TAXPAYER SIGNATURE
havI rlported abovI Irl true, correct and
HOME (}f)) 7(" -)' 'Ii/V) ~- _
WORK ( )
TELEPHONE NUMBER
GENERAL INFORMATION
,.. .
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHENT with ",lle..I. Int.rut .111' en Inferutl,n
lubaJtted b~ thl Hnenel.1 IntUtutlon.
2. InhlrJtancl tile btco,,, dlllnqu.nt nln. lonth. .'t,r thl dlc.dlnt', dati of duth.
3, A joint Iceolln' Is hobl. ."." ta,ough thl dlced.nt', nalll Wit added at a .athr of conyenl.ncl,
~, Aocount. (Including tho'l held b.twI." hUlbtnd and wi',) which thl dlcud.nt put In joint n.... wlthln ons v..r prior to
death Ir. fully hlCabl. II tranl'.r..
~, Account. .,tabll,hld jointly betw.." hUlband and wlf. lor. than one YI.r prior to doath art not taxabll.
6. Account. htld by . dlcldent "In trult for" anoth.r or other. er. hX8bl, fully,
REPDRTING INSTRUCTIONS . PART 1
- TAXPAYER RESPONSE
1. BLOCK A - If the Infor..tlol1 and cOlpuh\lon In thl (tOUCI ar. corrlet end dtductlon. art not btlng clallld, piau In ")("
In block "A" of Put 1 of the "TalCPIIYU Ruponll" notion. Sign two cor I., "nd lubllt th.. with your chick for the atount of
tftx to thl R,ght.r of Willi of the county Indlcllhd. Tho VIPlrt-.nt of AI"'lnu. "III ll1UI an offlcllllu......nt
(Fori AEY'154& DO upon rlcllpt of thl Rlturn frol thl R."lIhr of Willi.
Z. BLOCK fI - If the n..t IPlolfl,d on thl. notlol hilt bun or will b. r,porhd and tax paid with the P,nnlyl...anlll Inh.rltano.
TalC Alturn filed by thl dlc.d.nt', rtpr...ntfttl..... plao. IIn "X" In block "a" of Part 1 of thl "'lIlCPIYIr R..pon.." "otlon. Sign onl
oopy .nd rtturn to th. PA Vlpartllnt of RIl,llnu.. Buruu of Indi",lduII T8)(1I, O.pt Z&0601. ttllrrllburg. PA 11128-0601 In the
Invelop' provldld.
. !'.t'~!" C - U '~J f'",~I~~ 11'l~t'.....t1n" I~ 1,It1rorr.nt "nl1/nr dldu(ltJon. ar. hllllnQ dlll.ed, chick block "c" Md cOlplete Part. Z and 5
.ccordln" to the tnltruCltlonl bllow. Sign tWCl copl,. and lubllt thn wlth your eh.ck for th. a.ount of talC payabll to the Rlglthr
of Wlll1 of the county lndloattd. Thl PI. Olpartllnt of R.v.nuI will IlIuI em official u......ot (For" REV~1548 EICl upon r.c.Jpt
of thl rlturn frol th. Rlgi.tlr of Will..
TAX RETURN - PART 2
TAX COMPUT A TI ON
LINE
1. F.nt" thl d.t. the IIceount originally WII. ..tabUlh.d or tltl.d In thl unnlr IlCl,tlng at dati of duth.
HOTEl ror a d.ud.nt dyIng IIfhr 121121821 Accounts which thl dleld.nt put In jCllnt OIl'" within on. (1J year of dllth ar.
tlllabl. fully III tran.ft,.. ttow.v.r, thuI II an IIIclu.lon not to .JoIcud t3,OUll plr trlml"rll rlgardltu of thl I,IlluI of
the locount or thl nu.b.r of /lecount. h.ld.
If. daub I. alUrllk (u) apPurI blfo" your flrlt na.. In the Iddr... portion cf thll notlc.. thl U,OtlO IlCclu.lon
.lr..dY h,1 b..n dlductld frol thl aocount bnlanel al rlPort.d by thl flnlnolal Inltltutlon.
Z. Entlr thl to\81 bahnu of the account Including lnhrllt aecruld to thl dati cf dlath.
5, Th. perc.nt of the account thllt Is taMabl, for IIIch lur...lvor It dlttrllln.d .1 follow'l
A. The ptrClnt t&lClllbl. for joint "...tl utabllshld lore than onl Ylllr prior' to thl d.c.d.nt', duthl
I DIYIDED BY TOTAl HUMBER OF
JOINT OWHERS
ElClHtIJlll A joint u..t rlglltl"d
DIVIDEO BY TOTAL HUMBER OF X 100 . PERCENT TAXABLE
SURlJllJlHQ JOINT OWNERS
In the na.. of th. d.cadent and two othlr plrlonl.
1 DIVIDED flV 5 (JOINT OWNERS) DIVIDED BY Z (SURVIYORS) . .167 X 100 .. 16.1% (TAXABLE FOR EACH SURVIVOR)
B. Thl perclnt talCablt for ....t. cruhd within on. yur (If thl dlludlnt'lI dllllth or aceounU own.d by thl dlc.dlnt but hlld
In trult for aooth.r IndlvlduaH.l (tru.t blnlflclarl'~)l
1 DllJlOED BY TOTAL HUMBER OF SURlJlVIHO JOIN'
OWNERS OR TRUST BENEFICIARIES
)( 100 . PERCENT TAKABLE
Ex'.Pltl Joint account rtgllttrtd In thl nalt of th. dlcedlnt and two other plrlCnl and utablllhld within onl YllIr of duth by
the dle,dlnt.
1 DIVIDED BV Z (SURVIVORS) . .SO )( 100 . 50% (TAXABLE FOR EACH SURlJIVORl
4. Thl alount lubj.ct to till (lInl. 41 11 dltlrlln.d by mJIUplYlng the llccnunt bahnc. (lIn. 21 by th. p,rclnt hlllblt (.\Jnl S).
5. Enttr tht to\81 of tilt d.bt. and dlduotlon. 11Itld 1n ~trl 3.
6. Thl 1lI0unt tllCtble (11nl 6) 11 dthrtlmuS by lubtraoUng tht dlbt, and d.duotlonl (lln. 51 fro. th. alooot .ubjeot to talC (lln. 4),
7. Enter th. Ipproprttt. till rate (lInt 7J II d.ttr.lnld bllow.
A. Trllfllf"l to lInlll dllctndant. Including fatner, "other, hu.band, wl#l. Ion. daughttr, grandChlldr.n, lon-In-law,
dtughter-In-law, ,ttpchl1d And th.lr IlIu. ar. talCabll lit .Ix perClnt (6%l.
8. Tranlflrs to all othl,. Inoludlng brother, .I.tor, uncll, aunt, nlPh.w and nl.ct art taMable at f1ft..n JJlrclnt (151:),
C. If you Clhlllngl the ta)( rllt., pi.... IPlcH'} ~.our rthUon.hlp tc thl dleldlnt In the Brill provldld.
8. Th, atount of talC du. (IInl &) 11 dltlf.lnld by llultlplYlng thl ucunt taMabll 11In. 6) by thl tIIlC rlltl (1ln, 1).
CLAIMED DEDUCTIONS. PART 3
OEBTS AND DEDUCTIONS CLAIMED
AlloWlbl. dlbtl nnd dlduotlonl arG ritt.r.lnld II folloWl1
A. You hv.lh ~rt rupon,lblt for paYllnt. or thl Iltatl IUbject to adelnhtratlon by . Plr.onal rtpru.nt.tlvl 11 In.uffloient
to PlY thl dlductlbll It..l.
B. You lotua11y paid thl dlbt. nft.r d.ath of thl dle.d.nt and cftn furnllh proof of ply..nt.
C. D.bt. bllng olal.,d .u.t bl Itulud fully In Part 3. If addItional Ipael It n..dld, ul. plain f'lap.r 8 1/2" lC 11". Proof of
plyt.nt .IY bl r.qul.tld by thl PA OIPart.,nt of Rlv.nu..
TAXPAYER ASSISTANCE
IF YOU NEED FURTHER INFORMATION OR ASSISTANCE, CONTACT ANY
REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE
OR CALL THE BUREAU OF INDIYIDUAL TAXES, TAXPAYER INQUIRY UNIT IN
HARRISBURG AT (717) 787-8327.
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PURPOSE Of
NOTICE,
To fulfUl thl requirl..ntl of Seotlon 2140 of thl Inherltancl arId E.tate TaK ~ct, Aot 22 of 1991. (n P,S,
SloUon 2140),
PAYllEN1,
Oltaoh thl top portion of thll Hotlcl IInd lub,1t with your ply..nt to the Regl.t.r of WUlI printed on thl
rlv.rll .lcll,
-. Hake chick or MOney ord.r pavabll tOI REGISTER OF WILLS, AGEHT.
All paY.lntl rlollvld Ihlll fir,t b. appll.d to any intlrut which aay be due, with ,ny re..lnd.r applied to the taK,
REfUND (CRI,
A r.fund of 0 tl)( orldit, which 10111 not requutld on thl tax return, a.y b. r.qu..tld by cOMPleUng an "Appllcatlun
for Refund of Plnn,Y1Vllnla Inhlrltance and Eotate TaK" (REV-I3l!), Applications are available at thl OffiCI of
thl Rlght.r of Willi, ftnyof thl 23 RlVlnul Dlltrlot Offlcu or by oall1ng thl IP.cial 24-hour an.w.rlng IIrvl01
nUllblr. for for.. ordlrlngl In Plnn.ylvanla 1-800-362-2050, outsld. Plnnlylvanla and within loclll
Harrisburg .rll (117) 187-8094, roo I (717) 772-2252 (Hurlng lapairtd Onh!.
OBJECTIONS I Any party In Inter..t not laUstlld with thl appralsA.lnt, allowanol or dllallowllnce of dlductJon. or u......nt
of tl)( (inoludlng discount or IntereltJ II .hown on thll NoticI lIay obJlct within shety (60) day" of reclipt of
thll Hotley bYI
-.written prot..t to the Pol Clpart,,,nt of Rlv.nul, Board of ApPIDI., O.pt. za1021, Ilarrl.burg. PA 17128.1021, OR
--.Ieeting to havI thl lIaUer deteralnld at thl audit of thl aocount of thl Plrsonal rtprluntatlv., OR
uapp..l to th. Orphan.' Court
AD"IH-
ISIAAlIVE
CORREClIDH$,
Faotual errort dltcaYlred on thlt as......"t .hlJuld b. nddr....d In writing tOI PA O'llllrt..nt of Rtv.nuI,
Bureau of Individual Tax.., AnNI Post Au.....nt R.vlew Unit, OEPY, 280601, Hlrr-Itburg, Pol 11128.0601
Phone (117) 787-65050. Su page .s of the bookllt "Instructions for Inheritlnc. Tal( R.turn for a R..ld.nt
Dlc.dent" (REV-1S01) for IIn 'Kpl.natlon of lld.lnlltrfttlvlh correctable .rrors,
DISCDUN1,
If any till due 11 p.ldwithln thr.. (1) callndllr lonths after the dlc.d.nt'. death, .. flvt p.rclnt (Sin
dltcount of the tali' paid II allow.d,
IHlEREST,
Inter..' It charg.d big Inning with first day of d.llnqu.ncy, or nln. (9) 1II0nth. and eml 11) dlY
fro. thl d,t. of dllth, to the det. of pIIYIII.nt, YaK" which Llo..e dllinqulnt Lefort January 1, 1982
bllr Interllt It thl rate of IlK (6%) perolnt PI' annUM calculated .t . dally rat. of ,000164.
All taK" which ble... dllJnqlJlnt on or after January 1, 1982 will bear Jnt.r..t at a rate which will vary fro.
-cal.ndar yssr to cal.ndlr Ylar wJth th.t rat. announc.d by thl PA C.part.lnt of R.v.nu., Thl appllcllble
Inter..t rat.. for 1982 through 1990\ ""
'tW Int.nlt Rltl Oall~ Int.r.st Factor \:or Int.rut Rat. CIJl~ Intlr..t Faotilr
1982 m .000548 1966 10% .ooom
19U I6X .000436 1917 9% .000241
1984 m .000501 1966-1991 11% ,000501
1985 13~ .DOD5S6 1992 9% .0DDm
1995.1994 7% ,000l9Z
..Interllt It calcul.tld II followtl
INTEREST . BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
~.Any Notlct I"uld .ft.r the taK blco... d.lInquent will refl.ct an 1ntlrllt oalculltion to Ilft..n (UI daVI
beyond thl detl of thl........nt. If pIY.lnt It lIIade .fter the lnter..t COlIPutlUon dltt .hown on th,
Notice, addition.! int.r.at IIU.t ba calculat.d,
:3 13 IOC{ p.;-J,
/ L/- /1:;- /3
REY-1548 EX AFP (10"931*
COHHONWEAlTH Of PENNSVLVANIA
DEPARTMENT OF REVENUE
!IUREAU OF IHDllJlOUAl TAIlES
Of PI. 280BOl
HARRISBURG, PA 1712e-0601
',I,
c,
NOTICE OF INNERITANCE TAK
APPRAISE"ENTl ALLOHANCE DR OISALLOHANCE
OF DEDUCTION., AND ASSESSMENT OF TAK ON
JOINTLY HELD OR TRUST ASSETS
DATE lZ-1Z-94
COUNTY
CUMBERLANO
ESTATE OF BELICIC
KATHERINE R DATE OF DEATH 08- 06-93
FILE NO. ZI 94-0174
S.S/D.C, NO. 179-10-59Z3
KATHERINE R MOSE
148 HERMAN AYE
LEMOYNE PA 17043
ACN
94105674
REMIT PAYMENT TO:
REG1STER DF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
r- Aftounl R.ftlth~=1
CUT ALONG THIS LINE .. I<ETAIN LOWER PORTION FOR YOUR RECORDS ~
R 'EV: iS4"S - E'if. A j: p.- n"O: ijiY -.. - - - - - - - - - - - - - - - - - --- -.. - - - - -- - - - - - - - - - - - - - - -. -. - - - - -- -- - - - - - - - - - - - - - - - - - -.
-. - - --
NonCE OF INHERITANCE TAX APPRAISEMENT, A~LOWANCE OR DISALI.OWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 1Z-1Z-94
ESTATE OF BELICIC
KATHERINE R DATE OF DEATH 08-06-93
COUNTY CUMBERLAND
ACN
94105674
FILE NO. Zl 94-0174
TAX RETURN WAS,
S.S/D.C, NO, 179-10-59Z3
(X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION, HARRIS SAVINGS BANK
ACCOUNT NO.
01- 00037609
TYPE OF ACCOUNT, (Xl SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED lZ-04-69
TOTA~ TAX CREDIT
BALANCE OF TAX DUE
n ___''''0___0''''_
INTEREST
I TOTAL DUE
IF PAID AFTF.R THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ,
IF TOTAL DUE IS LESS THAN .1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRI, YOU "AY BE DUE A REFUND,
SEE RF.VERSE SIDE OF THIS FORM FOR INSTRUCTION5. )
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxabla Amount
Tax Rate X
Tax Due
10,6Z9,93
0,166
1,771.69
,00
1,771.69
.06
106,30
TAX CREDITS:
PAYMENT
DATE
OZ-ZZ-94
DISCOUNT (t)
INTEREST (-)
,00
RECEIPT
NUMBER
XA855956
.
NOTE, TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH Y2R TAX PAYMENT TO TliE
REGIP OF ,,\I!ILLS .j\tIlTHE
ABOVEl IlDRES!. Nrtft CUECK
OR MONEV ORQ5R PAo;;A4~E TO I
"REGlSTER OfhWILLS, 'AOEtH ,II
'\ ' ,
, t-.l
<:.:>
("
AMOUNT PAlO., f':: ,
30 '~ vi (I
.'1.
,.
_J_n....____..
106,30
,00
,00
,00
"
PlJRPDSE OF
NOTICE.
To fulfill the requlr,""t. of Slotlon 21ltO 0' tht Jnn.rUanel Ind Estat' 11X Aot, Aot 2" of 1991. (12 P.S.
StoUon 21..0),
PAYllEN1,
D,tton tht top portion of thl' Notlel and tubalt with your p~v..nt to the Rlgllt.r of Willi prInted on the
rlv.r.. lid'.
.. Hike chick or .onlY order payablt tOI REGISTER OF WILLS, AGENT.
All Plv..ntl r.celvld .h,11 flr.t b, applied to Bny Int.r..t which ..y bt dUI, with any r...lndtr applied to the ta~,
REFUND (CR)I A r.fund of a taM cr,dlt, which wo. not r.qultted on the ta~ return, .ay b, r,qultted by OOlplttlng an "Application
for R,fund 0' Plnn,vlvanh Inhulhnct and E.tlh TaMil (REV-13U>. Application. ar. available at tli, OffiCI of
the Rtgllhr of Wllh, IllY of ttlt 23 RevenuI District OffiCII or by calling th, 'Plclal 24"hour an.w"lng IIrylc.
nu~.r. for 'or.. ord.rlngl In P.nn.yIYlnla 14800~362.2050, out.Jd. PlnntylYlnls and within local
Harrl.burg Ir.. (111) 161.8094, TDD' (711) 172-2252 (H.drlng I.pllrld Only),
OBJECTIOHSI Any party In In1er..t not .atJ.fl.d with the appral....nt, allowancl or dl.allowlnc. of d.ductlon. or a.......nt
of tak (Inoludlng dl.count or Int.r..t) a. ~hown on thl. Hotlc. .ay objlct within IIMty (60) day. of rlcllpt of
thll Hotlce bYI
~.wrJttln protllt to the PA D.part..nt of RIy.nu., Board of A"p.ah, n.pt. 211021, Harrhburg, PA 11128.1021, OR
~~.llotlng to heY' the .,tt" deter.ln.d at the audit of the account of the per.onal r.pn..ntatlye, OR
..app.al to the Orphan.' Court
ADHIN.
ISTRITIYE
CORRECTIONS. Factual error. dl.coy.r.d on thll a.......nt .hould bl addr....d In writing tal PA O.part..nt of R.y.nuI,
SurllY of Individual TIM", ATTHI Po.t A.......nt Rlvl.w Unit, DEPT. 280601, Harrl.burg, PA 1712840601
Phonl (717) 187.6505. S.. page 3 of the bookl.t "In.tructlon. for Inherltanc. T"lC Return for a Rllld,nt
Dlcldent" (REY.IS01) for an .lCplanatlon of ad.lnl.tratJv.IY corr.ctable .rror..
DISCOUNT.
If any talC due I. peld within thr.. (3) cal.ndar lonth. aft.r tha dac.dlnt'. d,.th, a fly. p.rcent (S~)
dl.count of thl tllC Plld I. allow.d.
lN1ERESlI
Intere.t I. ch.rged b.glnnlng with flr.t dlY of d.llnquency, or nine (9) .onth. and onl III dlY
froft the dlt. 0' delth, to thl dltl of pay.,nt. TaMI' which blca., dllJnqu.nt b.for, Janu.rv I, 1912
bl.r Int,r..t at the rlt. 0' .JM (6~) plrc.nt plr annul calculat.d at a dally rate of .000164.
All talC.. whloh bloa.1 dlllnqu.nt on or 1ft" January I, 1982 will bur Int,,"t at a rat. which will vary fro.
c.lend.r y..t to cal.ndar y.ar with that rat. Innounc.d by th. PA D'Plrt..nt 0' Rlv.nUI. Th. appllclble
Inter..t r.t.. for 1982 through 1994 Irll
'/air Intlr..t A.t. Dlllv Int.r..t Factor :wr Intl"lt RU. DllIv Interllt Flctor
1912 m .000&48 1986 lDX .DOOm
1913 16X ,000431 1981 9:': .000241
198\ m .000501 1988-1991 llX ,DOOm
I98S m .0005S6 1992 9~ ,Doom
199H994 IX .000192
u Interll' II Calculated a. followlI
INTEREST . BALANCE OF TAK UMPAID X NUMBER OF DAYS DELINQUENT K DAILY INTEREST FAC~DR
'.An~ Hotlet I'.ued ft,tar the t,lC b.oo... dellnqulnt will r.fl.ct an lnt.r..t cllculatlon to flfte.n CIS) d'~'
btVond tht d4te 0' th. ........nt. l' Ply..nt 1. .Id. a,t.r the Int.r.., cOlPut.tlond". .hown on thl
NOtlcI, addltlona. I"terllt 'Ult b. ofllculatld.
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