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COHttDHWEAl HI Of PO'tSYlIJAHIA
DEPlRTHEHT Of REYEtfJE
BUREAU Of INDIYIDUAl TAXES
DEPT. 210601
HARRISBURG, PA 11121-0601
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INFORMATION NOTICE
AND
TAXPAYER RESPONSE
DALEV
303 N 23RD ST
CAMP HILL
ESTATE OF CARIOLA
S.S. NO. 179-26-7408
DATE OF DEATH 04-27-94
COUNTY CUMBERLAND
6
FILE NO. 21. '1'1- (,'1 I
ACN 94131442
DATE 07-26-94
TVPE OF ACCOUNT
~ SAVINGS
CHECKING
TRUST
CERTIFICATE
MICHAEL
BERNICE H
PA 17011
REMIT PAYMENT ANO FORMS TO.
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
DAUPHIN DEPOSIT 8K & T h.. provld.d the D.putunt wlth the Infor.aUon Illhd b.lo", which h.. b..n u..d In calcuhUna the
potentl.l t.x dUe. Th.lr record. Indlcat. th.t at tha d.ath of the above dac.d.nt, you war. a Joint ownar/b.naflclarv of thl. .ccount.
If you f..l thl. Infor.atlon I. Incorr.ct, plaa.. obtain wrlttan corractlon froa the flnencl.l In.titutlon, attach a COpy to thl. for.
and r.turn It to the abova addr.... Thll account I. tftxabla In accorrlanca with the InharltftRc~ T.. L.wI of tha Co..onwaalth of pann,Ylv.nla.
Qua.tlonl .ay ba an.wared by calling el17) 781-8121.
COMPLETE PART 1 BELOW M M M SEE REVERSE SIDE FOR FILING AND PAVMENT INSTRUCTIONS
Account No. 0021501939 o.t. 09-11-81
Edablhhad
To In.ura proper credit to your account, two
CU capl.. of thll notice .....t .ccoapany your
pay.ant to the Aaglltar of Willi. "aka check
payabla tal ~Ragl.tar of Willi, ADent~.
912.01
50.000
456.01
.15
68.40
TAXPAYER RESPONSE
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSNEHT. BASED ON. THIS NOnCE
Account Balanca
Parcant Taxable
A~ount Subjact to Tax
Tax Rat.
Potantlal Tax Dua
PART
[!]
[CHECK ]
ONE
BLOCK
ONLY
PART
~
TAX
LINE
r.:TURN - COMPUTATION
1. Oat. Eatabllahad
2. Account Balanca
3. p.rc.nt Taxabla
4. A.ount Subjact to Tax
S. Dabt. and Daduction.
6. A.ount Taxabla
7. Tax R.ta
a, Tax Dua
PART
~
DATE
PAID
PAVEE
HOTEl If tax pay.ant. ar. .ada within thrae
(]) eonth. of the d.c.d.nt'. data of daath,
you ea~ d.duct a 5% dl.count of the taM du..
An~ Inherltanc. ta. due will b.c~ d.llnquent
nine (9) .onth. .ft.r th. data of daath.
K
K
OF
1
2
3 K
4
5
6
7
8
rAD
1
2
.3 ..
4
5
6.
7
8
CLAIMED
A. ~ Th. abava Infor.atlon and tax dua 11 carraet.
1. You .ay chao.. to r..lt payaant to tha R.gl.tar of Will., with two cop I.. of thl. notlc. to obtain
. dllcount or avoid Int.ra.t, or you ..~ check box ~A" and return thl. not lea to the R.gl.tar of
Will. and an official .......ant wlli b. I..ued by 'h. PA D.part..nt of Rav.nue.
I. [:] Th. .bov. ....t ha. b..n or will b. report.d and t.. paid with tho p.nn.~lvanl. Inh.rltanc. Tax raturn
to ba fll.d b~ the dac.dant'. repr...ntatlva.
C. 0 The above Infor..Uon h Incorract and/o~.bh and d.dUctlon. ",.ra paid by ~ou.
You .....t COllPlat. PART 0 and/or PART ~ balo",.
If you indicata a diffarant t.x rat., pl.... .tat. your
ral.tion.hip to d.c.dant,
TAX Ot! JOINUTIlIJST ACCOUt!TS
K
DEBTS AND DEDUCTIONS
DESCRIPTION
\
TOTAL IEntar on Line 5 of Tax Computation)
OFFICIAL USEONL V. 0 AAF
PA.. DEPARrHEN:rOF. ~EV,"NUE
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AMOUNT PAID
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par jury, I d.clara that tha fact. I
.y knONladga and baliaf.
h.va raport.d abova .ra trua, corract
HOME (:~7 J :31- (" ~ 't\
WORK ( J
..... r:-nun t.JIIMD.~
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GENERAL INFORMATION
1. fAILURE TO RESPOND WILL RESULT IN AN OFfICIAL TAM ASSESSHENT '11th ~lICllbI. Intarnt baled on Infor..tlon
.ubalttad by the flnancl.l Institution.
2. Inharltanc. tax beeo... delinquent nln. .onths .tt.r U. decadent'a d.t. of d..th.
5. A joint .ccount h t.xable .ven thoUgh the decadent'. naaa w.. add.d .. . .att.r of canvenl.nc.,
4. Account. (Including tho.. held b.tw.en hU.band and wlf.) which thll d.c.dent put In Joint naa.. within ana y.er prior to
d.ath ara fully t.xabl. .. tran.f.r..
5. Accounts nt_lhhad Jointly bat.,.." hUsband Ilnd wlf. IICIr. than one y..r prior to d.ath ar. not taxabl..
6. Accountl held by . decadent ~In tru.t for" ano~r or a~rs .r. t.xabl. fully.
REPORTING INSTRUCTIONS - PART 1
- TAXPAVER RESPONSE
1, ILOCK. _ If the lnfor..tlon and coaputatlon In the not Ie. ar. corr.ct and daductlonl ar. not baing clalaad, plac. an "X"
In block ~AW of Part 1 of the ~T.xp.y.r Ra.pon.a~ ..ctlon. Sign two cop I.. and .ubelt th.. with your ch.ck for the aaount of
t.. to the A.gl.tar of Will. of tha county Indlc.t.d. Th. Depart..nt of Ravenue will I..u. an offlcl.l ..I....ant
(for. REV-15U [X) upon r.ulpt of the R.turn frCNI the Regllter of Wllh.
2. BlOCK I _ If the ....t .paclflad on this notlc. ha. bean or will b. reported and tax paid with thli Pennnlvanla Inharltlnc.
t.. R.turn fllad by the decedant's repr..ent.tlve, pleca an ~X~ In block ~Iw of P.rt 1 of the "taxp.yar Ra.ponl." .actlon. Sign one
copy and r.turn to the PA n.part.ant of Ravenue, lur.au of Indlvldu.l T.~as, Dapt 210601, H.rrllburg, PA 171ZI-0601 In the
env.lope provided.
1. BLOCK C _ If tha notlc. Inforaatlon II lncorr.ct and/or d.ductlon. ar. b.lng clal.ed, check bloc' ~C" and coapl.t. Plrtl 2 and 5
.ccordlna to the In.tructlonl below. Sign two cop I.. and .~It th.. with your check for the aaount of tax paYabla to the R.gl.t.r
of Wills of the county Indicated. the PA Dapartaant of R.venue will I.sua an official all...aant (far. REY-1541 EX) upon r.calpt
of the r.turn fr_ the R.glster of Willi.
TAX RETURN - PART 2 - TAX COMPUTATION
LINE
1. Ent.r the data the .ccount originally wal ..tabll.hed or tltlad In the .enn.r exl.tlng at data of dlath.
HOTEl for a d.cadent dying aft.r 12/12/121 Accauntl which the d.c.dent put In Joint n...1 within on. (1) ya.r of death .r.
taxabl. fully a. tran.f.r.. nowaver, th.r. I. an .xclu.lon not to .xca.d t1,000 par tran.f.r.a r.gardSa'l of the value of
this ac:caunt or the nuab.r of account I held.
If . double .It.rl.k (NN) .ppa.rl b.fora your flr.t na.a In the addr.11 portion of lhll notlc., the t1,000 axclu.lon
alr.ady has been d.ducted frDII the account b.lance a. rlported by the financial In.tltutlon.
2. Ent.r the total b.lanc. of the account IncludinG Intlr.lt accrued to tha data of da.th.
1. the percent of the account that II taxable for .ach .urvlvor II d.t.r.lned as follow.,
A. The p.rcent taxabl. for joint ....t. a.tablllhad acr. than ana ya.r prior to the d.c.dent.s deathl
1 DIVIDED BY TOtAL tUtBER Of
JOIHT OWHERS
Ex.-pla' A Joint ....t r.gl.tar.d
DIVIDED BY TOTAL HUMBER Of X 100 . PERCENT TAXABLE
SURVIYING JOIHT OWNERS
In the nb1t8 of the decadent and two oth.r p.r.anl.
1 DIVIDED BV S (JOIHT OWNERS) DIIJIDED BV Z (SURVIVORS) . .161 X 100 . 16,7X (TAXABLE FOR EACH SURVIIJOR)
B. Th. p.rcent t.xabl. for ....tl craat.d within on. yaar of the d.cad.nt's d..th or account. own.d by the dec.dent but held
In tru.t for another Indlvldu.Us) Urult b.n.UclarlnJt
1 DIVIDED IV TDTAl HUHBER DF SURVIIJIHO JOIHT
OWHEAS OR tRUST BENEfICIARIES
x 100 . PEACEHT TAXABLE
E)(8llpla~ Joint account r.glstered In the n... of th. decedent and two other person. and e.t.bllshed w!thln ana ye.r of d..th by
tha d.cadent.
1 DIYIDED BY Z (SURIJIIJORS) . .50 X 100 . SOX UAXABLE FDR EACIt SURIJIVORJ
~. The aaount .ubJ.ot to tex Cline 4) la d.teraln.d by .oltlplylng th. account b.lanca cllna Z) by the percent t.xable Cline S).
S. EntDr thw tot.l of th~ d.~t. and dedUotlc~. ll.ted In Pert 1.
6. The ..aunt t.x.bl. (lln. 6) Is dat.r.ln.d b~ lubtr.ctlng tha debtl and daductlonl (lln. 5) fro. the aaount .ubJect to t.K (lln. 4).
7. Ent.r the approprl.t. t.x rat. (line 1) a. deter.lned b.lDlif.
A. Tranlfer. to Iln.al da.c.ndants Including f.thar, ..th.r, hU.band, wlf., .on, daught.r, grandChildren, son-In-l.w,
daught.r-In-law, .t.pchlld and thalr II'u. ara tax.bl. at .Ix p.rcent c6~).
B. TrDRlf.rl to all ath.r. InclUding broth.r, sl.t~r, uncia, aunt, nlph.w .nd nlac. ar. taxabla at flftaen parc.nt cI5X).
C. If you chang. tha t.x rat., pl.... .peolf~ your r.l.tlon.hlp to the decad.nt In the araa provld.d.
8. The aaount of tax due (lln. 8) I. d.t.r.ln.d by aultlplylng the ..ount tax.bl. cllna 6) by tha t.x rata (lln. 7).
CLAIMED DEDUCTIONS - PART 3
DEBTS AND DEDUCTIONS CLAIMED
Allowabl. debt. and d.ductlanl ar. d.t.r.ln.d a. followl'
A. You legally are r..pon.lbl. for p.y..nt, or the .It.t. .ubJect to .dalnlatr.tlon by . p.r.onal r.pr..ent.tlva II In.ufflclent
to pay the d.ductlbl. It...,
I. You actu.lly paid the dabt. .ft.r d..th of tha dec.dent and can furnish proof of p.y.ant.
C. D.btl b.lng clal.ed .o.t b. It..llld fully In Part 5. If addltlon.l .pac. Is n.ad.d, u.. plain pap.r 8 l/Z~ . ll~. Proof of
p.y.ant ..y b. r.qua.t.d by tha PA D.p.rtaant nf Rlvanu..
. .....<.(.<..(.<<.. ..TAXPAVERASSISTAHCE.(..'"..' ,.<()..(...
. ... IFVOU. HEED FURTHERINFORMATIONOR.ASSISTANCE; COHTACTANV
. .,.... REGISTER OFWILLS,PA DEPARTMENTOf',REVENUE.DISTRICTOFFICE .....
OR ... CALL.' THE ... BUREAU.. OF INDIVIDUAL . T AXES;T AXPAVER.INllUIRV. UNITIH
. ..... HA~RISBURa AT(717)787~8327.><i
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m TOTAL AMOUNT PAID .68./10
art CW
RECEIVED BY II P~$N}'(!' ~/~\
MAr~Y C. LEW 6.(. /
REGISTER OF WILLS I
RECEIVED FROM,
&
ACN
ASSESSMENT l'l'
CONTROL ...
NUMBER
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BERNICE H DALr~Y
'('+1 "'1......a
303 NORTH 23RD STREET
CAMP HILL PA 17011
ESTATE INFORMATION.
~ FI MB R
(0121-1994-0691
EJ M CAR~OLA MICHAEL
I] 0 M
m
SSN 179-26-7408
FIR
MI
CUMBERLAND
A
REMARKS
BERNICE H. DALEY
SEAL
CHECK" 3718
REGISTER OF WILLS
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PIIIPDsE OF
NOTICE.
To fulfIll the r....r....b 0' hotJan 2140 of the lmerlbnui .... E.t.ta Tax lot, Act 22 of 1"1. (72 P.I.
Iectlon 2140).
PI. rtIEHT I
DIIhM:t1 the top portion of thl1 Notice MIl MAMIt ..Ith ~our paw...t to the A.....t.r of 'lUll prlnted on v..
rav.r.. I...
... .... check Dr -, ordrar ,,"1. tOI REOISTER CF WILLI, AGEHT.
AU p~t. "_.lvac1 -'-11 flrst be -.UMI to My Inta,...t which .., H Wa, ...th .., n..I,.,.,. BPPlled to the tax.
....... (ClIh · ro,..,. af . bx .,..It. ...1." ... not ,......t.. ... tho t... '.\\Im. _, .. ,......t.. b, C_I.Uno .. ....11..11...
for A.""-I 0' Pam.vlnnla lmerltanca MIl E.tat. Tax" (RE\I.lSU). App1JcaUon. .r. anU_Ia at the Offlc. 0'
the A....t.r of NU", SIn, 0' iN n A.v...... DistrIct Dfflc.. or b, c.Ulng tha ....1 24-hour an....rlng ""'.ce
n&IIIbar. for fO,...1 o"rlng, In Penna,lv..la 1-111"561-2050. oublda p.,.,.,lnn.a Ilnd ..Ith.n 10000l
Hlirrllburll er.. C71n 7.7-IOM, TDD. (717) n2-U5I: (....,.lng 1..,.lred Onl,).
D~CTIOHSI An, p.'h In Int.root not ..lhU.. olth tho "".1_1. .11...... 0' dl..II....... of -..11.... a, ....._1
of tax Clnchldlng dllcCQ'lt or Int.rs.u .. 8hoMn on this NoUca ..V object ..ltMn ...., (6D) dIIn 0' racelpt of
thh Notlc. bJl
....rltten prota.t to the PA o.p.rblant of Ravenua, IHrd of AlaPHIs, u.t. 2Ilall, Hlirrhburl, P' 17121"1021, OR
....IMUne to have the "U.r dat.r.1Md at thtI audit 0' tn. ~t of thtI parlOn81 rapr.lantlllva, OR
.........1 to the 0,.,..... Court
AD'UN.
ISTRATlVE
CORRECTIONS.
factu.l arror. dhcovar~ on this .....~t should H ~r"'ed Jn ..rlUng to. PA Dap.rt...,t of Ravenu.,
Bur... 0' InciSvJ_l T...., An)h Po.t A...I'-\t A.vl... Unit, DEPT. 210611, HarrlDurll, PA 11128-1601
PhoM (117) 717-6505. s.. pltge J of the booklat "Instruction. for JnhrlrJtwaca 'ax Aaturn for. A..ldant
Dac.dant" (R[Y"150lJ for., hplenaUon of adalnht...uvaIy correctabl. arror..
DISCIUIT.
If ." t.. due la p.ld ..lth!n thr.. (J) calendar IIOrllh. .ft.,. u. dacedant'. dHth, . five percant CS~)
dl.count of the t.. paid 1. al1owad.
INTEREsTI
Int.r.lt .. char..... bqlmlng ..Ith Urn day 0' dallnquanc" or nl,.. (9) IIOnth. .... one (1) dIIv
fro. tM dIIta of daath, to the dIIta of p.nent. Taxu tfhlch bM... dallnquent ba'or. January 1, 1912
baar lnhr.u .t the r.t. 0' .tx (U) perc."t par ...... calcul.ted .t a dal1~ rat. 0' .0DOI64.
All tax.. which a.c.. dallnquent on or aftar """rv I, 198Z will H.r Intar.lt at . r.t. which w111 var)' fr_
calend.r ~"r to calendar ,.ar with thet rat. WlnDUncMf b)' the PA na,.rt...t of Aavenue. Tha IIPPlIc_l.
Inter.lt r.t.. for "12 thrDUStl 1994 eral
Xur Inhl'..t Ret. D.I.v Intara.t FBatar l:ur lnt.r..t Aet. Dall", Inter..t FeetDr
1912 "X .DOOM' 19" lOX .000114
19.. I6X .DOOUI 1917 9X .ODOl47
1914 IIX .00OSOI 1911"1991 lIX .ODOSGl
"15 UX .00OS56 1"2 9X .000147
1"'-1994 n .000192
"-lntarut .. C111cuJatad .. followu
IHTEREBT . BALAMCE DF TAlC UNPAID X KUNBEI DF DA Y8 DELIHqllEHr X DAILY IHTEREBT FAC1'DR
".An)' Notice hlUed .ftar the tax becoee. delinquent ..111 raflect IIn Int.ra.t calculation to flU..... US) day.
ba1Dnd the dIIt. 0' the .....lIaWtt. If pa~t h .... .ft.,. the Int.r..t CDIIpUt.Uon dIIIta shown on tha
Notlc., additional Int.r..t BU.t be calculat~.
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