The URL can be used to link to this page

Home My WebLink About96-00143 , , .. ,7. , .... ., .' :; .~. . , I ,oJ' /, ~: ,to' ,~. " .,':' " " .:........./. '~.' t ~.~ .' :-,'..-';' . ,! ~'- ....)\ ," ,. '" ",~ . .", ' , , t;, t (-:'. ;:::' ( "." " .. , -, I ' ~. j:-'" ~' -" ,.' . ," . ,I " . '." ,.' .,:..~ .' ,. ,'1 , " .,. .. if:,..., ~: ",.'. >'4 " , ' " ~ 'I~:' ,~ ',' " ". .. ':,! .' ~ I"'" . :~:'~1"-,;-:-'~' ,J:: . .. .. ,.,' ~"; <;.,' '\ .~.~ .::.,~. ,'" t.P, ~t.' . r' ,_- .'. , . ~ , '. .. ," ,., , " , ' !:~~.,i.:t 2i~~":~" fro" ~<.;) ':" y~;:;':~:;'" ,'" ;":.;EJ.,',. .' ", " ' q ~. " .' .... ". . " I: ," :,.,:,: .' r'o . !i~'" " . ;" ,r,' )) '., ""' " ',.' ., " ",: i~r ~. ." " "r ,j h \,,' .:. " ,:;' .... ,,' v ", '., ,','.' ."', , ' , . ) "' . ~ , -: . :.., ;', '. '..',' ." " , '" ~~lo-". -....,.;..c _,..:-L-: r ....... ",___"_~.. ~'_'_.__ ..-.: o , ~ 1 'j \. I 4 . , " 1 . J I I , I \ . . , . .. -< i I ~ I . I I I I ,"' .... g , s\C!:: I 5;:;~ I >>><c.. , ... ciS . I .. ~ ,$ '-E I -0 =c; ; I c.':: . I ~ '" ,~ , I I i \ \ \ .~ ~', ....')"; '~~ c. r.. .... '. :'tl .,- D. 2 d:' - ~ Q},-J C!l c!. ~~ ~ d.1c::-; l-C/ - ,..-..J - 3 ~ (.Q C! ~ lI' .... . .-...''''.;;...."-;~-;.;.,..;.;.~,<.,, ',,-,::,-,..~- ~, :-_--l.,_,.__~ ? t'1 oJ II) ~ ~ tr rY' j ~ ~ 0 t-' - . ~ <t P ....I Q) - Vl "r-'~"--' ~ . - - - - - - - - - - , - I ! , I I I i t I. . " I " j , . t' I ',' <II ,.' ,J , ",fA'. i\"'. :......' f: , r I;. r: \ , I>'" \ ~. , ' i; I: ! .' J'" I , . " . ." .. .. .. ,'. I,: " , ...., 1'1, ~::I~ r'.' ~~~~ - . " -t .,'" I. ~ ,I (. f' ~ 1"'-1 t ' t f. f"l':> " ,. . .... \ . . 4 ,. "0. '. ,r, ~ \ . ,. i.!..f ~\,' " ',"t. , ~ .- . _ .,. , '" ' , , ".~ .- -, ... " ro " \. . "'. '~-'-'.".+....--"" - ; ~<,r;...J,i,~,';.,,..yt -.-.. --...... ..'-...."- . -.( -4 .- a.- , COMItCINWULTH OF PfHNSYlVAHIA IVIJlTMDlT 01' IIfVVU ~ 01 INDIVIDUAL TWI DOT. 110611 HARRlSIURG, PA 17111-D601 '* INFORMATION NOTICE AND TAXPAYER RESPONSE ..N"'....,",..., FILE NO. 21 - Y 6- , V3 ACN 96102189 DATE 02-10-96 TVPE OF ACCOUNT EST. OF VEL VA R DREI BELBI S 0 SAVINGS S,S. NO, 189-09-0088 0 CHECKING DATE OF DEATH 11-02-95 o TRUST COUNTY CUHBERLAND 00 CERTIF, RE"IT PAYIIEHT AND FORltS TO. REGISTER OF WILLS CUHBERLAND CD COURT HOUSE CARLISLE, PA 17013 HARV J LAUCK 614 N 2ND ST WORHLEVSBURG PA 17043 DAUPHIN DEPOSIT II( IT".. provll1ed the 0.."...... with tM Infor.tlon lilted bel_ Mhtch hili bMn u.~ In c.lcul,t1,. the patenUe. t.. dull. Their record. Indlclte thet at t.... deeth 0' t.... .txtvl dec..,.t, you wer. , Joint OWMrlbeneflcJ.rv of thle ecCOWlt. If you '..1 thl. In'or..'lon I. Incorrect, pl.... Obt,ln written correction 'ro. the 'Inencl,l In,tltutlon, ,tt.ch . copy to thl. for. ... nturn It to the MMNI Ilddr.... Thh ecCO!IIt 11 ....bl. In eccordMc. with 1M tmer1bnc:. hll L.... of t.... C.......lth of Penn.vlv."... OuII,tlon. ..., be enlWllrMl by ClUing (117) '11-IU7, COHPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAVHENT INSTRUCTIONS Account No. 8100206015 o.t. 05-01-91 hhbllahed 10,000.00 16,667 1,666.70 .06 100.00 PART TAXPAYER RESPONSE [!] . FAILURI 'l'O RUPOflD" WILL.. RElIUL T IN AN OFPlCIALTAX ASSI!SSN!HT lASED ON THIS HOTlCE """ To In",,.. proper credit to rour IICCGU\t, tlfO (1) copl.. of thl. notlc. .u.t IICCo.peny your p.~t to the R..I.t.r of Mill.. ~. check p.y~l. tal ....I.t.r of Will., 'tent", Account aalene. P.rcant Taxabl. --.nt S\lbjact to Tax Tax R.t. Potantl.l T.. Qua x HeIf[1 If t.. '.,....lI .r. -.eM .Ithln thr.. (5) MW'Ith. of the decelHrit". det. of "th, YOU ..y deduct . P: dllCOU"It of tM tn dull. Any lm.rltMCe tn due ..111 becOMl dlllnqt,IWlt nine ('I ~th. .ft.r the date of ~th. x [CHECK ] ONE BLOCK ONLY A, he ~. In'ot'llllUon ... tu due .. corrllCt. 1. You ..y choD.. to r.lt p.~t to tM R....t.r of MIIII with two copt.. of this noUc. to Obt.ln . dlscOU"lt or IWOld Int.r.d, or Vo:.I ..y chedr. bu. "A" WId return thh notlce to the R..lster 0' Will. WId an offlcl.l .....seent ..111 be I..ued by the PA Dep.rt-.nt of Revenue. I. 0 The move ....t hi. bHn or 11111 be r~rted and t.. p.ld IIlth the PWW'I.yl\lMI. rm.rltenc:. Tn nturn to be filed by \hi decedlnt". npn...,t.UVtl. C, 0 The ~e In'or.Uon I~ncorrect tndIo~t. and deduction. ...r. p.ld by you. You wit c~l.te PART ~ wrUor PAMT l!J bele.... If you indicat. a diff.rent t.x r.t., pl.... .t.t. your ..1.Uonlhlp to dacadant. '. '... '.OF:FICIALlUSEiONLYQAAF ....PAD~PARTHE,~[O~<REy~UE '.. PART I!l TAX RETURN - COHPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. O.t. E.tabl1.hod 1 2. Account aalance 2 5. P..cant Taxabl. 5_X 4. --.nt S\lbjact to Tax 4 5. Oabh and DeducUon. 5 6, --.nt T..abl. 6 7. T.. R.t. 7 X a. T.. Qua a PART [!J DATE PAD 1 2 .3 4 " .:5.. :6 7 8 DEBTS AND DEDUCTIONS CLAIHED r,:;.. "0. -' DESCRIPTION AHOUNT PAID PAID PAVEE I I TOTAL lEnt.. on Line 5 of Tax Coeput.tlonl . I~- Under penalti.. of perjury, I declare that the fact. I hay. reported aboy. ara true, correct and c.....lat. to t~ bed of .y knowledga and bellaf. 7 1 I ~ '~7 7/ ~ --f HOHE ('~' ) '7~",) -., I '.A ~al" J, WORK (~ ) _ TAXP IE - TELEPHO E NUHB R , "at" D T \ '. GENERAL INFORMATION 1, FAILURI TO RISI'OHlIIfILL RESULT IN AN OFFICIAL TAX ASSESSHEHT oIlh _11...1. Int....t ...ocI.. 1n.....U.. ~ltt'" b)' the flnenab. In.tltutlon. t. JMe"ltMOtl tax bee... dIIl1nquMt nine IMIl"Ithl Ifta,. the decedenP, dell of death. J. A Joint _cOY'll II t...bl_ nen thouIh 'M decedent', nMe WI IMIded II . .athr of convenience. 4. AcOOY'\tI Undue""" thOlI held tMtween hulbMd III'Id 1II1f.) ""'Sch the decedent put In Joint n.e. ..Uhln OM ,..,. pdo,. to ..th Ire fullW t....... .1 tnn,",.,. I. Aocountl ..t_UIhed Joln'lv bet...." hulbMd Met wlf_ Hr. then one ,..,. prior to eMI.h Ira not ,...01.. .. Account. held bV . decedent .In tru'l 'or. ~~,. or ather. Ira ',.lbl. full,. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. .LOCI A . If the 1"'orAtion ... COIIIPUtltlon In the notlc. ar. correct WId cMduc:t1on. .r. not being elalMd, ,llle. en "T" In bloa "'" of P,r' 1 of the "'_KIll"" ..spon.... ,ecUon. II." 1.-0 cop I.. Mid S\lbIIlt u,. ..lth your chedl for the MOUnt of t.. to the _..I,t.,. of Will, 0' the count, Indlc...... The PI o.plrt.-nt 0' Revenue 11I111 I.,ue en o"lcl.l ......-.nt ('orl R[V-l"l [I) upon recllpt ., the raturn fro. t~ A..I.tlr a' Will.. 2. ILOCK I - If the ....t IJ*lIfIN an thh notice hII. bHn or will" npartN ... ta. paid with the Penn.,lvMla InherltWICI TIU ..turn fllN by the decedent'. r..n..,htlva, plac. M ""X"" In black .... of Pert 1 of the .r..,a.,ar Ra.pan... .actlon. Sign ana c..., ..... nturn to the Pi Depart..,t of Ravenue, Iura.. a' Indlvl~1 'a.... Dapt ZlUIl, Harrisburg, PA 17121-0601 In the MYalope provided. S. ILOCI C - If the notlca Infar_tlon h Incarract and/or deduction. ara ..Ing clallled, chadt block .C- and cNP..ta Part. r ...t J according to the In.tructlon. balow. Sign two capl.. _ ....It thM ,.Ith .,aur chadt 'or the .-aunt a' tax pa,lIbla to the Reghta,. 0' Will. of ~ count, IndleatN. Tn. PA Q~rteent of Ravenue .111 I..ua an official .,...:a6nt 'tor. ~'V-I~' EX) upon rac.lpt a' the raturn fr_ the A..I.tar a' Willi. TAX RETURN - PART 2 - TAX COMPUTATION LIIE 1. Enta,. ~ det. the acCOWlt arl,I"IIY .... ..tllblhhad or tlUN In the ...-nar ..htlnt at data of death. HOltl Fo", decadent drl". aUa,. 121121111 Account. .....Ich ~ decadent put In Joint n... within ana (1) .,.a,. of death ar. taxllbl. 'ully .. trM,'ara. Howevar, thera h M a.clualon not to ..ceed tS,oao per tran,'ar.. r...rdla.. of the value 0' the accOW\t 0,. the f'Ulbar of account. held. If a doubl, a.ta,.11k C..) ."..r. ..fo,., your flr.t ~ In the addr... portion of thl. notlc., the .s,aaa a.clu.lon air"'" has bHn daductN fr_ the account b.llanc. .. raported by thl flnwM:lal In.tltutlon. r. Ent.,. ~ tot.1 ..1MC8 of the acCOU"lt Incluclll'll Int.,...t accrued to the ata of dIIIth. J. The pereMt of the account tMt la ta.llbl. for .ech S'Ur'Ylvar h dat.nlnad II fOU....1 I. ThI parcant tU1lbl. 'or Joint ...... ..t_lI..... .ora thM ana .,..r prlar to the decadent'. dnthl 1 DIVIDED IV TOTAL fUGER r:I DIVIDED IV TOTAL JUGER Of' X loa . PERCENT TAXAILE JOINT OWNERS SURVIVING JOINT OWNERS Ex...,I.. 'Joint ....t r....t.rN ln the nMI of the decadant and two ather per.on.. 1 DIVIDED IV J (JOINT OWNERS) DIVIDED IV Z (SURYI~) . .1'7 X lOa . 1'.1% CTAXAILE FOR EACH SURVIVOR) I. ThI pereMt taxllbl. 'or ....t. cr.atN within ana .,..r 0' the elKadent'. death or acCOlllt. owned b., the dleedent but held In tru.t 'or a'lOther Indlvls.I(a) Uru.t banaflclarlll)1 1 DIVIDED IV TOTAL frU(I[Jt Of' SURVIVUC JOINT OWNERS OR TAUST IEHEf'ICIIJIIES X 100 . PERCEHT TAXAIlE ExM!f'lal Jalnt ItCCD!..nt r.ghtarad In the n.. a' the decadent _ two other penon. and ..tllblllhad within ana .,..r of ctaath b., U. dKadant. 1 DIVIDED IV Z (SWVIV(ltS) . .sa X 100 . sax lTAXAIlE ,.- EACH SUNIVC.U 4. Thai -..,t IUbJect to tax Ulna 4) Is ."r.lned b., .,ltlphlno the ICCD!..nt b.lIWIC. Ulna Z> b., the percMt taxllbl. Ulna S). 5. Eftt.,. the total of the dabt, and deduction. ll,tad In P.rt J. ,. Thai..oY"lt taxllbl. Ulna ., h datar.lned by subtractll'll the dab.. and daGJctlon. Ulna S) 'rOIl the .......t subJKt to t.. (IIna 4>- 7. Ent.r U.. approprlata ta" rat. Ulna 7J ae dat.r'ln.d belOW, A. far dat., of death occurrl". aft.r '/30/94, the tax ,.at.. fa,. tran,'er. to .pou... .r. .. 'ollow'l J. Data. of de8th on or aftar 7/1/94 and bafar. 1111'S the r.t. I. S~. r. Dat.a of death on or a,tar 1111'S tran.f.r. to apou.a. will be t..ad at 02 tax r.ta. Nota. Far dataa of death ,rSor to 7/1/94 tran.f.r. to spou,., .ra taxabS. at 62. I. Tran,'ar. to llnaal de.eandanta Including f.ther, ..ther, .on, deught.r, ,r.,."Udr." .on.lnal.... daughtar.ln~I.w, .tepchlld and their I.IUS ar. t..Ibla at .1_ parcant ('2). C. Tran.far. to .11 other. Including brothlr, .I.t.r, unci., aunt, ~ and nlaca .r. ta.abl. .t fifteen parcent (ISX). D. If rOIl en.,.. the tax nta, '1.... IJ*llh your r.latlonshlp to the decadent In the ar.. provided. I. The.-unt 0' tax due Ulna .) .. detar.lned b., ..Itlphlno the .......t taxllbla Ulna ., b., the tax rat. Ulna 7>, CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allow_I. dabta and deduction. ar. eMt.r.lned II fall..... I. You 1...lly ar. r.span.lbla fo" pa,.ant, or the ..tata IUbJaot to ed.lnl.tratlon br a paraanal raprallntatlve I. InlU'flclent to ...., the Mductlbla It.... I. You _tUllh ,aid thl dabt. aUar eM.th of the dIe.....t and CM 'urnlsh proo' 0' ,a,.ant. C. Dab.. ..I". clallled ..,It .. U....N full., In Pert J. If addlt10nal spac. Is needed. u.. plain paper I 1IZ"" _ 11". P,.oof of pa.,..,t ..., .. requa.tN br the PI Depart.."t a' Ravenua. TAXPAYER ASSISTANCE IF YOU NEED FURTHER INFORMATION OR ASSISTANCE, CONTACT ANY RE9ISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE OR CALL THE BUREAU OF INDIVIDUAL TAXES, TAXPAYER INQUIRY UNIT IN HARRISBURG AT (717) 787-8327. TDDI (717) 772-2252 (HEARING IMPAIRED ONLY) . CQIItONWlALTH 01 PfHHSYLVANIA 1V1IlTItDfT .. _IU IUIUlJ .. INIIIVIIlUAL Tun DUT. ""11 HARlISIURO, PA 1712'."01 .. / ~-;-- (1' (; - 'I INFORMATION NOTICE AND TAXPAYER RESPONSE EST. OF VELVA R DREIBELBIS 5.5. NO, 189-09-0088 DATE OF DEATH 11-0Z-95 COUNTY CUMBERLAND FILl! NO. Zl' 'ie. ,. / '13 ACN 9610Z191 DATI! OZ-10-96 TVPE OF ACCOUlIT o SAVlI,"S o CHECKIHO o TRUST 00 CERTIf, 1...\1-41 II "t "..., MARV J LAUCK 614 N ZND ST WORMLEVSBURG PA 17043 REHIT PAYMENT AND fORKS TO. REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 DAUPHIN DEPOSIT IK . T hili pravlded tM o.p.rt...,t ..lth tht In'orAtlon IIIh4 ~Iow lIIhlch h.. bM,1 I ~.ct In c.lcul'Ul"II tM pat....tI.1 "x ..... Thtlr rKord. Indlnt. thIlt .t tr. d..th 0' the 1Ibov. decedent, you ...r. . JoInt OlIIMr/beneflcl...y of thll KCOU"lt. 11 you ,..I thh Infor..tlon II Incorrect, pI.... obt.ln lIIrltten correction 'rOIl the fIMnCI.I Inltltutlon, .ttKh . copy to this f Jr. Met nturn it to tM lIbove IIddr.... Thll KCOU"lt 11 t...bl. In ec:cor~. ..lth the JriwlrltMC' lex L.... of thII C~.lth (If p.-wIl/h.It"I.. au.ltlonl"y u. enlwered by cIJII"G (717) 7""!~7. COMPLI!TI! PART 1 BI!LOW . . . SI!I! REVI!RSE SIDI! FOR FILING AND PAVMENT INSTRUCTIONS Ae-.nt No. 8000377594 D.t. 09-Z5-91 E.hblhhed AccOW1t a.IMC. P....""t Taxllbl. Aaount SUbj..t to T.. Tax R.t. Pat""tl.l T.. au. 10,014.79 16.667 1,669,17 .06 100.15 TAXPAYER RESPONSE "WILLR!8ULT IN ANOFPICIAL TAX ASSESSHI!HT BASED OH THIS NOTICI! To In.ur. proper credit to your lecount, two CZ) copl.. of thll notlc. ....t ICCMP-W your ,apent to the Reghtar of IUU.. ..... cheCk Plylbla tOI "R..lltar 0' Willi, ag.nt-. K K ..nE, If tax pa~tI ar. .... ..Ithln thr.. cs) .",thl a' the dKedent"1 data 0' dHth, you Ay deduct . 5% dhcOU'\t of the tax ..... At1y lriwlrltMC' tax .... ..Ill bee... delinquent nlna (9) .",thl .ftar the data of death. PART m [CHECK ] ONE BLOCK ONLY A. KNtv. In'orutlon and tax .... II correct. You Ay chaOl. to r_1t p.~t to thrI .....t.r of WIUI .Ith two cap I.. 0' thlt noUn to ol1taln . dhcaunt or lIYold Intlrllt, or you My chIlck boN -A- .... return thll noUc. ~,. the Raghter of WUlI Met ., offlcl.l ......Mnt .111 be tuuad by thrI PA o.partMnt of Ravan.,'~. I, 0 lhe Ilbov. ....t hal b~ or .111 be rllPOrted and tax plld .Ith the P.-wIlYlvanl. Inhlrl~ lax return to ~ fll~ by thl decadent., ,aprl.ent.tlvl. C. 0 The IIbov. InforAtlan l~ncorrlCt andIo~tI ... deduction. ...rl p.ld by YOU. You ....t c..,l.t. PART l!J .ndIor PAR' l!.J balow. If you indic.t. . dlff.rant t.. rat., pI.... .t.t. your r.hUanohlp to d..otdant. OFFICIAL USE aNl V 0 AAF, ~ADEPARTMENT OF REVENUE . ., PART ~ TAX RETURN - COHPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. D.t. E.tabllohed 1 2. Account Balance 2 S. P.re""t Taxllbl. 5 K 4, _t Subj..t to TaM 4 S. llabh ..... DaducUan. 5- 6. Aaount Taxllbl. 6 7. TaM R.t. 7 K e. T.. au. e .PAD . 1'-~___ ',st... P.RT [!] DATE PAID DEBTS AND DEDUCTIONS 2 3 " 5 6 7 8 CLAIMED I~J PAVEE DESCRIPTION AMOUNT PAID I I TOY.L IEnt.r an Line 5 a' T.. Caaput.tlanJ , perjury, I decl.re th8t the f8Ot. I have reported 8bov. ara true, correct 8ftd y knowladll8 ..... ball.'. HOME ('1,'/ 1 '7 t .1 ,- 't 77/ r WORK ( 1 , GENERAL INFORMATION 1, FAILURE TO RESI'OND WILL RESULT IN AN OFFICIAL TAX ASSESSIIEHT oIth _11.001. Inl....l be... ... Inf....tlon IUbIIlttM by the flrw'tC". In.tltutlon. z. Jnhrlrlt~. tax bee,,1 .Unquent nlM .",th. dtl" the Ac~t'. .t. 0' desth, S. A Joint 1Ml00000t 11 t...bl, ,..,en though the decMent", ,.... we, .sded .1 . ..tt.,. of corwenl."u. 4. Acoc:Iutt, Uno Iud Inti tho.. held IMt....... hultMnd Md ..lfs) which the decMtent put In Joint MM' MItM" OM v..r prior to deeth .r. full, taxabll II 'ren,'.r,. S. Account. ..tabllshed Jolntl, bet....... huabMd Md ..If. ~r. then one v..r prior to ~.th .r. not t..8bll. ,. Account. held by . decMtent "In trult 'or. ~ther or other. Ir. ,..able fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. .LOCK." If the In'.rAtlon .-.d COIlPUhUon In the notice .r. carrllCt Met deduction. Ir. not belnt clelNd, plK' en "'X"" In block A"A of '.rt 1 0' the ""TIIJIPlver RI'pon,,- ..ctlon. SIgn two copln Md suIMIlt thM with wour cMck 'or the .-unt of t.. to the R..altlr of Will, of the county Indlc.t~. The PI o.p.rt.ent 0' A.v~ will tltue en offlcl.l .......-nt ('or. REV-1M' DO \4lOr'l rec.I,t of the return frOll the Rqhhr of wIU,. t. .lOCl I . If the ....t tpeCllfled on thh notice hili been or ..Ill be repo,.ted end tile p.ld ..lth the Pem.ylvanl. InherltWIC' Tu ..tum flled b1 the decedlnt"' repr..entatlv., plac. ., "T" In block ..... of P.rt I 0' the "hMpay.,. ..spon.... .ectlon. Sign OM COP1 ~ ,.atu,," to the PA o.pa,.t.-nt 0' ..venue, lur.eu 0' Indlvl~1 T...., Dlpt Z.0601, Harrisburg, PA 17IZ.-0601 In the enwlope ,,.ovlded. J. ILOCI C - If the notlc. In'or..tlon .. 1r~ornct ..uor deduction. ar. being cl.IMd, check blodc "C" end cOllPI.t. Pa,.t. 2 .. 5 according to the Inst,.uctlon. balow. Sign two copl.. end IlAMIIt t~ ..lth you,. check for thot ~t of to p.yabl. to the R....tn 0' ..Ill. ot tna county Indlceted. The PA Departaent of ..venue ..III I.sue en of,lcl.1 .......-nt (For. REV-IS4. EXI upon rec.lpt of the ,..turn f,.OII the .egl.t.,. of "III,. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Ent.,. the dIItl the lCCCM'It originally.... ..tablhhld or Utled In the .......,. IIChUng at d1t. of de.th. MOTEl Fo,. a decedent dying aft.r 1l/1l/1l1 Account. which the decedent put In Joint MM' ..lthln one (I) Y"" of de.th ar. tlMIbI. fully.. tran.f.r.. Howev.r, there I. an ..clu.lon not to 'Mclld '5.000 pe,. tran.f.r.. r.g.rdl... of the v.lue of the KCount or the ,...,. of KCount. held. If . doubl. ..t.,.I~ (..) ."..,.. bafor. your flr.t neae In the ~,.... portion of thl. notlc., the 15,000 ..clu.lon .In_ hi. been deducted ,,.011 the KCo..w'lt b.llnC. .. ,.epo,.ted by the flnanel.1 In.tltutlon. I. Ent.,. the tot.1 tNIlsnce of the eccount Including Int.r..t ICCr'Uld to the dati 0' death. S. TtM pe,.cant of the KCo..w'lt that II tullbl, for nch suM/lvor .. det.,.aIMd II follow'l A. TM per-cent tDIbI. fo,. Joint ....t. ..tlbl1lh1c1 IOra th8n one y..,. prior to the decedent". de.thl 1 DIVIDED IY TOTAL NlICIER OF' JOINT OWNERS E...,I.I A Joint ....t ragl.t.red DIVIDED BY TOTAL NlICIER OF' X 100 . PERCENT TAXABLE SURVIVING JOINT OWNERS In the MM of the dIe,"*,t end two othe,. per.on.. I DIVIDED IV 5 (JOINT OWNERS) DIVIDED IV 2: (SURVIVORS) . .167 X 100 . 1'.7% (TAXAILE FDA EACH SURVIVOR) I. 1lM pe,.c....t tDIbI' fa,. ....ts crllted ..Ithln OM YII" of the decedent". de.th 0,. accounts owned by the dIe..,..t but hlld In tr-u.t fa,. snathe,. Indlvldual(.) (tr-u.t blneflclarl")1 1 DIVIDED IV TOTAL NUKIER OF SURVIVING JOINT OWNERS DR TRUST IEHU ICIARIES X 101 . PERCENT TAXABLE E"IIPI.I Joint ICCount raght.red In the RIM of the dKadlnt end tvo other parson. end ..tablllh1d ..Ithln ana ya.r of de.th by the dKldant. 1 DIVIDED IV 2 (SURVIVORS) . .50 X 100 . 50~ (TAXABLE FOR EACH SURVIVOR) 4. The..,..,t subject to tu (I1ne 4) b detar.lnad by wltJplylng the account "1~ CUM Z) by the percent tDabl. (U". S). 5. Ent.,. the total of the dabt. end deduction. Ilatld In p.rt S. 6. The ~t tuabl. Cline 6J b det.raJned by .ubtractlng the debts end deduction. (11". 5) fr.. the aaount .ubJact to tax Ulna 4J. 7. Ent., thellPProp,.J.ta tax r.t. UII'II 7) II det.uJnad balow. A. Fo,. dat.. of death occurring Iftar 6/50/94, the tax rat.. for tr.......r. to spou... .r. II 'ollowlI 1. DIIt.. of ....th on Dr .ft.,. 711/94 end before 111195 the rata 11 n. 2. Oat.. of ....th on 0,. aft.,. 1/1/95 tran.f.r. to ~... ..Jll be t~1d .t O~ tax r.t.. Not.. For dat.. 0' de.th p,.lo,. to 7/1/94 tran.f.r. to spou... .ra t.Mlbl. at 6~. I. T,.an.f.r. to 11,....1 deac:andant. JnclucUng father, IOther, .on, dalght.,., grandchlldran, .on-Jn-l..., daught.,.-In-law, .tepchJld and thalr J.sue .r. taxlble .t .J. pa,.Clnt (6X). C. T,.an.far. to .11 othe,.. IncludJng brother, .I.t.r, unci., sunt, nephew end nlace ar. taxabl. .t 'If teen percent (15X). D. If you chIlnga the tax rata, pl.... specify YOU" r.lIt1onlhlp to the dacecWlt In the .raa provJded. t. ThI.-ou"It of t.. dua (lJI'lI II h detlraJned by .ultlplylng the MO!.oftt tuabl. UJna 6J by thl tile r.ta Cllna 7). CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED AIlowabl. dabt. and deduction. .r. det.raJned .. 'ollow'l A. You 1...111 .r. ,..spon.lbl. fa,. p.~t, 0,. the ..t.t. subJsct to ~lnJ.t,.atJon by . personal repr.aantatlva I. JnsuffJcJant to PQ the dlductlbl. It.... I. Vou actually p.ld the debt. .ftar de.th of the dacldant and can fu,.nlsh proof of pQMl'tt. C. Dabtl being c1.IMd ....t ba It..I,,1d fully In Pert J. If additional splC. 11 nHdad, u.e pl.Jn p...r . 1/2"" x n". Proof of P.,..,t NY be raqu..tld b1 the P' Dep.rt.."t of Rwenue. .. - 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 INDIVIDUAL TAXES. TAXPAYER INQUIRY UNIT IN". .. HARRISBURG AT (717) 787-8327, TDDI (717) 772-2252 (HEARING IMPAIRED ONLV) , , ........} , ~- : ! ~ , CDMNONWrALTH Of PfHHSYLYAH1A lllPMTIUT " R[VDU "'AU 0# INDIVIDUAL 1&X[I D[pf. 110"1 HARlJIIURO, Pi 17111-0'11 *' " ."')--- 5" "-)- - '! EST, OF VELVA R DREIBELBIS 5.5, NO, 189-09-0088 DATE OF DEATH 11-02-95 COUNTY CUMBERLAND FILl! NO. 21- '/'(, -/1./3 ACN 96102193 DAT! 02-10-96 TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST !Xl CUTU . INFORMATION NOTICE AND TAXPAYER RESPONSE 100'54'U"P".'" .. MARY J LAUCK 614 N 2ND ST WORMLEYSBURG PA 17043 REMIT ~AYHENT AND fORMS TO. REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 DAUPHIN DEPOSIT lit . T he, provided the Depart.." ",Ith the Infor..Uon lht~ belOlif which hel been und In calculaUI'II the potenUal tax dull. Their rKordl Indlcat. tNt at the death 0' the ~ decMlent, you ver. I Joint OWIerlbenllflclary 0' thl. ecCOla"It. If rou ,..1 \hit lnfo....Uon II Incorrect, pl.... obtain ",rltten corrltCltlon 'rOIl the flnMClal In,tltutlon, attach. copy to thl. '0,.. .... raturn 1t to the lIbova Met,.... Thh KCOI.rlt II tlxllbll In Kcor~. ..1th tM IrIMIrltMCI TalC L.... of the eo..cw.ulth 0' P..,nlv.,ta. Due,llon' ..y be entwered by CIlllng (717) "7-ISZ7. COHPLET! PAil,. 1 BELOW II )I II SEI! RI!VI!RSI! SID I! FOR FILING AND PAVIICllT INSTRUCTIONS Account Ho. 8100479275 o.t. 02-27-95 Eltob1hhod Account 8al~. Percent Tax_I. Aaount SUbject to T.. Tox R.t. ~otontl.1 Ta. Due 2.008,88 50.000 1,004.44 .06 60.Z7 TAXPAYER RESPONSE 'AILURI TO RI!SPOND WILL R!SU\. T IN AN OFPICIAL TAX ASSI!SSN!HT IASID ON THIS HOTICI! To Insur. proper credit to your .cCO!IIt, two (I) copS.. of thh notice ...t acCCMlPlnY your pay8eftt to the A..I,t.r of Willi. "-kl check p.y~l. tal -R..l.t.r of Will., a..nt"", x HOTEl If t.. PI,.ent, .r. .... Mlthln thr.. (]) .onth. 0' tN decadent', de.. of dMth, you ..y ~t . 5X dlacOt.nt of the tax ..... Any Inher!tWtCI tu .... ..Ill bee_ delinquent "1,.. (9) ~th. Ift.r the dIIt, of de,th. x ~ART [!] [CHECK ] ONE BLOCK ONLY A. .... ~. lnforAUon 8M tax .... II correct. 1. You.., choo,' to r.lt PI)'HI'It to the R..htn 0' WUlI vlth two copS,. of thh notlCI to obtsln . dlacOWIt Or" rtOld 1"'ar.lt, or you MY c:hrKk box .,.. MIl nturn this noUce to the _..ht,,. of Will, 8nd In offlcla. ......-ent .,111 be J..ued by the P& Oepart-.nt 0' Revenue. I. 0 1M ebov. ....t h.. bMn or ..111 be nported 8nd tax paid with the PennI'Y1VMI. InMrltWtCI Ta raturn to be '11M by the decedent', repruentaU.,.. ; C. D The .aMI.,. In'orutlon l~nc:orr.-ct llndIo~ts WId deducUon, ...ra IHIld ~ you. You ...t cCMlPhta PUT L!.J """0,. PUT L!J below. If you indicat. . dlff.rent taM rat., pl.... .t.t. your ..1.tlonlhlp to decadant. ,.r,:<.OfFICIAL[US,E ONLY, 0 MF: !",'(; ';.' PA., DEPARTNEHJ"OF,:.,REYENUE, , .'., ,.:: PAD",:":",:",:+,,:"':,;"::\1iY;"";:~",:::":',",,:,". ::: : ": "":::<1" "" "",'" """'''"'" ,..-, 2 3:~ '.........::;'. ':~~/"". '..' , "4 ,)';~::..5'" ,,6 7 v 8'" DEBTS AND DEDUCTIONS CLAIMED . l:X~-:", .,-..' ~ART ~ TAX RI!TURN - COHPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. ~.t. Eatab11ahod 1 2. Account I.l~. 2 5. P.rcent f..abl. 5 X 4. Aaount SUbject to T.. 4 5. Oabh and OoducUona 5- 6. Aaount Toxoblo 6 7, T.. R.t. 7 X a. T.. Due a ':'~-: :.: " .. -"--'~"'-:-" ':'<""",',: ~ART [!J DATE PAID PAYEE DESCRIPTION AMOUNT PAID I I TOYlL lEnt.. on Llno 5 of T.. C08PUt.tlonl . Under penaltl.. of perjury, co.p1.t. to tho bo.t of .y k I declare that the fectl I have reported ~v. are t~, correct and va and boll.f. HOME (1"/11) '1t..3 - ~(7 7 I WORK ( ) ";'~~6 DA GENERAL INFORMATION 1. FAILURE TO RESPOHD WILL RESULT IN AN OFFICIAL TAX ASSESSIIEHT .lIh _11...1. In...... ......... In,.,...I... ~.tt~ bv the flnenolal JnltltutJan. 2. IntwrltMCe tu: ~. deUnquent "1M ~th. ,nar tlw dec:.-nt" dIIt. of delth. S. A Joint lIClCW1t I. ta.... IY'" though the decec*\t" ~ .... lidded .. . ..th, of conv."lencl. 4. ...oun" lIncludl", .ho" ....Id ..._ ..._ ... .1f.1 ""left .... -...... put In J.ln' ..... .Ithln .... ..., .d.. .. death .r. fully t....1 .. .r.nl,.r,. 5. Accounts ..tIlbHIMeI JolntlV bet""" hUabend Md ..lI. lieu" ttwt one y..r prior to death ar. not ....bll. ,. Accounts held bv . dec~t Rln trult for. enother or other' .t. ,..lIbl1 fully. " REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. IlDCX. _ If ..... In'.'....... ... ._....... In ..... no.... ... ....... ... -.e...... ... no' ..I", .1.1...., .1... ... ..... In .Iock "." a' h" 1 ., .... "'I....... ........." ......... SI...... .opl.' ... ._11 .- .lIh .ou. ..... ,.. ..... ..... ., ... .. .... ...1..., ., will. a' .... .oun" Indl....... T.... .......... ., ....... .111 I.... ... .,,1.1.1 ........,. (For. m.1541 VO upon recllpt of tM r.turn 'reM! tM .......r of WtUI. " IlDCX I _ If ... ..... ._Ifl'" ... thlo no"'. he. .... Of' .11I .. ._..... ... ... ..Id .lIh ... ._nl...I. I....d..... T.. .."'"' fII'" .. ... _......'. ...,............ .1... ... ..... In .Iock "I" a' .... I a' ... "To...... ..-.." ......... SI....... .... ... ,.",.n .. .... .. .......... a' ........ Iu'." a' Indl.ldual T..... .... '....1. He,.I>bu", .. 171'.'...1 In .... envtlope provided. $. IlDCX C . If .... no"" In'......... I. Inc...... ondI.. -.e...... ... ..I", ...1..... ..... .Iock "t" ... ._1". ..... , ... $ .....dl'" .. .... In............ ..I... SI...... .001.. ... .....1. U- .lIh .ou. ..... ,.. ... ..... .f ... .....1. '0 ..... ...10'" a' Will. ., .... .ounty Indl....... Tho" .......... .f ._ .11I 10_ ... .HI.loI ........,. (fe.. RfV'ISU EllI .-. ,...1.. 0' the r.turn 'reM! the Retl"" of Villi. TAX RETURN - PART 2 - TAX COMPUTATION LIt<< 1. Enter the ..t. the lKCCU't or.IIMlh .... ..tebllltwd or UU.cI In the ...,er ....Ung .t dIIt. of dMth. VOTE. ,... _...... d.l", .n.. IZlIZI... ...oun" ""Ich .... _...... put In J.ln' ..... .Ithln - Ul .... ., d..th ... .....1. full. .. .....01.... _.......... 10 ... ..cluol... no' .. ....... IS,... ..' ......,.... .....dl... .f .... vol.. of the eccount or the ....r of ecc:ount. held. If 8 doubla ..t.rlsk (..) ."..r. befora your flr.t ~ In ~ ~ra" portion of thl. notlca. ~ .',DDO aMclu.lon 8lraiIdY hII. bMn cMduCtH frOll tM eccount blilMCa .. reported bv the flMI'tCld In.Ututlon. I. [ntar \hi total blil.nc8 of the ecc:ount IncludIng Int.r..t accrued to the dIIt. of death. S. TM percant .f \hi Kc:ount thllt .. tpebla for .ach lUrvlvor I. det.ralned .. fo110111'1 A. TM perctll'lt taxebl. for JoInt ....t. a.t.ll.e.d ..ra then one y..r prIor to thl decadent". de.ths I DIVIDED IY TDUl _ Df DIVIDED BY TOTAL IUIIE' Df . I" " p[JlC(NT T....lE JOINT OWNERS SURVIVING JOINT OWNERS Ex..lal A Joint ....t r....t.rH In the n8M of the daC8dent Ind two other peraon.. 1 DIVIDED IV S (JOINT OWNERS) DIVIDED IV I (SURYlYORS) . .167 1C 100 . 16.n: nAXAILE fOR EACH SUtVlVOR) I. Tho ..,..... ....... f.. ...... .,...... within.... .... .f ..... _......'. _'h or ...oun" - .. .... -...... .... ..Id In tru.t for 8nQther Indlvl~I(') (tru.t beneflol.rl..)1 . 101 " PER<ElIT T....lE I PIYIDCD n lDUL ""IMlER Of SUtVIVlHO JOINT OWNERS OR lRUSf IEHEFltlloRlES Ex_I.' join' ...oun' ...10...... In .... .... ., ... _...... ... ... ..... ........ ... .....11_ .Ithln .... ..., a' _th .. tha decadent. 1 DIYlDED IV Z (SlIIVlVORS) . .50 1C 100 . sIX UWlLE fOR EACH SUNlVOR) 4. Tho..... ....J... .. ... (II... '1 10 ......1_ .. ..IU.I.I", .... ..coun' ..I.... Ul... ZI .. .... ........ .....1. (II... $1. 5. Ent.r tha total of the dabts Ind dadUCUon. lI.ted In hrt S. .. Tho..... .....1. (II... .1 .. ......1_ .. .ub....U", .... _.. ... -.eU.... (II... 01 "00 ... ..... ....J... .. ... (II... 41. 1. Er.t:r thl ~~ep~l.te .~~ ~..e 'tift. ~, .. ~.t.~.I"~ hal~. A. for dat., of de.th occurring aft.r 6/S0/94, the tlM rat.. for tr8ft.f.r, to apou..' ar. ., follow'l 1. Dat.. .f death on or .ft.r 1/1/94 Ind before 1/1/95 the r.t. I. S~. Z. o.t., of death on or .ft.r 1/1/95 tran,f.r' to .pau'" Mill be tpH at O~ t.M rata. Mota. For data. of de.th prIor to 7/1/94 tran,far' to .pau... .ra t..abl. .t 61. I. Tranlfan to 1IM11 de.cand8nt. Including f.ther, _thW, .on, deught.r, gr.wchlldran, .on-In-IMI, dauGht.r-ln-l.., .tepchlld Ind thalr I..ue ara taMable .t .1- percant (6X). C. T'on.'....o .11 ...... Includlnl ......,. .1..... unci.. aun'. nophoV and nl... .,. .....1. .. '1"'" ..,.on' (IOXl. D. If you chinle the tax r.ta, pl.... ","If>>, your ral.UClftlhlp to thl decadent In u. ar.a provided. I. TM ~t of tax due Ulna .) Is datar.lned by .,Itlplylng U. ~t t.M.II Ulna 6) bV thl tp r.ta Ulna 7). CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED AUOIIIMlI. dabts and deduCtion. ar. det.ralned .. followl1 .. You 1...11. .,. ,......1.1. ,., ........ .. ... ...... JObj... .. ...Inl.....lon by . .......1 ......on...I.. I. Inou"I.lon' to pav the deduCtible It.... .. You "tu'Uy paid thl .,.btl aftar death of thl decedent and can furnhh proof of pa,..."t. C. Dab" ..I", ...1.... .... .. It_I.... fully In .... $, II ....IU....I ...... 10 -, u.. ...In .-. I 1/Z- . II", ....f a' pa,..."t "'I be reqUlltH bV thl PA Dlpart.."t of R.v.... TAXPAVER ASSISTANCE IF YOU NEED FURTHER INFORMATION OR ASSISTANCE, CONTACT ANY" REGISTER OF WILLS. PA DEPARTMENT OF REVENUE DISTRICT OFFICE OR CALL THE BUREAU OF INDIVIDUAL TAXES, TAXPAYER INQUIRY UNIT IN HARRISBURG AT (717) 787-8327~ TDD' (717) 772-2252 (HEARING IMPAIRED ONLV). FILl! NO. 21'- 'k / v3 ACN 96102187 DATI! 02-10-96 TVPE OF ACCOUNT o SAVINGS !Xl CHECKING o TRUST o CERTIf. , COI"OHWUlTH at PfJreCSYLVAHlA llEPUTllEHT 01' Il[V[IU ItMEAU OF INDIVIDUAL TAXEI DEPT. 110601 HARAlSIURO, Pi 171z..a'Ol *' I 'J ~) '). C) INFORMATION NOTICE AND TAX PAVER RESPONSE IU.I..IU'IP ".K' EST. OF VELVA R DREIBELBIS S.S. NO. 189-09-0088 DATE OF DEATH 11-02-95 COUNTY CUMBERLAND MARV J LAUCK 614 N 2ND ST WORMLEVSBURG REHIT PAYHEHT AND fORHS TO. REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PA 17043 DAUPHIN DEmIT ax I T hili provided the Depart..,,' ..Ith the tnfor..tlon lilted below which M. bHn Uled In calcuhtl"l the pot."Ual tu ..... Their record. Indlcat. that at the dHth ., the ~ dec.."t, you ver. a Joint OWIer/bMtlflcl.ry of thh ecCOU1t. If you ,..1 thl. Infor..tlon 1. Incorrect, P..... obtain wrltt.n correction fro. the fl~l.l In.tltutlon, ,ttech . copy to thl. for. WId r.turn It to the IlboYI eddr.... Thh eccOU'\t 1. tallllbl, In eccordenca ..ith the lm-fltMeI hll L.... of the C......lth of P.......ylv8nl.. ou..tlon. .., be .,,~red by calling (717) ,,'-IJ21. COMPLETE PART 1 BELON . . . SEE REVERSE SIDE FOR FILING AND PAVMENT INSTRUCTIONS Account No. 0029148464 Date 04-26-76 E.teblhhad AccOW'It "1~. '.rc~t T.xebl. ~t SUbjaclt to TIlX TIlX Rate PotenUal TIlX Dua To InlUr. proper credit to your ecCOU1t, two (2) cop I.. of this notice ...t KCaep....y vour p.~t to the A..I.t.r of Mills. ~. check p,vMJI. tor .....hhr of "Ilh, ,....t... PART [!] 4,868.13 16.667 811.37 .06 48,68 TAXPAYER RESPONSE 'AILURI.TO RI!SPOND MILLRI!SULT IN AN O'FICIALTAX ASS!SSHI!NT BASI!D:OH THIS NOTICI x HOTEl If tu p.,....ts .r. .... within thr.. (S) eonth. a' the dececMnt's at. of de.th, you ..y deduct . U dhcount of the talC due. My IrNrlhnc. talC due will becoMI delll'lClUWlt nine C,) eonths .ft.r the at. 0' ddth. x [CHECK ] ONE BLOCK ONLY A. 0 The ebav. lnforNtl~ Ind tax due I. cornet. 1. You NY choo.. to re.1t p..,.ent to the AlGht.r of MUI. with two capl.. 0' thh notlc. to obtain a dl.count or avoid Int.r..t, or you laV check box -,- Ind return thl. notice to the A..1.t.r of "III. end en a,flcl.1 .......-nt will be I.~ by the PA o.p.rteent of Aevenue. I. 0 The ebav' ....t has ~ or wl11 be reported end tax peld with th. P......YI""I. Jm.ritenc. Tu r.turn to be 'lied by the decedent". n..r........tlve. C. ~ ebav. Infar..tlon l~nc.orrKt ~c~t. Ind deduction. wer. paid by you. You ....t eaepl.t. PART l!.J endJor PART ~ below. If you Indlcat. a different tax rat., pl.... Itate your ralatlanlhlp to dacadont. .,OFFICIAL,'USE ONLY 0 AAF PA. QEPART"EflT~,OfiREVENUE:,1 ;:.. :::-.:,:: :~.:-:':'. :_"::'-::::-'::"::-~~;:~':;:~::":".( ::.:,.;.,:' '.-'-:. ;. ,';: PART ~ TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LI~E 1. D.la Ealablhhlod 1 {., f/'-.::u:;- 7G.- 2. Account aalanca 2 ~ j;,~ I", ,3 5. rercent Ta)(abl. 5 x // . /~L.: 7 4. Aacunt SUbjaclt to Ta. 4 P/..I. ,r 7' 5. Dabb ..... Daclucllan. 5 -/7SH.I~'{~:l-=- p17Y.J>? 6. _t Ta.abla 6 (P 7. TIlX Rata 7 X oc.. a. Ta. Dua 8 r.7 '-'. "::~ PART [!] DATE PAID ;( DEBTS AND DEDUCTIONS PAD., 1 2 3 4. 5 , 7 8 CLAIMED . .~~~ .:':"\. ~. . ,'.-; :';':~:. . .",;;.,.., . :;~">:::-';..' . ~,.,,', ",. ..:..:.. ,." PAVEE DESCRIPTION . . :,J/.' > ~ . c. TOTAL IEntor an Llna 5 of Ta. Coaputatlanl . Under penaltl.. of perjury, I declare that the f.ctl I have reported abov. .r. true, corraot and cOllPbta to t b..t of ay knowladga ..... bellaf, HOME ('7'7) 7~.;;-f'77 / TA1J~1.r:Jsr~E ~... J, - W~:~E~~ONE N~HBE: v~~r~ .... "'-,'-. .,'1 , GENERAL INFORHATION 1. fAILURE TO RESI'ONIl WILL RESULT IN All OfFICIAL TAX ASSESSIIEHT .Ith _11...1. In..r..' ..... on Inl.r..Uon ~ltted by ~ fln8nCla1 In.tltutlon. I. lmer!tWICI tu bee'" deUnquent nine .,'hl ,fta" the _.."t's data of dMth. I, l J.ln' ..._' 10 .....1. ..on .- thO __". ... ... ..... .. . uU.. .1 ......onl...... 4, ..._.. IInol...l.. thO.. hOld ..._ .......... .... .11.1 "'1'-' thO __, ..., In J.ln' .... .Ithln - .... ..... .. death .r. fully t..~l' '1 .r.nl,.rl. I. ..._.. .....llohod J.ln'I' ..._ ........ and .If. .... \hOn - .... ..1.. .. ....n .r. no' .....1.. .. Account. held by . deCedent ~I" tru.t forw ~~r or o~r. .t. ,..Ib.' fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAVER RESPONSE 1. ILllCI( l _ 11 thO Inl....Uon and c_..Uon In ,hO ""II.. .r. .or...' and de<NCUon. ... no' ..I.. cl.I.... .1'" an ..... In block .l. .f Po.' 1 .1 thO .T_ay" ...~.... ...U.... II..'" copl.. and .....It .- .Ith .... ...... I.. thO -' .f ... .. thO ...1.... .f wllh .1 .hO ._" lndlc.''', Tho PA 000"'_' .1 .........111 I..'" on .fflcI.L .....-. (fa... REV-1M' [X) upon rKelpt of the r.turn 'r~ the _..lItar of Will.. Z. ILllCI( I _ 11 thO ..... _If I" on thh no.lc. no. .... or .111 .. ._.... .... ... ..Id .Ith thO ........L_I. I............. T.. .....m m.. b. .hO __". ....._..U... .1..' on ..... In bloc" ... .1 .... 1 .f .hO "T....... .......... ...U..., 11..- .... and r.....n .. thO 'A 000"'_' .1 ......... au..... .1 Indl.lduOL T...., 000' '1060L. H.r.I...... 'A 171ZI'0601 In thO erwalopll prOYlded. I. ILllCI( C _ 11 thO noU.. InforuU", I. lno...... ondIor de<NCU.... ... ..I.. cl.I..., chOC" block .CO and c_I... ..... , and I ....rdl.. .. thO In......U.... ..I... II..'" cop I.. and ....It .- .ltn .... ...... for .hO -' .1 ... .....1. .. ,hO ...10..' .1 WI\\O .1 ,hO counll Indlc.'''' ThO PA ......_. .1 ....... .111 10_ on .fflclol ......-. (F..' R(11-1541 [XI ...... ....1.. of the r.turn ft. the R..lItar of WU1'. TAX RETURN - PART Z - TAX COHPUTATION LIME 1. [n'" thO do" thO ..c_' ....1..11. ... .oI..lI0h0d or UU.. In thO _r ..hU" .. do" .1 ....th. HOn, F..' __I 0111.. .It.. IIII"IZ. lcc_" ...1'-' thO ...._t ...t In j.ln' .... .Ithln - III .... .1 ....th ... t....I. lull. .. ..onol''', _.... thO" 10 on ucluol... ""t t. ...... IS,OOO ... tron.f.r.. .....dl... .f thO vol... .1 the KcCMlt or the nuIlIber of IICc~tI held. II . daubl. .....1.. 1..1 ....... ..,.., .... fl..' ... In thO oddr." ....1... .f 'nl. notl.', .hO ",000 ..clu.lon alrudY h.. bMl'l deduCtlld 'rOIl the ec:COU'1t ballnCe .. ,..ported by the flnencl.l In.titution. z. Ent.r the tot.l balanc' of the Kcount Including Int.rnt KCrued to the dIIt. of duth. J. The perc~t of the KCDU"t that 11 \exabl. for .ech suntlvor I. det....lned .. follow" A. ThO ..._. .....1. f.. j.ln' ...... ..t..ll0h0d .... \hOn - .... .d.. .. thO ...._t'. ....th. I DIVIDED IV TOTAL _ OF DIVIDED IV TDTAl - OF X lOO . PER([MT T6lWLE JOINT DWMEIlI SURVJYIIC JOINT DWMEIlO Ex...1a. .. Joint ....t regllt.red In the neM of the decedent WId two other per.on.. 1 DIVIDED IV I lJOINT OWNERSI DIVIDED "' Z lSURVIVORSI . .167 X 100 . 16.7% (T""LE FOR EACH SURVIVORJ I. Tho ...con' .....1. I.. ...... c...t" .Itnln ..... ,~" .1 tho _'" ....th .. ..._t. - b. thO __t .... hOld In tru.t for .nother IndlvldullU.J (tru.t bln8flciar1uJI I \ I DIVIDED I' TDTAL _ OF SURVIVIHC JOINT DWMEIlO OR TRIlIT IEMEFICIARIES X 100 . PERCENT T6lWLE E._I" Join' ..c_t ...ht.rod In thO ... .f thO _' and .... ..hO. ........ and .....II0h0d .I\hln - .... .1 ....th b. the deCedent. I DIVIDED IV Z (SURVIVORSI . .50 X 100 . lOX (T6lWLE FOR EACH SURVIVORI 4. Tho _' oubj... .. ... III.. .1 10 ..t...I.... b. ...111.1.1.. thO __. ..I.... III.. 'J b. thO ....on. .....1. III.. 'J. S. Ent.r the total of the debts end deduCtion. lhttKI In Part J. 6. Tho _' .....10 III.. 61 10"......1"" b. oub....II.. thO...... and de<NCII"" CII.. 51 f." thO -' oubl'" .. ... III.. 'J. 7. En'.r U.. ........,..l&t. ta~: rate (tlne'J c: dttt-"!~~ IJd~. l. F.r do'" .f death occur. I.. .1..' 6"0'94, ... ... ..t.. I.. .....,... t. 'POU'" ... .. 1.11.." 1. Data. of death on or aft.r 7/1/~ end before 1111'S the rata 1. JX. Z. Data. of ~th on or .ft.r 1111'S tran.far. to SPOU'" will be taxtKI at ax tax rat.. Hotal For dlt.. of de.th prior to 7/1/94 tran,f.r. to 5PQU'" .ra tlxlbla .t 61. I. Tronof'" t. 11...1 ............. Inol...l.. h'hO.. ..tlw., ..... d.......... .r.......IWon' ....-In-I.., ......tar-ln.l..., stltPChl1d ... their hsue .r. taxllbl. .t .lx percent (6%J. C. T....f..... .11 ...... Includl.. br....r. .1.t.., uncI., oun', ...... and nl... .r. .....1. .. III'''' ...can. (ISX'. D. II... __ thO ... ...., .1.... _II. y..' ..1.tI_l. .. thO __I In thO .... ....1.... I. Tho _' .f ... .... III.. II 10 ..t...I.... b. ...11I.hl... thO _t .....1. III.. 61 b. .hO t.. ..t. III.. 71. CLAIHED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIHED Allowabla dabta ... dedUCtion. ara dataralned a. follow'l A. ... I_II. ... .......o1bl. f.. ...-" .. .hO ....t. oubl'" t. ...lnht..lI... .. . ...._I r.....on..tI... 10 In...ff1c1on' to plY thl cMdUCtlbla It.... I. ... ..tuall. ..Id thO ...... .11.. ",'n .f .hO __, and con fuml'" ...., .f ...-" C. Dab" ..I.. cl.l... ..... .. 1t..1... lull. In ....., 11 ..0Iltl_1 _. I. ...-. u.. .1.ln ._r I 112" . 11.. ....,.f payMnt ..y ~ rMUl.td by the PA PeplrtMnt of Rnanue. TAXPAVER ASSISTANCE :"':::':":".:' IF YOU NEED FURTHER INFORHATION OR ASSISTANCE, CONTACT ANY.n REGISTER OF WIllS, PA DEPARTHENT OF REVENUE DISTRICT OFFICE.n:< OR CAll THE BUREAU OF INDIVIDUAL TAXES. TAXPAVER INQUIRV UNITIH' HARRISBUR9 AT (717) 787-8327. TOOl (717) 772-ZZ52 (HEARING IHPAIREOOHlV) ',/ :1 I I :'j ,'; ~ "' I " ;,:1 ~! , ""1 'j ",", l.'.j ~,'I ~,-~ ii ',~.,l '/ 'j ; ~j d ! 'I "i1 ~ ~i..._ ._.-'.-.. - -- -'-- ---.,.. .,- . '~ ..~-- n \ ~ ~ (\ I '\ I . I ; 1 ~' ' , ~~~ " -....- '.- ........- , 't " , ; J J --~- r ~ , c Ot .' ,. , '. \. '" .~ ., ' ... ,. '''. . '<-. " . . "'.'" I ' , ~ ''- ..' ( ~ . ,. " tl " , , ".J ~". ~...~, '", >' . ..&.. ~ 'I) "', r... \ ,I Iff /~, . , " . ., I " ~. ~ . j J t' , '. "'. ". \, ~, ~ . .f ~~ ~ ---- . ~ - "" __J'f J , \ '_-'--"'-'-- .--- , "i. 0--0/ d/.9c. .., H.~/,- "/~ '...-v _ ,')0"...,.. rr(g"t--'/S/CK;;' e;'",c:- ,h//-<..<,.,,S, (?4I'/.I.I("'-,~AZi?r'.?'. rt7v~ ~U.se:. , -z:;q, t:7~.#d/f'c:. / " x -0 .,2 ~-- /,- /M, r-a / /' in7' /S- .. , ~ '21f- .../ .. "---'--' - ,..._-:..... ::_-_."-',~ .,..",..^~..".,....---_. --.;-,.~.::..:--:~.... ~'_._---'-'" ~~ --~. . '''J ... ...... I"" ' , . ~ ,. "" > , -. . ... '. '(a. .... . "'.. ,1 .' " I .. ... 1--, (' ' , . -.. .... , J I ," 'I ! -i' .~ .1 " , t.. , , , ~. .., t, ' ~. ~ , ,f .. ~ ..... -~ - ..... .,--~ -r4 .- ! -" -.... "W--" -- , ..,-- . .------ -~ 'r . - . ~I ~_ .... - -. - -.,.-. ._+- .-'- ---~-"':";'~'----._------ . .- -- -- RECEIVED fROM: i ACN ASSESSMENT I!I CONTROL 1;1 NUMBER AMOUNT MARY J LAUCK 'f610!1!l9 '100.00 614 NORTH 2ND STREET WORMLEYSBURG, PA 17043 96102191 9/01 Olil193 .100.15 "0.27 I ESTATE INfORMATION: !I I NU ER II 21-1996-0143 SSN !I NAME Of DECEDENT (lAST) (fiRST) ~ DREIBELBIS VELVA R II DATE Of PAYMENT EJ POSTMARK DATE COUNTY 189-09-0088 (Mil CAN to!' IlBlID POO1MAIIt DM'B CUMBERLAND DATE Of DEATH REMARKS MARY JANE LAUCK fa TOTAL AMOUNT PAID .260.42 CW RECEIVED BV ~j (}, ct!.tD...J ~J C'PONIJUlI ~UA X.in.I. MARV C. LEWIS JC~ REGISTER OF WILLS REGISTER OF WILLS "'; f SEAL CHECK. 5431 -- -- - - - - --- - - - - -~ - - - - - -:- - - --:- ~.-;-.-::~.~~ .;' .~ .j ~. , " ",' \' .. ,0 t. . ~ i \, of .-. --. ... __ .-,J "Y . .,...-- ---_.~- --..........-~~ I .r--- _.-""--,,-,, -~- "..- ------ -- ---. ----- -- - -- --, --- -- - -- - - - - - - .-- - ---- '..' ,,"" . -""~"-,,,...,,,,, If;,~"o.i1Ji1) :>l"'~ "'~ "'f"~'!>Jli~J;1I;''tIi'iI. ..~,,'''.. ", '. ;>~'(i;.:rt>i )~l ~'j;'~:~~~.lffl~Y.1:i"Jnrl;~;;l!;V rr/!, ',~t\:,,,-i~@!~t~~~~'1tM~1t.~l.fi.~ ,,~i,}'~!t~" f;, \1, l! .., ,).I,.,.,!,; :l',J":','t'~~ !':I.'-/':'~i~I~'~"i!''=:1l':>~f~~~~i'~:;~C~TTi'f1'' ':'ilI::I~~":;'~1;<"'-~i",,.TJ}1~,,,,l~~"'f!';:1'.~,, ',,~ 'c.-' -, .~.. ~., '."~' """. . ,,~,Y. i.,", ~ .~ ,,1. ~~ ttm.'{l....~,. . , -: p',; , ,r. ,~::!{ :,~' ! ~:!:.,:;";}f.:i ~tL::: . ~1.\':~~r->>\'i!,ii't.~W~,. ~t1~ ~~"'~~"~':l{it:';"".41.>1i,'\\,~,,~~J!i1.t.I'"~' ,~'-I,\2 ..',c.","'. >'.. '",,'.. ,",-" ""1', 'r.', ;7T\,&A'l-'I\J";""",~~,,,-.. ~, ......l.._~_~,.~ I .4>.~,~ ~,:.. .~~~.. (.....,H~/ilt......iJ.v..... "r'4:~0"'''' ~w.. ~t.~!J'.~ ~tiii:..~id'J;;t.i.ii.iat~,- ~..::--.! RECEIVED FROM, & ACN ASSESSMENT I!I CONTROL i;I NUMBER AMOUNT . PAULINE C WINTERS 309 SECOND ST BOX 316 . SUMMERDALE, PA 17093 "I... oe 190 .JOO.l~ esTATE INfORMAJION, m FI MIER Ii1 21-1996-0143 m NAME OF DECEDENT (lAST) ~ DREIBELBIS VELVA IIIWE F ~M!NT B POSTMARK IW'E OUNTY SSN (FIRST) R 189-09-008B (Mil . REMARKS PAULINE WINTERS m TOTAL AMOUNT PAID .100.1~ DO , , SEAL CHECK" S101 RECEIVED BY 9Jt?l ~ ( I,UI..ldJ MARV CLEWIS -' jf1h/,1/iJrt' . REGISTER OFWILLS REGIBTER OF WILLS rT a ,I ~------------------~~~ .: . ..., , ---------- ,I i ~ ,. \. .., ~, . fl' II , ,. \. .,. f '.' . .( q---. ----4 _".--0 ..-.-.. , --::::r r \- -,. ._----~._, --.- , , . . , I ------------- - ----- ---------- -- - ---,. RECEIVED FROM. & ACN ASSESSMENT P:' CONTROL I:iI NUMBER AMOUNT PAULINE C WINTERS 309 8ECONtJ ST BOX 316 8UMMERDALE, PA 17093 .ou.c/ .,CJ1UC1.,2 189-09-009E1 (MI) SSN (fiRST) VELVA R . fa TOTAL AMOUNT PAID ."0.27 DO REMARKS PAULINE WINTERS SEAL RECEIVED BY ,;.. o/. ')i MARY C. L~ 18 /'fttf11:/f;//Jj..:.l REGISTER OF WILLS . (j ... CHECI<It 3102 REGISTER OF WILLS ------------_.~~-~----~~-~----_. ..' '" . "" ,. , .,. ,.' .. '~r' " , .,. ,,<t' , ; ',!' , i" ': .' ~ , ,. .~.._.- ..- I'. t.1 i.;~~ ~;.~ ~ \,".: \II" \!:;~\ "'/ '&~ ~4 .- .. _.;:.~:;~: . ~J;";.r .. .......~. or , , PI.IIPOSE III' tcJTlCEI To fulfill the requlr..-nt. of Section 2141 of the I~rlt~. end Elt,., Tax Act, Act 22 of ."1. (72 P.S. Section 2140). PAYIEJfT . 01'''' U. t_ portion of thh Notice Ind .-it ..Ith your P.~t to the _-aht.r of Will. printed on the ~r.. ..dI. -- ftiIlIc. check Dr .-..y or.r p'yMlle tal MeiSTER Of' WILLS, AC:DfT. AU PIIVIIMtl received aha11 first be ...11... to Wly Int.r..t which "Y M 0.., .,lth eny r..l,..,. ..,1111d to the tax. IlI1\ICD (ClUI .. r.hn:I of . tax credit, which .... not ,.....,..tld on the h. nturn, ny be r......tlld by c-.al,Ung WI "AppUcatlon for A.~ of PennI,tWlnla l~rlt8nC' Ind Elt,t, Tu. (REV-ISIS). application. .r. .vel1ebl. It the Dfflce of U. _..I.tar of "Uh, .",. of the Z3 A~ Dhtdet Dfflc.. or by ceiling the .,eela. n-hour ."....".". ..rvlce ,.,..,. for for.. orderlngl In """lylVWIla 1.....-16Z-2050, aulaide PennI')'I","I. Ind within loal HerrSIburI .r.. (717) 7.7-IOM, m. (717) nz-rzsz (....,.1"11 1..lr" OnhJ. OIJECTIOMlI "" perb In Int.,...t not ..th,11Id with the ..,,.,1...,., .UORnCe or dl..Uownc. 0' deduction. or .....-.tt of tmc Uncludlng dllcOU\t or Int.r..t) II ahoMn on tt1le NoUc. MY object withIn .bb (60) dly. af receipt af thl. NoUCII 117. .-..r1tten prot..t to the PA o.p.rt.ent af ..venue, ao.rd af Appe.l., Dept. Z.1021, Harrllburl, PA 1712.-10Z1, GR .-.INU,... to hive the _tt.r det.ralned at the Mldlt of the ecCCU1t af the per._1 r..,r..."..Un, GR .-......1 to the Qtphen,' C4urt AIIIIN- IITlUTlVE CCIRIt!CTZIICII 'Nn..l arror. dlacov.red on thll .........,t Ihould be Ilddr...ed In .,rlUno tal PA Dep.rt.."t af R...,.,.,., ..,...., af Indlvl"'l T...., Ami Po.t A.......,t Revl_ Unit, DEPT. ZlO'OI, Herrllbur" PA HUI-UOI Phone (717) 7.7-'505, Sea p... S of the bookl.t Rln.tructlon. for Inhlrlt.nc. T.. ..tum for. R.,ldint Decedent- (REV..n,l) for... ....I_UDl"I of _lnlltnUv.h correctabl. ...ror.. DIscaMTl If ..., ... due 11 paid within thr.. (S) cal....r .onth. aft.r the decadent'. death, a flv. percent (S%) dbcount af the tax paid I. .U__. IHTDI!ITI Int.r..t 11 charged e..lmlna with fI...t dQ af dlll"...,..cy, or nlM (.) ~lh. W'III OM (1) day f.-- the data of death, to the det. af p.,..,t. Tu.. which bee.. dlllnquent Mfor. JanuIIry 1, 191Z bear lnt.r..t at the ...t. of .S. (~) percent per ~ calcul.ted .t . dallv r.t. of .GOGI64. All tu.. which bK-. dIIllftClUW't Dl"I or .ftar January 1, 1912 ..Ul bear Int.....t at a rat. which ..Ul vary fr. cal"'r VMr to c.l....r vaar .,Ith that rat. IMCU'Ced by the PA o.art...,t of Ravenue. The ..,Ucabl. Int.r..t rat.. for 1..2 through I'" .r'l 'lilt Int.raet w.t. Dallv Int.r..t Factor %Dr Int.rut R.ta D.llv Intar..t Feetor I'U ZOX .000504' 1.17 'X .DDDZ47 19U 1&% .aDD4)' 1'61"1"1 IIX . DDDSDl 19M IIX .DODSOI 19" .. . DDGZ47 1915 UX .ODOSS. 1"'-1994 n .DDDltZ 19.. lOX .GaD274 1"5-1996 .X .DD0247 ....Int.r..t I. calcul.ted .. followlI IIITEIIEIIT . SALAMCE OF TAll ImPAID X NVKIER OF DAYS DELINQUENT X DAILY IIITEIIEIIT FACTOR _.Any Noth. I..ued .ft.r the talC bee.... dlllnquent .,UI nf1act an Int.ra" calcuhUDl"I to flftMn US) _. beyond the data of thl .....l8Mt. If p.,..,t 11 ... .ft... the Int.rnt ~t.Uon data thoMn on the NoUc., IIddltlDl"lllI Int.r." ....t be c.lcul.ted. PIIlI'OSE IlF NOTICE. PAYMENT. AEF\llDCCRh ~C1ID1C11 mUM- ISWTlVE cc.RE:CTlDHlI DIICCUfT. IHTtR!ITI .:..", To fulfill the requlr..-ntl of Section Zl~O of the Jnherlt~. end [,tat, 'ex Act, Act ZZ of 1"1. ClZ P.S. Section 2141). Dltadt the top portion of thh HoUR end ~lt ..ith ~,. p.~t to the bghter of WUh printed on U- rlnn. .Ide. _.. ..... check Dr MM)' 0"''' payebll tOI REGISTER OF WILLS, ACEHT. All p.,.ent. recaS",_ ...11 flrd M ..,11ee1 to MY Int.,...t which .., be ckJIi, with .,y ,,_1"',. ..,lIed to the to. , t.knd of . tax crecUt, which .... not r~.ted on the to r.turn, MY be r~.ted by c~ht1"' In -AppUc.Uon for Rltw.I of Penn.,lva'll. InherltMCI end Eltet, Tax"" (REV-nU). Appllut1on. .r. .....Ullbl. at the Office of tfw _..1st... of lUll., MY of the ZJ Rewnue District Dlfle.. or b, Rill,.. the ...-ell. 24-hour .....rlt'll ...."lee ....... far to,... Orde"S",1 In PennIY1YMJ, 1.ln"162-2050, out". PeM"l"".' end within lout HIIrr.IbY,.. .r.. (717) 717-IOM, TUD' (717) nz-usz CHMrlng I....red OnlY). "'" PIIttv In inbrelt not ..U,fllld .,Ith the .,r.l...,., .Uow.nc. or dl..UOWMCI of deduction. 0,. .....MMt of tax Uncludl,. dlKDU1t ar Inhrun .. Ihown an thle NoUe. MY abject within Ibb ('D) dlI,. of recel,t of thl. NoUce byl --wriuen prot..t to the PA PeperbMt of A."......, ao.rd of Appe.ls, Dept, 211011, tterrhburll, PI. 17121-1021, OR --.Ieeth.,. to Mve the _U.r dehralned .t the MJdlt of ttM MCOl.I1t af thtI perHMI r~n...,t.Uve, 01 --.....1 to the Or""',- Court FlIOul .rror. discovered on \hie ........,t should be eddr.tnd In writing tOI PI. Pepert.."t of A.venue, ....... of Indl"I"l T...., ATTNI Po.t .....--.t Aevl... ~It, DEPT. 2ID'DI, "-rrlaburll, PI. 17Ue-l6D1 Phone (717) 717-'5D5. See pegs S of the boOkl.t -Inttructlon. for Inherltenc. Tax A.turn far. A..ldent ~t- (REV-1S0l) for en .xplenetlon of ~lnl.tr.tlvelY correctebl. .rror.. If IftY t_ due It ,.Id ,dthln thr.. (3) e.l"r ..,th. .ft.r the decedent'. dMth, . fI". pere."t (SU dltGOU'\t of the tax ptld It .llowed, Int.r..t It ct.rged beg1,.,1,. with fir" dly of delinquency, or nine (9) ....th. end OM (I> dIIy frOll the dlt. of de.th, to the dah of p..,..,t. Tu.. .."lch bee.. dtllnquent before ~ry 1, 1912 betr Int.r..t .t the r.t. of ... (6%) percent per ....... c.lculettd .t . dilly r.t. of .UDI64. 1011 t.... .."Ich btceMI dII11nquent on or .ft.r .....ry I, 1912 ,,111 beer Int.r..t .t . ret. .....Ich .d11 very frOll eel"r y..,. to e.l"r year "Ith thet ret. ~ed by the PA o..rt....t of A."...... The 1PP1l~le 1nt.r..t r.ta. '0,. 1912 th,.ough 1996 .r'l xur Int.,..t A.t. D.ltv Int.,...t Faeto, xur Inte,...t A.t. D8l1v Int.,..st FlHltar 1HZ ZOX ,UDS41 1917 OX .UOZ"7 1915 161 .ItGnSl 19"-1"1 IU .GUSOI 1'" IIX . UUIl I"Z OX .UOZ" 1'15 ISZ .DUSH 1995-1994 n ,DDIl9t 1916 lOX ,GUll" 1995-1996 OX .UItZ"7 --Interllt II etlculated .. followll IIlTEIlElIT . SALAIlCE OF TAll UNPAID X HUftBER OF DAYS DELI"QUEKT X DAILY IIlTEIlElIT FACTOR __Any NoUe. l..ued .ft.,. the ta bee.... dII11fMlUWlt will r.fleet en Int.n.t ctlcul.Uon to flftMn (IS) dey. beJDnd the ut. of thl .........,t. If p..,..,t It Mdt .ft.r the lnt.rllt COIIPUttUon d.t. thown on the Hotle., tddltl~l Int.r..t .u.t be ctlcul.t~. ('. I> '0> () 1\ HOTICE OF IHHERITAlfCE TAlC APPRAISEftEHT1 ALLOMAHCE OR DISlLLOMAHCE OF DEDUCTIOH>>, AHD ASSEBSIlEHT OF TAlC OH JOINTLY HELD OR TRUST ASSETS REY-154S EX AFP (12-95* COfIQtoffALTH aF PDICIYLYAHIA DlPAlnEHT Of' REYDIJE Il.IlUIlllf INDIVIDUAL TAXES D[pT. ZI.'U HARAIIIlItG, PI 17UI"UGI DATI! 04-01-96 COUNTY CUMBERLAND ESTATE OF DREIBELBIS VELYA R DATE OF DEATH 11-02-95 FILE NO, 21 96-0143 S,S/D,C, NO. 189-09-0088 MARY J LAUCK 614 N 2ND ST WORMLEYSBURG PA 17043 ACN 96102193 , CUT ALONG THIS LINE .. RETAIN LOWER PORnON FOR YOUR RECORDS ~ Ri!;;:isira-Ei[-AFP--iiif:9sj------------------------------------------------------------.---------.-----------.. NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 04-01-96 REMIT PAYMENT TOI REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 Aoount R..itt.d ESTATE OF DREIBELBIS YELVA R DATE OF DEATH 11-02-95 COUNTY CUMBERLAND ACN 96102193 FILE NO. 21 96-0143 TAX RETURN WAS. S,S/D,C, NO. 189-09-0088 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION. DAUPHIN DEPOSIT BK a TR CO ACCOUNT NO. 8100479275 TYPE OF ACCOUNT. () SAYINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE DATE ESTA8LISHED 02-27-95 Account Ba1anca Pare ant Taxabla x Amount Subjact to Tax Dabt. and Daduction. Taxabla Amount Tax Rata X Tax Dua 2,008.88 0.500 1,004.44 .00 1,004.44 ,06 60.27 TAlC CREDITS: PAYMENT DATE 02-15-96 RECEIPT NUMBER AA112513 DISCOUNT (+) INTEREST (-) .00 NOTE. TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOYE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO. "REGISTER OF WILLS, AGENT." AMOUNT PAID 60.27 60.27 .00 .00 .00 TOTAL TAX CREDIT BALANCE OF TAX DUE INTI!REST TOTAL DUE . IF PAID lFTER THIS DAT~"SEE REVERSE FOR CALCULlTIDH OF ADDITIOHlL IHTEREST. · I IF TOTlL DUE IS LESS TKAH II, HO PAYHEKT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" I CRI, YOU KAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FO~ FOR IHSTRUCTIOHS. I . : H ~f1f NOTICE. To ful'lll the r~lr..-nt. of Slctton 2140 of the Inherltenc. ~ E.t,t. T.. Act, Act IZ of ."1. 172 P.I. Section 2140). PAVtEJfT. DetMlh the top portion of thll MoUn'" ....It IrIIlth rout PQMnt to the R..l..., 0' "UlI printed on the rewr.. .ldI. ... ..... check Dr -..y orde,. peyllbll tal REGISTER OF WILLS, ACENT. All ,.,...b realved shell first be ..,UMI to -w Int.r.at WItch _1 tMi due, ..Ith MY' r_lnder 1IPP1led to the tax. REFUND Calh A r1Ifund of I tu credit, which VI' not requested on the to r.turn, MY be r..,.lted by cOIIphtl". ." -Application for hknl 0' PemeylVWl11 InherltMCe ... [,t.t, Tax- (AEV'"UlJJ. Appllcatlon. .r. aV1Illllbl, It the OffiCI of the _".It,r of VUh, ..., 0' the Z3 Revenue Dbtrlot OffiCI' or by calling the specl.l Z.'"hour .......'11'1I "Mllce ~. for '0,., orderS"" In PennlYlv."l, 1."0-$12-2050, out.lde PennlylVWlI. MIl ..Ithln 10081 Hlrrllburl Ir.. (717) 7'7-1094, TDal (717) 77Z.ZZSZ CHeerlnt 1.,.1,. Only). DlJECTIONSI IIM.....tv In Int....1t ..t ..U.'11Id ..It" the ...,..1...."., ,UDWMCa or dJ..UOMMCe of deduction. or .....__t of tu Unoludl". dllCCUlt or lnhr...U II ..., on thh Notice _1 obJKt ..I thin .Ixty UOJ day. of ree.lpt of thl. MotlN ~I ....rlttsn prot..t to thI PA Dlplr~t of AlVenuI, laird of Appell., Dept. Z'10ZI, Hlrrlaburg, PI 171Z'.10ZI, OR ...leetb.. to MYII tn. _ttar detlNllned at thI .....It of thI KCCU1t of tM ptIr'DMI rllPn.sntltlft, OR .......1 to u. Grptwol.' Court _IM- IITlIUIVE CCIIAEcnlld. 'eeul errore discovered on thll ........,t should IMI 8ddr...ed In ..rltlng tOI PA Deparbwlt of AIVenU8, aur... of Indl..,I....1 Tu.., A"'" Po.t b......,t alt'll... IMlt, DOT. 210601, Hlrrlaburl, PA 1712'-0601 Phon8 (717) '1'-'SOS. ...,...) of tM bookl.t -tn.tructlon. for tnherltencl TIX A.tum for I a..ldent a.o.dInt- (REV-150l) for sn ..,I_Uon of ..lnl.tratlWlb carreebbl. error.. DtlCDllfTl If Ml' tax .... II p.ld "Jthln thr.. ()) calsnclllr ....th. IIt.r the dec..,..t'. death, I five parC<<'lt (5%) dllOCU\t of thI tax paid II Il1owd. 1IlTlIlEIT, tntlr..t II charged betlmlnt with flr.t day of dell~y, or nlna (.) aonth. and OM (l) day f,.. thI data of death, to the data of P'YHnt. ,.... ..nlch bec.-. delinquent IMI10n ..........ry 1, 1912 beer Int.r..t .t the r.t. of .1. (AX) parcsnt par annul calculated It . dilly r.t. of .000164. All tau. which bec_ daU,...,snt on or alt.r ........ry I, 191Z ..Ill bMr Inter..t at . rlt. Mhlch ..Ill vvY fro. oel__r per to cal__r year ..lth that rete amounc:ld by tM PA Depart.."t 01 A.venue. The sppUcabll Inter..t rltl' for 1'" thrOUlh I'" Ir., lilt Int.r..t Rete Dellv Inter..t Feeter Xur Int.r..t Re" ns.lv Int.r.lt Feeter I.ar I'as I'" I'" I"' ulntere.t In I'X IlX IS! lOX I. calculatld .1 ..00541 . 'GOO' .000301 ,OOO3S6 ,00011' fall_I' I.., l.aa'I"1 1"" .").1"" 1"5-1'" 'X lIX 'X n 91 .000247 .00OJOl ....,41 .0001U .000ZU INTEREST. IALANCE OF TAX UlIPAIO X If1IIlIEI OF OAYI OELIHQIIEIlT X DAILY IIlTEREIT FACTOR uAny Notice hlUld aftar the tax ~. del1~t Mill nllNt .., Int.n.t calculation to 11ft... ns) day. lMlyond thI det. of tha ......-nt. 11 PI,.."t II ..... Ifter tM Intenlt ca.putetlon date Ihowt on tha ~tlc', 8ddltlonal Int.re.t .u.t IMI calculated. 00 c:- ~ ::0 3!!! ;,?~ 0:;'. C. ., t:.: ~1 ~ " r: " "'< " f I - r~ , C7\ ~. ""0 ~' " ;?:;.: " N :g~ e in () - ... P\lRl'OSE Dl' MOnet 1 I. 'ulflll .ho r_I....... ., ...11.., Z1" .f .ho Inherl''''''' .... E"'" 10, A.., Ac' 22 .f 1991, <72 P.', section 21..0). PAMHTI o.t.cn the top portion af thl. Notice and ,uo.lt with your ply.-nt to the ..,1.t.r of will. prlntad on t~ rl...,r" dde. .._ ...... cheek or .oney ordtlr pI.,abl. tOI RECISTER OF WILLS, ACENT. All p....... ....Iv.. ...11 ,I..' .. appll.d .. on. In...... whl.h ... .. du., vl'h on. ....Ind.. ..pll.d .. .ho .... REFUND (tIll1 A ..'und ., . ... .r"I'. which ... no' ..quo.t.d .., .h. .., ,,'u.n. ... .. ..qu....d .. ....I..lna on .Appll...I.., ,.. ..'und .f pann..lvonl. Inhe.lt.... .... E."" I.,. 'REV'I'l". Appll...I... ... .v.II..I. .. ,ho Of' I.. ., .ho ...1.... ., Will., on. .f .ho 2' ..venue 01...1.. 0"1....... ..llln. .ho .p..l.l 2'-hoU' on....lna ...vl.. nu-ber. for for" orderlngl In penn,vlvanle ,-800-562-Z05D, outllde Plnnsylvanla end within locII HarrlabUrg .r.. (717) 117-109., tOOl (717) 71Z-2ZSt (H..rlng lapelred Only). OIJECllONS. An. p.." In In..r..' no' ...I.'I.d .I.h ,ho ..p..I....n.. .11.."" .. dl..II...... ., d.duC.I..,. .. ......eon. ., ... Ilncludlna dl..oun' .. Int.r..t' .. .hOvn .., thl. H..I.. ... ..j..t .Ithln .I,t. '0" d... ., ....Ipt ., thh Notice byl __..It.on pr....t t. tho PA O.p.rt..nt ., ..v.nu., I..rd ., App..I., O.pt, 211021, H...I.oo,., PA 1'12'-1021. OR -..I..tlna .. h.v. .ho ..tt.. dot.r.ln.. .t ,ho audl' .f .h. ...ount .f .h. p.r.onel ...r...nt,'lv" OR --."..1 to the Orphan,. Court AIIUH- lSTAAtlYE CORRECTIONSI Fectu.l .rrot. dl.cov.red on thl. .......ent ,hould b. addr...ed In writing tOI Pi Dlpartlent 0' R'v~" lur.eu of IndlvIdu81 T...., ATTNI po.t A.,....~t AlvI.w unIt, DEPT. 280601, H.rrl.burg, PA 17121-0'01 PhOne e717l 717a'SOS. 5.. pegl S of the book lit "In.tructlon. for Inhlrltenc. TI. A.turn for. A..ldent Dee.dlnt" fREValS0ll for Bn I.planltlon of ed81nl.tr.tlvll, corrie tab I. .rror.. DISCOUNT I If on. t., duo I. p.ld .I.hln thr.' 1" ..I.nd.' eon.h. .'t.r .h. d...don", d..th, . flv' p.r.ont ISXI dI.count of the tlx plld I. .11awed. INTEREST l Int.r..t 1. cn.raed beGlnnlna with fIr.t dl' of d.lInquency, or nine (.l ~th. .nd one ell dlY fro. the d.t. of ~.th, to the dltl of plvaent. T.... which bee'" delinquent b.for. Jenulry i, 1.82 be.r Int.r..t .t the r.tl of .Ix (6Xl p.rc.nt p.r ennue celcul.t.d .t . d.lly rlt. of .000164. All t.,.. whl.h ...... d.llnquent on .. ,".r Jonuor. I, \..2.111 .... In..r..' .. . r.t. whl.h .111 .... ,... c.llnd.r y..r to cIIsnd.r y..r wIth th.t rat. ennouncld by thl PA DIP.rt.~t of A.v.nul. Thl IPpl1cabll Int.r..t r.t.. for l'IZ through 1996 .r" tIII tnt.r..t Alt. DIllY tntlr..t Fletor xur tnt.r..t Rltl De'lv tnt.r..t Fletor 1982 l'as 19" 19I5 1916 aalnt.r..t 20X lOX 11X UX lOX 1. cllcul.ted ., .0005'" .00001 .000101 .00015' .OOOU' follow" 1987 1918-1991 1992 199]-199' 1995-1'" ox 11X 'X 'X 'X .000z,.7 .000101 .00DZ'7 .000192 .000247 INTEREST R BALAHCE OF TAX UHPAID X HU"BER OF OAYS OELIHQUENT X DAILY IHTEREST FACTOR a-Any Notice I..ued .ftlt tM t.. blco'" d.Unqu.nt wlll nfllct en Int.rllt cllcullUon to flftHl1 US) etav. blvond the d.t. of the .........,t. If pevlent I' ,ad. Ift.r the Int.n.t c~t.Uon d.tl ,hOWn on the Motle., eddlUonll Inurllt .....at bl c.lcui.tad. COtMQNW[AL T1t Of' PDlCSYLVAHIA IJDIAl1ltDf1' Of' A[YDI.E ItItfAlJ Of' INDIVIDUAL TAXEI OUT. ""Ol HARAJIIUAG, PA 171ZI.I'01 *' INFORMATION NOTICE AND TAXPAYER RESPONSE . REVISED NOTICE ... EST. OF VELVA R DREIBELBIS S,S, NO. 189-09-0088 DATE OF DEATH 11-02-95 COUNTY CUHBERLAND FILE NO. 21- 'i {.. - 1"'",;1, ACN 96102188 DATE 02-20-96 TYPE OF ACCOUNT o SAVINGS o CHECKING o TIlUST 00 CERTIF. . m.lIdll." II."' PAULINE E WINTERS 309 2ND ST BOX 316 SUHHERDALE PA 17093 REHIT PAYHEHT AND FORKS TO. REGISTER OF WILLS CUHBERLAND CD COURT HOUSE CARLISLE, PA 17013 DAUPHIN DEPOSIT II( . T hili provided the Dep.rt~t with tM InforAtlan 11ItH "low "'Ieh hill!! been u.1td In ~lwbtlno the patMtI.l tax durI. their neord. Inctlut. that .t the dHth 0' thll .tMrvII dKMent, VOU w.n . Joint OMMr/benll#lcl.rv 0' thh IKCOU'\t. If rou '..1 thl, In'or..tlon I. IncorrlKt, pl.... Obt.ln ..rlttM correction fr.. the flnencl.l In.tltutlon, .ttech . copv to thl. fOnl ... ntum It to the IIbovtI Iddr.... Thh lKCClU1t It t...I. In KcordMctl Mlth the InhlrltMCtl Tax L.,. of the r __Ith of PIl'YI.vlvaotla. Due.Uon. IIQ be MlWlrld bv ulllno (717) 717.IU7. C;OHPLETE PART 1 BELOW II II II S;;! REVeRS!! SID:! FOR FILING A::ll i':''iH<:;li I::::TRtiCTIONS Account No, 8100206015 o.t. 05-01-91 Eatablhhed AcoOU'lt a.1MO. Percent To..le ~t Subjaat to Tax Tax R.t. Potontl.l Tax Due 10,000.00 16.667 1,666,70 .06 100.00 TAXPAYER RESPONSE ifILL;, AUUI. T, IN AN' 0Jl'~~IAL:TAXA8SUSHI!K1'BA81D. OHTNIS; HOTlea... To Intur. proper crHIt to vour KCCU'It, two (I) copl.. of thll noUc. .....t KC,,1nY yair ,.,..nt to tM Real.t.r of will.. "-k. chick p.yabl. tor ~eal.t.r of Will., Agent-. x x NOTEI If tax p.,....,.. .r. .os within thr.. (J) Ilonth. of the declCMnt". dIIt. of dHth, rou uv dIO.M:t . ~ dlsccutt of the tax .... &nv lm.rltMCtl tax due will ~ dlll"..nt nine (9) IMM'Ith. .ft.r the data of dIIIth. PART I!l [CHECK ] ONE BLOCK ONLY A. abov. InfotNUon ... tax durI It corrlKt. You .V chao.. to rlllt pav-nt to the Reaht.r of Willi with two copl.. of thll notice to obt.ln a dhcOU'\t Or' awld Int.r..t, Or' YOU IIIV ~ box -A- Md r.tum thlt notlc. to the RIII.t.r of Wills ... en offlcl.1 ........,t Mill be hlUed bv the PA Dlparblnt of Rn..... I. 0 The ..,.~ ....t hII. bean or ..Ill be rapor'ted and tax p.ld Mlth the """.v1v.n1. lmarltenca Tax tlturn to be fllld bv the dlc:edlnt.. rlptl....t.tlYII. c. 0.... above Infor.tlun Ikl.ncorr-.ct 1W'Id/~~.~tl lltId ~tlOfI. war. ,.Id by YOU. You ...t c....l.t. PAIIT L!J WldIor PART l!J below. If you Indicat. . different tax rete, pI.... .tat. your rel.tionshlp to decedent. P[',WVOFFICIAV US,E<oNLY1}ClA~F51 ','\<.'i"';,. PA ... DEPARTHENT.:' OF,.: REVENUe:::::,.>, j JOINT "'TRUST ACCOUNTS .PAIi;t'; .~,,'i, ,.,.,..""",.".. ;:',i'~"'.'..""" ,;.,,, ....," .';:','\:,;.iN ::!:?: ::?:,i:i~:;::;': :.:'; '-::4--: ;.;: :-::~:~~}}: :;:~iSD22:-: ::.:~:~':-'~::::.;~,~,., " ,',,' z' , ' .' :.:.':~:::t':;::r~'i::':" '. . . ..:~~!~::;:'~~.;<.:~. ." ... ;::'>":-':~~~~:A.:,- '~'1'l(~':<;" . .. ',:':: , .; :~{:;: ." ,,~ >' .:: ~:.;: :::-:-:,', ",>';;', ';::;::.:",::i:':,,~~,~>,::::' . 7 ..8."".. DEBTS AND DEDUCTIONS CLAIHED ., -, . --::~ PART ~ TAX RETURN - COHPUTATION OF TAX ON LIN[ 1. D:t. Ca!~l!,hLi 1 2. Account a.l~ 2 5. P.rcent Ta.able 5 X 4. _t Subjaat to Tax 4 5. Dabta and Deductiona 5 6. _t Taxabl. 6 7. Tax R.t. 7 X a. Tax Duo a ::-::; ::;::::,i'3:~=::-': .,.. '. .,.~ .:. :'~:i'"'' .. '.":~ :-::.: ::'::,'~::x':,,:;~ :~::!::: PART [!] DATE PAID PAYEE DESCRIPTION AHOUNT PAID I I TOTAL lEnt.. on Line 5 of Tax Coaput.tlonJ . ~r pena1tl.. af perjury, I decle~ thllt the fact. I have .-.ported abov. .re true, cor.-.ct .-,d ~.ta'Jo tho beat)! .~dga and beU.f. HOHE ('71"'}) '1 '>).. . ....2.." I ':2.'-" //~r'1;{lAJ WORK ( ) SIGNAfURE TELEPHONE NUMBER DATE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT .lth _II."'. Inl....1 ..... ... Inf....U... .w.ltted by the flnenoS,l In.titutlon. Z. J~rItMC' tax *OM' del1nquent nine ""thl aft.r the deu"""' d.h of ..th. S. A Joint eccount II ,...bl, IVM thoUgh the decedent', nMII .... lidded .. . ..tt.r of convenlMCI. 4. Acoount. ClnaluclJntI tho.. held bet""" hulbWMl .-ld "If,) which the dM:-*'" put In Joint ~. wUhln OM y..r prior to delth at. fully 'a.lbl. .. tren,'.r.. 5. Aocot.r'th utlblhhed jolntlv bet..... hulbend end ..If. .r. tMn OM 1M" prior to dMth .r. not '111...11. ,. Account. held bv . deCedent "In tru.t 'or" ~ther or o~r. ar. ".lbl, fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAVER RESPONSE 1. IlOCK A . If thII Infor..tlon ... cOIIPUhtlon In the notlc. .r. correct end deduCtion. ar. not being chlMd, placl ." "'X"' In block -," of Part 1 of the "Taxpayer Aupon.'- .ectlon. Sign two copt.. end .w.1t ttt. .,lth your check 'Or' the ~t of tax to the _....'ar of Will. of the county Indicated. The PA o.p.rt-.nt of R.v~ "Ill 1.1Ue en offlcl,l .......-nt (For. REV.l541 EX) upon recalpt 0' the r.turn froe the R-.I.t.r of Will.. z. ILOCI. _ If the ....t .pecifled on thl. notlc. hili bMn or ..Ill be reported .net h. p.ld ..Ith the P."".yl".,I. InMrltenc. Tu R.turn filed by the dKedento. repn..,t.tI"., plec. ., "T" In block ..... 0' P.rt I 0' the "T..p.y.r R..pon.... .ectlon. Sign OM copy end return to the PA Dep.rt.-nt of R.venue, Bur..u of Indlvldu.1 T.xa., Dept Z10601, Herrl.burg, PA 171ZI-0601 In the ~.lope provided. J. ILOCK C _ If the notlc. lnfor..tlon 11 Incorrect llndIor deduOtlon. .re being ct.IMd, chICk block -c"" end c.,.l.te P.rt. Z Me! 5 accord I,.. to the In.tructlon. Mlov. $Ign two copl.. end IUbIIIt thM with your chICk for the .-aunt of h. p.y.l. to the Rqht.r of will. of the county Indlc.ted. The PA nap.rt-.nt of Revenue ..Ill I.sue ., offlcl.1 ......-.nt (Fora REV~IS41 [X) upon recalpt of the return frOll the R-.llhr of Willi. TAX RETURN - PART 2 - TAX COMPUTATION LIIE I. Enhr the uta the KCOl.nt originally w.. ..t.l1ahed or titled In the ........r .d.Ung .t d.t. of death. IIJTEl For a dacedllnt dying aft.r lZ1ll1lZl ACCOU1t. .....Ich the dec.ant put In Joint neM' within OM (II yur of death ar. tu.la fully a. tr~"an. Howev.r, there 11 ~ ..clu.lon not to exceed n,ooo ,.r tret\Sf'r.. r...rdla.. of the V11lua of the lICCCM\t or the nuaber of eccount. held. If . double ..t.rlsk (..) .".ar. Mfor. your flr.t ~ In the addr... portion 0' thl. notlc., the '5,OaO ..clu.lon .lreadY has bMn daducted 'roe the acCOlM1t b.l.-.c. .. reportltd by the 'InWlClal In.tltutlon. Z. Ent.r the total b.l.-.c. of the account Including Inbre" eccrued to the d.t. of dMth. 5. The percant of the account that 11 taxabl. for .ach survivor 11 det.~lned .. 'ollow'l A. Tha parcent tantll. for joint ...... ..t.l1ahed ~r. ttwl OM par prior to the decadent". dMth: 1 DIVIDED IY TOTAL NUKIER Of DIVIDED 1'1 TOTAL tuIIEJI Of X 100 . PERCEKT TAXAILE JOINT QWHERS" SURYIYIHO JOINT OWNERS EJtallPl.1 A Joint ....t r......red In the n-. of the decadent and two other parton.. 1 DIYlDED IV 5 (JOINT OWNERS) DIVIDED BV Z (SURVIVORS) . .167 X 100 . 16.7% (fAXAILE FOR EACH ~IVDA) I. The percent tp.l. for ....ts cra.tad "Ithln OM y..r of the decadent.. de.th or ecCClU'lt. owned by the decedent but held In tru.t for ~thar Indl"ldual(.) (tru.t beneflclarl..I: 1 DIVIDED 1'1 TOTAL tufIER OF SURYIVIHC JOINT OWNERS DR TRUST !EH[f'ICINUES X 100 . PERCENT TAXAIILE EJtaapl.l joint ecCOl.I"It r....t.rMS In the MH 0' the decedent end two othel" patlon. ... ..t.Ushed ..lthln OM YNr of death by the decadent. 1 DIVIDED IY Z (SURVIVORS) . .50 X lOa .. sox (TAXABLE FOR EACH SURVIVOR) 4. The.-GUnt subject to to: Ulna 4) Is det.ralned by .,ltlplylng lM ecCCU'1t ~lenc. Ulna ZI by the parcent h..I. Ulna 5). 5. Ent.r tha total of the dabts ... deduction. Illtad In P.rt 5. 6. The.-aunt t...l. (Una 6) I. datl~lnad by IUbtrectlng the debt. and deduction. Ulna S) froe tha .-ount naject to tu Ulna 4). 7. Er.t~~ ~~~ E;~-~rl.t. ..~ ~~t. (11na 71 .. det.ralned balow. A. For cIat.. of dMth occurring aft.r 61SO/M, the tax rat.. for trM,'.n to SPOU'" .ra a. follow.r 1. Dat.. of dMth on or .ft.r 7/1/M and bafor. 1/1/95 the r.t. I. lX. Z. Oat.. of de.th on or aft.r 1/1/95 tran.f.r. to 'POU'" ..Ill ba taxed .t 0% t.. r.t.. Not.l For cIat.. of death prior to 7/1/M tr~,'.r. to ,pou... .r. taxebl. .t 6%. I. Tran".rs to lIne.l deacandwlt. Including f.ther, .other, .on, deught.r, gr-*hUdran, .on-In-l..., deught.r-ln-I..., .tepchlld and thalr .._ are t...l. .t .b pereant (~). C. Tran,'.r. to .11 other. including brolMr, .I.t.r, unci., aunt, ~ and nlac. ar. t..abl. .t fIfteen parcent (15%). D. If you chanDa the tax r.t., pl.... specify your r.l.tlonshlp to the decadent In the an. provided. I. Tha.-aunt of tu due Ulna I) I. det.ralned by INltlplylng the .-ou"It tax.l. Ulna 6) by tM tu nte UI". 71. CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowabl. debt. and deduction. ar. det.r.lned a. follow. I A. Vou I...lly .re r..,on.lbl. for payaant, or the ..tat. subject to edalnl.tr.tlon by . par.onal rapr.sentatlve I. Insufficient to p.y the deductlbl. It.... I. You ectuaUy p.ld the dabt. aft.r dMth of the dacadant .net can furnish proo' of p..,....t. C. Dabts baIng c1.IMd ...t be It..bed fully In Part 5. If addltlOMI ~ 11 needed, u.. plain papar . Ill"" . 11.. Proof of P.yaant ..y be reque.ted by the PA u.part-.nt of Rawnua. y:-:-" .. TAXPAYER . ASSISTANCE :IF YOU' HEED FURTHER" INFORMATION OR ASSISTANCE, CONTACT ANY:,-,: '..' :::::;:;:<:'::':'" REGISTER OF WILLS, PA DEPARTMENT. OF.. REVENUE. DISTRICT OFFICE. ..';{(" OR CALL THE BUREAU OF INDIVIDUAL TAXt;'S,TAXPAVER INQUIRY UNITIN""iX;\i. HARRISBURG AT (717) 787-8327. TDDI (717) 772-2252 (HEARING IMPAIREOONLY)\Y ... CCMtOtM:ALTH DP' PENNSYLVANIA D!',AI,HD't UP' R(Y[NU! ILIt(AU UP' INDIVIDUAL uns MPT. lIun HARlISIlM, PA 11UlaD6I1 *' ~ ..- II "'.I~III ,,, 11."1 INFORMATION NOTICE AND TAXPAYER RESPONSE II REVISED NOTICE II II II FIL! NO. 21 - 'fl., ~ /'13 ACN 96102190 DAT! 02-20-96 TYPE OF ACCOUNT o SAVINlIS o CHECKING o TIlUST l&l CERTIf . EST. OF VELVA R DREIBELBIS 5.5. NO. 189-09-0088 DATE OF DEATH 11-02-95 COUNTY CUHBERLAND PAULINE C WINTERS 309 2ND ST BDX 316 SUHHERDALE PA 17093 REHIT FAYMEHT AND fORKS TO. REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE. PA 17013 DAUPHIN DEPOSIT BK . T hat proyldM the ~.rt....t with thl Infor_tlon l"tM tMlow which hili been U.M In c:IIlcul'U" tM pat...tI.1 tax dull, TMlr rKord. Indlut. that .t the de.th of thl Ibov. cMcMlent, you wer. . JoInt owner,,*-flc1sry of thl. KCCU\t. If you f..1 this Info~tlon I, Incurract, pi.... obt.ln wrltt... corractlon froe the flnenel.1 In.tltutlon, .ttach . copy to thl, fo~ WId rsturn It to the Ibov. eddr.... Thll KCount 11 taxlbl. In Kcordanc. with the ImerltWIC' Tu L.... of tM eo..onw.alth of PamIYI..,."la. Qu..t1on. _y be .......rM by ulll,. (711) ll1aISZ1. COHPL!T! PART 1 B!LOIl II II II S!E REVERSE SlDI! FOR FILING ANU "ATH!!H'" INlIiTi\;JCnONS AcoOWlt 110. 8000377594 Data 09-25-91 Eatablhhad ACCOW1t a.1WtC. Farcant Taxabla ~t SUbject to Tax Tax Rata FotenUal Tax Dua To In.ur. propsr crMlt to your Kcount, two IU copl.. of thh noUc. ..,.t K~ YOU" Plv-ent to the R-al.tlr of Will.. "-k. check p'rabl. tOI "-al.t.r of Will" Alant-. FART [!]I 10.014.79 16.667 1.669.17 .06 100.15 TAXPAYER RESPONSE . .,AUURITO RISP<IHD"UL . RUUL T.IH. AHOFPICIAI;.:t'AXAS8!88HI!HT:. BASlD.. ON'THIS HOTICI., A. ri"'l'TM 1Ibov. Infor..Uon MIl tax ckte II correct. U:::J I. You..y choo.. to r..1t p'v-ent to tM R-aht.r of wllh with two cop I.. of thl, notice to obtain . discount or .....Id Int.r..t, or you -.y check box "A. WId r.turn thl. notlc. to the R-al.t.,. of Will, WId ... offlcl.1 ......-.nt ..Ill tM I..uad bv the PA Daplrt-.nt of Revenue. x x HOTEl If tax pa~ta .ra .... ..Ithln ttv.. en .w1th, of the dec......t.. eMta of ..th, you .-y daduct . 5X d.."....,t of tM tax dull. My I.....rlt.-.n tax dull ..Ill bee-. dell....-,t nine (9) aonth. .ft.r the eMt. of dHth. [CHECK ] ONE BLOCK ONLY I. 0 The abov. ....t hat bean 0,. ..Ill tM r....rted and tax ,sid ..Ith the '.-nayl..,."l. lmarltance Tax return tL be filed by t.... decadent', r"."ltatlv.. C. D The abova Info""Uon I~ncorract and/o~t. MIl deduction. ...,.. p.ld by you. You .....t COllPl.t. PARr l!J and/or PART l!.J tMIOIIf. If you lndlc.t. a dlff.rent tax r.t., pl.... at.t. your ralatlonahlp to decadent. FART I!l DATE PAID it;, .......i'iOFFICI~l:lI~E)~.NLV.)O~~fi .. ... ........... PA.. DEPIIRTHEMt~,O~~tREVENUE ...... ...(j .:.p.',:...:....A..,....:...D......2~.i.. :...........'..... ..,....':~:;.:'.:::.....~ , ,r ~, . :':'i-.". :.',' ',;. . . -.. . >,~ '.. .., . ." ~ ;'::.:y.:~n~:;,;-:::;,>.;;;:::,~ ':,:,f'::"":'" .- :.::):::>~: ...., ,~. ,'-'--," ' ' -..~ ;.tt;.- 4: '" ','. '. .':...:..-..~~_.~:-~,:..-~;::; ..' .."..".,. ,. ..."..,.. :"::' .,. '. ~:~~~ ::.:.;::;.~;::>:~~:;: :.:, ;::: .:; :': :,::- ::'.,7. ..8 DEBTS AND DEDUCTIONS CLAIMED FART ~ TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS lINE J. Dat. e.tabllah.d 1 2. Account B.lenc. 2 5. Farcant Taxabla 5 X ~. ~t Subject to Tax ~ 5. Dabh and DeducUona 5 6. ~t Taxab10 6 7. Tax Rat. 7 X a. Tax Dua a ",:,';':;::J-;' "") PAYEE DESCRIPTION AHOUNT PAID I I TOTAL IEntar on line 5 of Tax C_taUonJ . Under penaltl.. of perjury, I declar. that t~ feet. I hay. reported abov. .r. t~, correct 8nd ';j""1ota to. the beat r. ay knowledga and bellaf. HOHE ( ':I / ~l) '7 >, "1 ?J ~ I (MA~~(fx~l'''i " I ~ W~~~~~tlP:E N~HBER GENERAL INFORHATION 1. fAILUU TO RESI'OHII NILL RESULT IN AN OfFICIAL TAX ASSESSHEHT .lth _11'''10 lntorut batad... Inlo..II... IUbaltted by the flnanol.1 In.tltutlon, I. Inher!tMC. tax beG... delinquent nine .....th. aft.r the decHWIt". nt. of de.th. J. Ii Joint acccutt h tulbl. ."en though the decadent'. nMII .... added .. . _U." of c~Ienc:.. 4. AoOOU\t. Clnoludl,... tha.. Mid tMt...... hutbllnd IInd ..1f,1 which the decadent put In Joint MA' ..lthln OM y.ar prior to deeth ara fullv ta.lbl. .. tr~.f.r', I. Aooounh ..tlblllhed Jolntlv bat...... hulba-Ml and ..If, ..,.. than OM y..r prior to dMth .r. not taxllbla, .. AocounU held by . cMcadent -In tru.t for"' ..thar or other. ar. t.x..l. fullv, REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. ILOCI A .. If the Info,..tlon ... coeputaUon In the notice .r. corrlKt WId deduction. .r. not IMlnt cta'''', plK' en "X" In block .... of Part 1 of the "'TlJqlayer lIIe.pon... .ectlon. Sign two c-.I.. and .w.1t thM with your cMck for the -.,t of t.. to the R"I.tar of Will. of the county IndlcatM, ThII P" Oapart.ant of _avanus ..Ill I..ua an offlcl.1 .....s.ant (For. ArVal"l EXI upon rec.lpt of the return frDl the ...I.tar of Will.. t. ILoa I .. If thII ....t IPecIlf1M on thh noUc. hili baWl or will be reportM end tax paid ..Ith the Pamlylnnle InhlrltWICa Ta. R,turn filed by the ~t'. r...r.....t.tlv., plac. ... -r In blocll. ..." of Part I 0' the -taxpaver AI,""". ,action. Sign OM copy and retu,.n to the P" Dap.rt..nt of A.venue, Iura'" of Indlvlduel T...., Dapt ll"II, Harrlsburl, P" l1IZI."Il In the Il'WIlope proy lded, S. ILOCI C .. If tM notice Infor_tlon 11 IncClrrect ~or deduction. an tMI,. chlsed, cMck block .C' and c....l.t. p.rt. Z WId S according to the In.t,.uctlon. bel..., Sign two copl.. WId ..It thall ..Ith your check for the ......,t of tu payable to tM AI,tater ar YIII. of ~. r,~~~: I~le.to~. ~. D~ Dap.r~'"t af p.tt\~ \'111 1.~~ ~ ~"I~I.1 ......~. 'F~.. ~a154~ rY, I~ r.,.!pt of the r.turn froa the R..I.ter of Wills. TAX RETURN - PART 2 - TAX COHPUTATIDN lIIE 1. Enter the At. the KCount orJllnIIlh' .... ..tlblhhld or tlt1M In thai .....r e",U" at data of death. HOTEl Fo,.. Deeadent dvlna .ft.r lUIUll1 "CCCMrlt. .....ICh the decadWlt put In Joint ".... within.,. ClI ~,. of death .r. taxabl. fullv .. tran,f.r.. HowIv.,., there I. an ..elu.lon not to .xceed .s,aol par tran.fer.. r...rdl... of the value of the ....,t 0,. the nuear of IKCOU'1t. held. If . doubl. .,t.rllk (MM) appear. before your fl,..t ~ In the ~re.' portion of thl. notlc., the '5,011 ..clu.lon .lrMCtv ... been daductM froe the Kccutt b111.-.c. .. ,.aportM by the flnMCla. In.tI tutlon. 2. Ent.r the tot.1 bailWICI of the KCount InclucU,. Int.,...t KCrwd to the dIIt. of _th. 5, TM pa,.cant of tM KCount thllt II taxabla fo,. nch survivor 11 atenlnad a. foll....1 A. The parCWIt tuabl. for Joint a,..U a.tlblllhad ..r. than one ,..r prior to the decadent'. ct.aU'll I DIVIDED IT TOTAL HUKaEA OF JOINT OWNERS ExlllllPllt A Joint ....t r-ahterM DIVIDED IV TOTAL tuCIlR Of X lID . PERCDtT TIXAILE SURVIVING JOINT OWNERS In the naM of the decadent'" two other penon.. 1 DIVIDED IY S CJOINT OWNERS) DIVIDED IV 2 CSURVIVORS) . .161 XII' . 16.1% (TIXAILE FDA EACH SURVIVOR) I. The pe,.CWlt tulbl. for ....U cra.tM within.,. va" of the dec......t.. death 0,. Kcountl owned bV tM dec......t but held In trust for another IndlvlduaIC.) Ctrust bana'lclarl,.). x ~~., . rmttKT '"AILE 1 DIVIDED IY TOT"L HUHIER Of $URVI~ING JOINT OWNERS DR TRUST aEHEFlCIARIES ExIlllPI.. Joint IKccutt r....t.,.ad In the naM of the dKMlent and two othe,. parson. WId ..tablllh1d withIn.,. y..r of dMth bV U. cMcadent. 1 DIVIDED IY t CSURVlVORS) . .50 X 101 - SOX CTAXABLE FOR EACH SURVIVOR) 4. TM MCUlt _JlGt to tax (line 4) I. det.,..lned by ..,Itlphlng tM KCCKJrtt bal.-.c. Cllna 2J by the pe,.c...t tulbl. Cllna 51. 5. Ent.r the tot.l 0' the debt. and deduction' II.tad In p.rt 1. 6. The....,t t....I. Cll". .) I. dataralnad by I\.tJtrectlng the debt. WId dlcb:tlon. Cllna 5) fro. the MCUlt "'jact to tax CUna 4). 1. Ent,,. U.. ~I~rl.\. t.. rata (lirA ~) a: dat.,.aln:~ bll:u. A. For dIIt.. of dMth occurrlt'll .f..,. 6131194, the tax nt.. for tr....f.rs to spou..' .r. a. '011..." 1. D.t.. 0' death on or .ftar 1/1/94 and bafor. 1/1/9S the r.ta I. lX. 2. Oat.. of de.th on or .ft.r 1/1/95 tran.f,r. to apGU'" viII be t...ad at OX tax r.t.. Hot.1 For dat.. of dMth prlo" to 111194 tnnll.r. to ,pau... .r. tuabl. at 6%. I. Tr...".ra to llna.1 de,canct.ntl Including father, ..ther, son, daughtar, grandchildren, .onalnal..., deughtar-Inalaw, .tepchlld and their I,,,,, .,.. tsxlbl. at al. percent (6%). C. T,.an,f.r. to .11 other. Including b,.other, ,I.tar, uncI., ~t, nephaM and nlec. .,.. t.xabl. at ,I't.-n percent (15%). D. If you chMga the tu rat., p..lII. speclh' you,. r.l.tlonshlp to the dacedant In the .r.. p,.ovldad. I. The MCUlt 0' tax due CUna .) II dat.,.alned by ..,Itlphlng the MCUlt taxlbl. Cllna .) by the tax rat. (1lna 1). CLAIHED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIHED AIIOW*bI. dabt. and deduction. .r. det.r.lned .. foil....' ... You 1...lly .r. r..,on.lbl' for payaant, Dr the ..tat. "'jact to adalnl.tratlon by . personal rap,..tant.tlve I. InlUfflolant to p,y the deductlbl. It.... I. You ectu.lh paid the dabts .ft.r death of the decadent and CIr'I furnllh ,roof of P........t. C. Debts tMlng c1.lead lU.t tM It..bM fulh In Part S. If additional apaca .. naadad, UN plain PllPlr I 1Ir . 11-. Proof of pav-ant ..y be raqua.tM by the P" Dep.,.t....t of Revenue. .:.....'..,. : '. ,.,:....: . TAXPAVERASSISTAHCE.-:::-':'-,,'.-:': .-::':::' .. .'-;'_.":-::'~':~",~,:...:..~.". IF YOU NEED FURTHER INFORHATION OR ASSISTANCE, CONTACT ANY.. ...,. REGISTER OF WILLS. PA DE?ARTMENT OF REVENUE DISTRICT OFFICE..:.> OR CALL THE BUREAU OF INDIVIDUAL TAXES TAXPAYER INQUIRY UNITIN{))... ........ HARRISBURGAl (717)787~8327... TDD' (717)772-2252 (HEARINS IHPAIRED.(JNt'O\ .N. ~T1t 01' I'l*SYLVAHIA IVU'_' 01' ..VVU ILIIUU Of INDIVIDUAL TUU DOT. 11"11 HAIIlllURG, PA 111tlal'Ol *' II ",.IMI It ." ,'.MI INFORMATION NOTICE AND TAXPAYER RESPONSE REVISED NOTICE II II II FILl ACN DAT! NO. 21 - ql., . (I/.-J 96102192 02-2D-96 II 1111 PAULINE E WINTERS 309 2ND ST BDX 316 SUHHERDALE PA 17093 TYPE OF ACCOUNT EST. OF VELVA R DREIBELBIS 0 SAVINlIS 5.5. NO. 189-09-0088 o CHECKING DATE OF DEATH 11-02-95 DTIlUST COUNTY CUHBERLAND l&l CUUf. REHIT PAlHEHT AND fORKS TO. REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE. PA 17013 DAUPHIN DZPOSIT 8K . T hII. provided the Dap.rt....t .,Ith the Info,...thn IhtM tMl.. WIldt he. bean usacl In cllcullU", the pot...tlll ... due. Their r...rd. 1t1dlclt. tMt It the de.th of the ...... dK.....t, vau .r. I Joint ownar"*-flol...y of Uti, account. If you f..l th.. In'o,,,,Uon 11 Incorract, pl.... obt.ln ..rltt... corraotlon fr.. thI flnwlOl.1 In.tltutlon, .Uech . con t. thl, fOMl WId return It to the ..... addr.... ThIl KCOU"It I. taxlbl. In Mlcorct.nc. with the Inhe..!tWlCe 'I. L.... 0' ... eo-...lth of PannIYIYWlII. CkII.Uon. -V be .......rM by caUlnt (117) 711.ISl1. COHPLlTl PART 1 BlLOIl II II II Sll RlVERSl SIDl FOR FILING AhD PAYHlNT INSTRUCTIONS AooOWlt 110. 8100479275 o.t. 02-27-95 Eatablhhad ACCOWlt 1.1_. P.rcant Taxabl. ~t SUbject to Tax Tax R.t. PotenUal Tax Dua 2.008.88 50.000 1.004.44 .06 60.27 TAXPAYER RESPONSE ..' 'AJLURI rOjRUl'CJ!Gli"JLLRUUL T.IHAH'.Qp'~ICIALj~TAX(A8SU8Hl!HTBA8ID,OH .'~ISi; ~.c:a( To Insure proper crMIt to wour eoc....t, two UJ COlli" of th.. notiu ..,.t ac~.",. vour PIIv-ent to the R-aht.r of Will,. "-kl check ~I. tal ~..I.t.r of Will., Agent-. x M:JTta If tu Plv.WIh Ire... tdthln thr. CSJ IIOnth. of thl .s.cadant'. dltt. of dMth, you -v decalGt . 5% dllCOUnt of the tax dull. '"' Inherlt..- tu .. will ~ d11l1,...,.,t nine ('I .nth. aftar U. eMt. of "th. x PART [!] .. 1boY. Infor..tlon ...t tax ckte 11 correct. 1. You MY choo.. to rMlt p.~t to the R..late.. of Wllh ..Ith two ~I.. of this notice to obt.ln . dllCCM'lt 0,. IYOld Int.re.t, or you ..,. check box "A" and return thl. notlca to the _....tar of 111111 WId ... offlc1,1 .........., will be lllUed by the PA o.part-lt of R........... [CHECK ] ONE BLOCK ONLY .. 0 The above ....t has ~ or will be nportad WId talC ...Id '11th the PamIYIYWlI, Inheritance TalC ,..turn to be fl1N by the decadent'. rapr,.."tIUvI. C. 0 TM eboft InforAtlon l~ncorrlClt 1lftd.'o~h and ~t1onl were paid by ycMl. You ...t c08PI,te PART l!.J Mdlor PART L!J btIl_. If you Indlcat. . dlff.~t tax rat., pl.... .t.t. your r.l.tlonohlp to decadent. '.m~.i;j\lf%..OF~~CIAL\.U~E.'..9.N.~ liW;~fi1:~AJj'1 :M1t\?i. ~A.i.DEPA.!!!~~~rj..qr'~II,~YJ!!lIJ,l;;i:MI ;.~,~.~,.r..t...'..',~.,AIt:..,'~.,...'.'...'::.,'~,::...~.~.'.;'..'..:,..;..:.....'...,...... .....'.-:...;:;-~'~.~.,~,. ," '~ .::..~:::~~~ :~:: ~~;;:~~~~~~~~:~~::'::~;~~:;;:;.: ~~;:~.~ ';~;"IIlo' '<' , :':~;'W;:<::;::!:,c;:::,:':;::::);:;::i~.;"~:':~::::;:;:':::._ \*~lo;'?:',"":'> :~", .:,.; .~. ,,-"." :':::::i::;:::~;:~~~i~~~:*":::;::~~i:?;.::)1::;~;~.::::>:;;:~~:>'~:~ ,~)i';:.. .. 'm::t~; 4~'~ . ',' ...:':" :':,;.:_::,;;.;::.:::~::,::r:;::;;~~:~.;:;::~:>: ;~~:~:k~~:::' ~~~t::, .... .. ,. ..,~..:",;::.~:,:=::~,;:;;~~:.,::i .,......;,',...:.~...;,;:,~,.:',:.':...>...::....~:.'..:;......'.:...~~:.::..711,. ,'.:t...:..'.~:...,~::'" " , -.. '.;' -~ ;,;. '. , ,". ~,' , _ ;:: ::;:::.:::.:&:~;e::~_~~:~;<.:':...,:..,!. ..,', :"'. i_:__.';.jo';':::'?':-':::~~;.:~;L:.~':::'~::;;~:;':: . ~ DEBTS AND DEDUCTIONS CLAIHlD PART [!] TAX RlTURN . COHPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. O.t. Eatabllahad ! 2. Account a.l8nC. 2 5. Parcant Taxabl. 5 X 4. ~t SUbject to Tax 4 5. Debte and DaduoUona 5 .. ~t Taxabl. . 7. Tax R.t. 7 X I. Tax Dua 1 PART [!] DATE PAID PAYEE DESCRIPTION AHDUNT PAID I I TOTAL CEnter on Llna 5 of Tax ~t.tlonl . IhIar ......lU.. of perjury, I declara that the fecta I heva ~ted _.. .ra t...... cor.....t and ladga and baU.f. HOHE ( 7 I '1) I'J "':l - ~.... '\ j WORK ( ) ,'U' ".'" DATE r~ - GENERAL INFORHATION 1. fAILUR! TO RESI'OHII WILL RESULT IN AM OffICIAL TAX ASSESSltEHT .lth _11...10 In.....l booed... In,.._II... ~ltted bw the 'l~l.l In.tltutlon. t. Ime,lbnca t.. bee_. dellr~.,t nine .w1th. ,nor the decedent'. <<Nt. of death. S. A joint IlCIOCMtt II t.x...l. ...,." thoulh the dac......t.. n-. ".. MkIacI .. . ..tter of conv...lanc:.. 4. Aooauntl (lnalucllne tha.. hill' blitlfHn hulMnd ..... wlfa) ....Ictt the decedent put In Joint neae' within OM YN' prlo,. to dMth or. fulh tUN.' '1 tr....f.n. I. Ao......t. astlbUehed Joint., bet...." hu...... and ..If. ..ra thWI OM VNr prior to dHth ora not t..llbla. ,. Aocount. hIIld b, . dleadent -In tru.t for- ~t"r or other. ara t.x...l. fullv. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE J. SLOCI('" If the Inforntlon WId coeputatlon In tM notlc. or. co,.rect and deduction. ara not tMl,. chlMd, ,lac. ... "'X"" In block .A" .f Port I of the ~u"aytlr .,spon..- ,action. Sign t..o cOP." MIl .utMllt t"- with your chick for thIi ......,t of tax to the _..I.ter of Will. .f the county Indlc.ted. fhl PA Dap,,.t-.nt of Revenue ..Ill I.sue ... official .......ent (for. REV-I"I [I) upon recolpt of the roturn fr.. the ...I.t,,. of Will.. Z. ILOCI. - If the ....t .....1fIM on this notice has b4.-. or will be nportM and tax paid ..lth t.... P."".yl......l. ImarltWIC' Tu Raturn fUN by the dec......t'. rapr.....t.tI"., piKe... T In block "'I" of Part I of the -Taxpayer R..pon.." nctlon. Sign OM copy WId return to the PA Dapo,.t.-nt of RlYanue, au,.aau of Individual T.x.., Dapt 110'11, Harrl~rD, PA 111Zlal'Il In the .......Iope ..rOYldad, J. ILOCI C - If the notice InforHUon II Incorract ..uo,. deduction. or. IMino ClI8INd, chKk block fOe- WId coeplet. Parh Z WId S HCIordlnt to the In.tructlon. tMI.... SIgn two copl., and ...It thM "lth yOUr chack for the ...w1t of tax payllbla to the R..lItar uf wUh Qr th6 ~.~i' In:=l:atad. The rJ, D~:l"tftnt :Jf Rwr't\... ...1'.1 lrrvtl I!tn cUle!!'! U.-'l''''.'t''"1;: (C'('r. Of\I-l56P El" l,r,tM r"'.'rt of the raturn fr.. the R....t.r of Wl1h. TAX RETURN - PART 2 - TAX COMPUTATION UN[ I. Entor the dIIt, tM account orl.lnIIlh .... ..t.ttUIhed 0,. tlt1M In the .....r ,d.U,. .t d.t. of dHth. HOTEl For a decadent dying afU" IUIUIlI Account. which tM cs.c......t put In Joint ".... ..lthln DnII (I) y..r of dIIth Ir. ts.SlbI. fulh .. tr..."en. Howwir, thera II ... .xclu.lon not to .xcHd n,laa pe,. t,.....f.,... r-a.rdl... of tM YlIUII of the MICOloI'tt or tM ,.,..oar of account. held, If a doubl. ..t.,.ltk (..) .....r. befo,.. your flr.t ~ In tM addr.'. partlon of thl. notlc., the IS,III exclu.lon .lrNdv he. been daduGtM fr.. the account b111~ .. reported by the f!MnClI.l In.Ututlon, I. Entar the tot.1 bII1WIC' of tM Kcount Includl,. Int.,...t KCruM to the dIIt. of _th. S. The perc...t of the eccount that h tullbl. for .ach survivor II dat....lned .. foll..... A. The perMnt tuSlbI. for Joint ....t. ..tllblhhed liar. .,., OM par prior to the dKadant-. ddth. 1 DIVIDD IV TOTAL fUCIEJI aF DIVID IV TOTAL tuCID rJF X III . PERCENT TAXAILE JOIHT IM€RS SURVIVING JOINT CM€RS [)c....I.1 "Joint a"at r..hterM In the "... of the decedent WId two other person.. I DIVIQ[D IV S (JOINT CM€RS) DIVIDG IV z: (SURVIVORS) . .161 X laD . 1'.7% CTAXAILE FDA [A(H Sl.RVIVCln I. TM percent tulbl. fo,. ....t. created within OM par of the decadent-. daath or KCCU'ltl owned by the dKadant but held In tru.t for another Indlvldual(.) (tru.t beneflclarl..)1 I DIVI~ ty TOTAl ~[A or SURVIVING JOINT OWNERS DR TRUST IDIUICIAaIES X 111 . PERCDfT TAXAlLE b....I.1 Joint ItCCOWlt r-ahtared In the ,..... of the decadent WId two othlr penon. WId ..tllblhhed ..Ithln OM veer of dNth by the dec......t. 1 DIVIDED IY 1 (SURVIVORS) . ,51 X 1.1 . SOX (TAXAILE FDA EACH SURVIVOR) 4. The..cult UJHt to tax (11,. 4) II det....lned by .ultlphlng tM acc....,t b11IW1C. Ulne l) by the percent taxllbl. Cline S). I. Entar the total of tM dabt. WId daduotlon. IlItM In h,.t S. .. The ~t ta..bl. UI,. ,) h det....lnecI try subt,.actlng the debts WId deduction, ClI". 5) f,... the -.w1t il.DJact to tax (11".4). I_ Lnt.r tna appr.,rl.t. t.. ratM (lll~ 71 .a J.l.,&:~~ b.lc.. A. For dIIt.. of dNth occurring .ft.r "SliM. the tax r.t.. fo,. tr...,f.n to SPOU'" .n I' foll....1 1. Qate. of dNth on or aft.,. l/I/M and befora 1/1/.5 the r.t. I, SX. I, D.t.. of dNth on or Ifter 1/1/'5 tran.f.r. to spou", Mill be tued .t IX tax r.te. Notll for datI' of death prior to l/I/M tran.f.r. to .pau... Ir. taxllbl. It 'X. I. Tr",,'.r. to lineal da,candWlt. Includlna f.ther, aother, son, cleuahttr, lI,.andchlldr..., .onalnal..., deught.,.-ln"I..., .tepchlld WId their ....... Ir. tulbl. at .Ix perc...t C6X). C. Tran.f.r. to III other. lnoludlng b,.other, .I,t.r, uncia, aunt, ~ WId nlec. Ir. tulbla at fifteen percent (15%). D. If you chanrge the ta. rat., pl.... speclfW rour r.lltlonlt'll, to the decedent In tM Ir.. prOYldId. .. TM ~t of tu M Ulna I) II datlr.lnad by ..,ltlphl,. the ..cult taxlblt Cllna ,) by the tu ntl Ulna 1). CLAIHED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIHED AU_IIbI. dabtl WId daWctlon. Ir. dat.~lnad III foll_.. A. You 1...lly .r. r.sponllble for p.,.ent, or the a.tat. il.Djact to ~Inl'trltlon bV . peraonel rep,..,entatlve I. Insufficient to PlY the daduCltlbll It.... I, You ectullh peld the debt. aft.r ....th of the dec......t and c... hlrnhh proof of PIYIlWIt. C. Debts bel,. olal_ aull be ttMbM fully In Pa,.t S. If addlU.".1 lPactI I, nMdId, UN pllln ,..,. I Ill"" . 11". Proof of P'18I"t ..y be rllClUll.tM by the ,.. DapartMnt of ..........a TAXPAYER ASSISTANCE . .. ... . IF YOU NEED FURTHER INFORHATION OR ASSISTANCE, CONTACT ANY ... . REGISTER OF WILLS. PA DEPARTMENT OF REVENUE DISTRICT OFFICE. . . OR CALL THE BUREAU. OF INDIVIDUAL TAXES, TAXPAYER INQUIRY UNIT I" > .... HARRISBURG AT (717) 787-8:527.. TDDI (717) 772-2252 (HEARING IHPAIRED ONLY)