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GENERAL INFORMATION
1. 'AJLUft! TO RESPOND WILL USULT IN AN OffICIAL TAX ASSESS"EHT with .ppllceblt Inhr..' b..M on Info'"Uon
.......U.d b., the fI".,..,I.l '''''Hullon,
t. InherltMCI 'n bleD... dtIl1nquent nln. lonthl .,..r 'h. dlud-"t', dl'l of dill",
S. A joint .ccount I, ".ebl. Iven though thl dle,denl" "... WI' Iddld .1 . ..tt.r of conv,nl.nc..
,. Account. (Incl~lnt tho.. "lld bltween hu.b~ ~ _If,1 which thl d.c~tnt put In Joint ".... within ani V'" prior to
de,th .r. full., h.nbll .1 I,.",h,..
I. Account. .,,"tlthed Jolntlv between hu.b~ and wlf. .or. then on, Y'" prior to de,th .r. not ,..ebl.,
.. Ae.GUnt. held b., . dlcedent ~I" truI' forM ~ther or other. .r. 'IMDblt fullv.
REPORTING INSTRUCTIONS - PART 1
- TAXPAYER RESPONSE
1. .lOCI a - If the Infor..tlon ~ co.put,tlon 1n the notlc. .r. corr.et end deductlonl er. not bllng cl,I..d, pllCI en MX.
In block -,- Qf P.rt 1 of the "T..p'v.r A..,.n.I" ..ctlon. Sign two co,l.. .nd .~It t~ with your ch~k 'Dr the ..-unt of
t.1C to tM I.,hhr 0' WUh 0' t~ county Indlc.t~. Th. PA D.p.rt..nt 0' hvenu. wUl luUII ." offlcl.1 ......NtIt
CFor. I[V-IS.. [X) upon r.c.lpt 0' the r.turn fro. the R.gl.t.r 0' willi.
Z. ILOCI I . If the ....t lpeclfl~ on thll notlet h.. b..n or will b. r.,art~ tnd t'll ,.Id with the P.nn.vl",.,,11 I,.;,erlhnu
fllC R.turn fll~ bV the deced."t.. r.pr..entltlv., pl.c. en "X" In block "I" of P.rt 1 0' the "fl.plv.r A..pon.," 'Ictlon. Sign 0".
COPV and r.turn to the PA Otplrt.."t of RI~, lur.tu of Indlvldu.l fl.'" Dept 210601, Hlrrl.burg, PA 11128-0601 In the
,"v.lop. provided.
s. ILOCX C . If the not Ie. In'oreatlon I. Incorr.ct ~/or dlductlon. .rl being cl.lted, chick block "C" end CDIPllt. Plrt. 2 end J
Iccordln, to the In.tructlon. bllow. SI,n two cop II' .nd .ub.lt th.. with vour chick for the ..aunt of t.1C plvebl. to thl R..I.ter
of WII!, of the county I~dic.t.d. Th. PA Clplrt.."t 0' R.v.nuI ..III I..ue an of,lclll ........nt 'For. R[V-!5~' [X) upon rlcllpt
0' the r.turn froe thl RIgl,t.r of Will..
TAX RETURN - PART 2 - TAX COMPUTATION
LINE
1. Enter the dlte thl Iccount orl.lnllh .... utdlllhld llr tlt1~ In the .aMlr ulltln, It dlh 0' dl.th.
HOlEI ror. d'c~t dying .ft.r 12/12/1Z1 Account. which the decldant put In Joint n.... ..I thin on. (1) y..r of dl.th .r.
hllabl. fulh II trM,fl". How.v.r, thlre h an uc!utlon not to 'lIclld u,oao ptIr tran.fe,.1 re,.rdl... of thl "'IIUII of
thl .ccount or the nutblr of IcCount. hI!d.
I' . doubll I,t.rlsk (..) eppl.r. bl'or. your flr.t n... In the Iddr... portion 0' thl. notlc" thl 1),000 'lIclu.lon
Ilrlecty hi. been deduct.d frot thl Kcount blhncl u reporttd by the flnenclal Institution.
Z. [ntor the totll b.lancl of thl .ccount Including Int.r..t Iccrued to thl dltl 0' dIIth.
). The perc."t 0' thl ICCount th.t I. ttllth!. for .~ IUrvlvor I. det.reJned I' 'ollow'l
A. The percent tllCthll for joint ....t. 'Itabllahld tor. than on. y..r prlllr to thl dle.d."t.. delthl
1 DIVIDED IV fOUL HUMIEA OF
JOINT OWNERS
Ex_hI A joint ....t reghter"
DIVIDED IV TOTAL JoUtIU 01 X 100 . PERCENT TAXAlLE
SURVIVING JOIHT OWNERS
In the n... 0' the dee.dent .w two othlr person..
1 DIVIDED IV ) (JOINT OWNERS) DIVIDED IV Z (SURVIVORS) . .16' X 100 . 1'.7~ (TAXAILE FOR EACH SURVIVOR)
I. The perc."t t..lbl. for ....t. er..ted within one ya.r 0' thl dlc.dlnt'. de.th or leeount. OMn.d bv the dectdtnt but h.ld
In tru.t 'or If'IOthtr IncUvldUaU.) Uru.t blnlfleltrlllJI
1 DIVIDED IV TOTAL ~A Of SURVIVINC JOINT
OWNERS OR TRUST IEHEFlCIARIES
X 100 . PERCENT TAXAILE
ExMPhl Joint eccount reghtered In the n... of the dtced."t IIInd two other par.on. end ",abUshld ..lthln OM yaer of da.th by
the dlcedent.
I DIVIDED IV 2 (SURVIVORS) . .50 X 100 . sax ('AXAILE FDA EACH SURVIVOR)
~. The.-aunt IUbJect to tllC (11".4) I. det.r.lned by eultlplyln, the account b.ltnc. Clln. 2) by tha p.re.nt t,lIlbl. (11". )).
5. Enttr the total 0' thl debt. tnd deduction. Iltted In Pert ).
6. ThI.....",t t.nbla (11". 6. h det.relned by lubtrectlng thl debt. end deduction. HINI 5J froe thl HOUrIt .ubj.ct to till (lIne U.
1. Enter the 8PtIroprl.t. t.. rata ClIn. 11 .. ulhr.lned balow.
A. For det.1 0' dl.th occurrln, .ft.r 6/)0/94, thl t.. r.t.. 'or tren,'.r, to spous.. .r. .. follo"'1
1. D.t.. of dI.th on or .,tlr 7/1/94 end bI'orl 1/1/95 the rftte I. lX.
2. D.t.. of d.lth on or .ft.r 1/1/95 trtn,'.r. to .pou... ..III bl ta..d .t OX ta. r.t..
Not" For dlt.. of dI.th prior to 7/1/94 trtn,'.r. to .pousa. .r. t..abl. .t lX.
I. Trln.f.r. to Iln..1 de.cendent. Including f.th.r, tothlr, .on, deughtar, grtndchlldran, .on-In-Iav,
d"''''hr-In-I..., Itepchlld and their h.ue .r. t..ebl. .t .Ix ptrcent t6:(J.
C. Tr.....f.re to .11 othare Including brother, .hter, uncll, I\.W1t, nephew and nlecl .r. tuabl. .t flft..n percent (lSXJ.
D. If you ch.".. thl till r.t., pi.... .peclfy your "I.tlonshlp to the deccdtnt In thl tr.. provld.d.
e. Th..-aunt of t'll dUe CII". el I. d.t.r.lned by IUltlplylng thl ...unt t,1I1b11 (II". 6J by the t.ll rata (1In. 7).
CLAIMED DEDUCTIONS - PART 3
DEBTS AND DEDUCTIONS CLAIMED
Allowebl. debt. end deduction. .r. dlt.r.lned a. 'ollowII
A. You leplh .r. rupon.lbl. for p.yeant, or thl IIht. .ubjaet to IdIIlnlltr.Uon by . plrlOMl "p"tlnt.tlvl II In.ufflclent
to p.y thl deductlbl. It....
B. You actu.lly p.ld the debt. .,t.r d..th of thl dlced."t end can furnish proo' of p'v.."t.
C. Debt. being cI.IHd lU.t bI It_Iud fulh In Ptrt l. If ~1tlonll UN. h na~. Uti pl.ln paper. l/Z" II 11". Proof 0'
P'Y8ent Ny b. reque.ted by thl PA DlPert.."t of Rlv"""
TAXPAYER ASSISTANCE
IF YOU NEED FURTHER INFORMATION OR ASSISTANCE, CONTACT ANY
RESISTER OF WILLS. PA DEPARTMENT OF REVENUE DISTRICT OFFICE
OR CALL THE BUREAU OF INDIVIDUAL TAXES, TAXPAYER INQUIRY UNIT IN
HARRISBURG AT (717) 787-8327. TOO' (717) 772-2252 (HEARING IMPAIRED ONLY)
IQPOR Of
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To fulfill the requlreeentl of IlGtlon 2140 of thl InherltlnCe Ind E,t.t. Ta. Act, AGt It of ."1. 172 P.'.
Iootlen 11411.
DltllCh the 'OfI portion of thlt Notloe Met ..-It with your ,IYNnt to the Allht., of Will, printed on the
rlYer.. aide.
.. ..... check or 110M>>' order ,.nbl. tal HGISTER OF' lULLS, AGEHT.
AU p~ts ~1ICI.IVed _U Unt be epplltld to MY Inta,..t which ..y be due, with MY r..lnd1r IIPPUM to thl to.
A r.,\ftd o' . tn orldlt, which .... not r"u..ted on tM tax raturn, ..y bI requested by c...btl.... ... ....Uctltlon
for Refund of Penn.ylv~l. Inherlttnel Ind Eat,t. Tu. (REV-I'l)). Applleltlona .r. ev.ll~l. at the Dffle. o.
the Atll..., of Willi, InY of the ZJ Revenue DI.trlct af,le.. or by calli", the .,.cIa' Z4-hour ...~rl"' ..rvloe
~r' for ,.,., ordlrlnGl In Penn111v.,10 l-IDD-S6Z-ZD5a, out.lde Pennaylv.nla ~ within loc.l
HM,lIbur. ar.. (717) 7.7-IIM, fDOI (717) nz-un CHearlng I..,..,... On!w).
DLECTlONSI an, partv In lnter..t not AU.fled ..lth tM ...reh......t, ,UOVMCt or dl..UOdftC' of dtcIucU.... or ........"t
of tax (Includlne dl.count or Int.r..t) .. IhoMn on thl. Notlc. taV ObJeot ..Ithln .I_tv (,.) d.v. of rectl,t of
thit NoUctl byl
....rltttn prot..t to the PI Dtp.rt.ent of R.venue, Ia.rd of Appe.l., Dept. Z11021, Harrllbur" PA 17IZI.1IZ1, OR
....I..U.... to Mve the _tttr deta...lned at the ...It of the MOCM1t of the p.noral r...r.""ttU...., 01
.-......1 t. the OrptWl.' Court
AllctN-
IITllATlV!
CORRECTlONSI
DIICOlIIT.
POIALTYI
11lTDnT.
Ftc\utl .rron dllCOY.red on thlt ........,t Ihould be IIddr...ed In ..rltlng tOI PI Dep.rt..,t of Atverut,
Iur..u of Individual T...., ATTHI Po.t A....lllnt Review unit, DEPT. ZI"ll, Htrrlabur" PA .7111."0.
Phone (717) 7'7.'505. Set PItt J of the bookl.t -In.tructlon. for JnhtrltMC' T.. R.turn for. R..ldent
Dtctdtnt- (REV.1S0.) for tn .xpl~tlon of ~Inl.tr.tly.lv corrtct8bl. .rror..
If tnV tu dull .. ,.Id ..Ithln thr.. (J) altndtr .onth. .ft.r thl dtctdtnt'. dnth, . flv. percent (~)
.UlOOWtt of the tax "Id I. .U.......
Tht 15% to --.-.tv non.,.rUol,.Uon ,...Itv .. cCIJIII)Uted on the total of the tall tnd Inter..t ........., tnd not
,.Id befortl .....rv II, I"" the flr.t day .ft.r the end of the tu __.tv ,.rloll. Thl, non.,.rUol,.Uon
"",ltv I. ....llbl. In the ... ..",.r end In the tht ._ U.. period .. you ....ld .....1 the tax tnd Int.r..t
that ... been ......Id .. Indlcttld on thlt notlc..
Int.r..t 111 dwrflllCl ..Iml,. ldth flr.t cltv of dtll~v, Dr nine (t) .onths tnd CInt (1) dQ
fr.. the dlt. of _th, to the dlt. of ,.y.ent. T.... .....Ich bee-. dlU,.,...,t befort ......rv 1, 1912
betr Int.rllt It the nt. of .s. (lX) ,.rcent per ...... aleutltld .t t dtlh r.t. of .0111".
AU t.... which btc-. dtll,.,...,t ... or Ifter J.,..rv I, 1912..111 bltr Int.r..t .t t rtt. .....Ich ,,111 very f,-.
altndtr v..r to ClI....r v..r ..lth thlt nt. MnOUr'ICtd bv tht PI Deptrt..,t of Revenue. Tht tppllclbl.
Int.r..t r.t.. for 1'.2 through I'" .r'l
VIO' Intlr..t R.t. Dlllv Int.r..t Feotar VIO' Int.,lIt Alt. Olllv Int.r..t FlOtor
1'12 lax ,aDGSU 1911 IX .110247
I9U lAX ."0451 I9g-I"1 IIX ,nlSOI
1914 IIX ,nlSOI 1"1 'X .000247
I"S UX ,anS56 I"S-I'" n .011192
1916 IIX .001274 I"S-I'" ox .010247
-"Int.n" I. Clleul.tld .. fOU....1
INTEUlT . UL&IICB OF TAX UNPAID X NVllIEI OF DAYS DELINQUEN1' X DAILY INTEUlT FAeroR
nllf1 NoU. It.... .ft... the tu: '*'-. dtllnquent ..111 nft_t tr'I Inter..t ctllculttlon to flUeM nl) _a
beyond the dtt. of the .........,t. If paJlMnt It ... Ifter the In....... .....ttUon dlt. ...... on the
Notice, tddltlontl Int.r..t .ust be Clleul.tld.
1/'
COMMONWIALTH OF PINNSVLVANIA
DIPARTMINT OF RIVINUI
INHERITANCE TAX
STATEMENT OF ACCOUNT
~~/-
tLlRIAU 0' INDIVIDUAL TAMIS
1....IIAHtl I'. DIVIIION
1IV'7, 111..1
HMIIIII&.ItO, PI 11UI"""
"'.u.... .,'1......
15,19 '-;dl
07-01-96
BURTSAVAOE
11-27-95
21 96-0207
CUHBERLAND
96106086
Aoount Rooltled
EDWARD H BURTSAVAOE JR
327 SOHERSET DR
SHIREHANSTOWN PA 17011
DATI
!lTATI OF
DATI OF DIATH
FILl NUMIIR
COUNTY
ACN
EDWARD
H
MAKI CHECK PAVABLE AND RIMIT PAVMINT TOI
REGISTER OF WILLS
CUHBERLAND CD COURT HOUSE
CARLISLE, PA 17013
HOTE' To lnouro propor .redlt to ~our ....unt, oubolt tho uppor p.rtlon of thlo foro with ~our to. po~oont,
CUT ALONG THIS LINI ~ RETAIN LOWER PORTION FOR YOUR RICORDS .....
iil'y:U.-0-j-ix-Aj:ji-Coi:9i.-i------.ilii-iiliiiiiiTAHC!'-f;.x-s;'A'Tiiil'tif-OF-;.Ccoi.itfTuii..-u--u---u_..----u
ISTATI OF BURT SAVAGE EDWARD H FILE NO.21 96-0207 ACN 96106086 DATI 07-01-96
THIS STATEHENT IS PROVIOEO TO AOVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NANED ESTATE. SHOWN BELOW
IS A S~RY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAY"ENTS, THE CURRENT eALANtE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSHENT DR RECORD ADJUSTHENT, 06-24-96
27.05
PRINCIPAL TAX DUE,
PAYHENTS (TAX CREDITS),
PAYHENT
DATE
03-07-96
RECEIPT
NUHBER
AA112590
DISCOUNT (+)
INTEREST (-)
.00
AHOUNT PAID
27.05
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
27.05
.00
.00
.00
o IF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAN .1,
HO PAY"ENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" fCRI,
YDU HAY eE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. I
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,A'mENT1
De~ the fti pa..t~on of thh NoUu .nd lubIIlt with your PlyHnt ... pavabll
....lnted an ttM rIVI'" ,Ide.
,J 0" \Ij- r=
CJ a: ch lU t-
o: ' - ~
If RfIJDDlT DE~' chKk or 110M)' orMr payM.' tal
.._ If NOH-REIIDEHT O[C[DDn alike cheCk or MWMY ord.,. PIY"'.I
to thl n... Met add,."
REGISTER GF WILLS, AGENT.
to, COI1l1OHWEALTH OF PEHHSVLVAHIA.
All PlyMfttl recllved fhell be -..plied flrtt to ..,y lnter..t which MY be dUe with ....y n..lnder ...,1111d to the hll,
RUUND (CAli A ..efund of . tax cndit. which .... not reque,ted on ttM T.. R.turn, MY ~ requested by c~l.t1ng ....
"Application 'or Ref\nl of P.m.'Iv...... lm-rlt.nc. WId Elht. h... (REY-UU). Appllutlonl .r. IVIUM.. It
the a"lcI of the R..lltar of Will., ~ of ttM 23 Alv.nue Dlttrlet O"lc.. or 'r~ the Oeptrt.-nt" Z4-hour
....~rl"' service ~r' for for" ordlrlngs In P...,.ylv....l. l-100-362-Z050, out_Ide P...,.'lv....1.
end withIn locI I Harrlaburl .r.. (717) 7'7.1094, TDDI (717) 172-2252 (He.rlng I.,..red only'.
REPLY Tal au..Uont r...rdlng .rrou conhlned on thll notlc. ahaUld be -'drn.ed toa PA Dep.rt....t of Aev""'" lur..,
of Individual Tax.., ATTHI Po.t A.......nt Aavlew unit, Dept. Z10601, Harrl.bUr., PA 171ZI-0601, phone
(717) 7.7-65OS.
DISCDlIfTa
If MV tax due 11 paid ..Ithln thr.. (S) calMdar IIonth. .ftar tha daclldant'. death, a flv. percant es:u dllcOW'lt
of the tax p.ld II .UCMf8d.
PENALTY.
The 1n tax ....ty non-p.rUclp.Uon pen.ltv II CCMIPUted on tM tot.1 of the t.lC and Inhust ......ad, MIl not
paid bafor. JlftUarv 11, 1996, the flnt d.V .ft.r the end of tM tu aMI.tv period.
INTEREST'
Int.r..t 11 cMrgad beglMlng with flnt day of d.llnquencv, or nlM e') IKlnth. MIl OM (l) day frOll the data of
death, to the data of P'VHllt. Tax.. Nhlch bee.. dII11nquant bafor. January 1, l'.Z baar I"t.r..t at the rata of
al. e6X) ptIrCMt per .,..,.. calculated at a daUv rata of .0001". AU hu' which bee... ctellnquent 4?" WId aU.r
Januarv 1, 1"Z ..Ill be.r Intar..t .t . rat. which ..Ill vary fros calandar va.r to c.landar va.r ..Ith that r.t.
announced bv the PI Dep.rt....t of Aavanul. The appllcabla Int.r..t r.t.. for l'IZ through 1996 ara.
Vaar lntar..t A.h Dal1v lnt.ra.t Factor Y.ar tnt.rnt R.h a.lh Inter..t Factor
I9IZ lOX .OD0541 1917 9X .00DZ47
1'15 lOX .OOOUI 1''''1991 11X .000301
1'" 11X .DOUOl 199Z 9X .ODOZO
1'U ISX .000356 199'-1994 7X .0001.Z
I'" lOX .DlDZ7,. 1"5'1996 9X .00DZ47
....tnt.r..t I. calcul.ted .. foll..1
INTEREST . BALAHCE OF TAX UNPAID X HUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
....Anv Hotlc. I..uad aft.r the talC ~. delinquent ..Ill r.flact en Int.r..t calcul.tlon to fifteen (15) day.
baroM the data of the ........"t. If P.YNnt II .eda .ft.r thl Internt coaputaUon data shown on the
HoUca, addlUonal Inhr..t !lUst be c.lculated.