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184988 COMMONWEALTH OF PENNSYLVANIA
DlPARTMINT O. RIVENUI
OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
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JOANN FISSEL
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769 ERFORD ROAD
CAMP HILL, PA
17011-1126
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ESTATE INFORMATION:
~ FilE NUMBER
Ii1 21-1996-10~B
1:1 NAME OF DECEDENT (lAST)
~ BLACK M W
II DATE OF PAYMENT
EJ POSTMARK DATE
COUNTY
SSN 159-50-6074
(FIRST) (MI)
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CUMBERLAND
DATE OF DEATH
REGISTER OF WillS
m TOTAL AMOUNT PAID .49.44
CW
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MARY C. LEUIs ~JUAt.- .
REGISTER OF WILLS
REMARKS
JOANN FISSEL
SEAL
CHECK" 4861
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CDMOHWrAllllor PfHHSVlVAHU
DlPAalt'll:Nl Of REVfNU(
lUAfAU Of INDIVIDUAL lAKES
Dl.Pl. 110601
.lARAln~, PA I1UI.UOI
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INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 (/~ - !Of'b
96159249
12-17-96
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EST. OF M W BLACK
5,5. NO, 159-50-6074
DATE OF DEATll 10-06-96
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
IX] CHECUNG
o YRUST
o CERTlF.
JOANN FISSEL
769 ERFORD RD
CAMP HILL
PA 17011
RE"IT PAY"ENT AND FDR"S TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
DAUPHIN DEPOSIT BANK I has provided the Departeent with the Infor.atlon lilted below whiCh hal been used In calculating the
potential tlx due. lhelr recordl Indicate that At the delth of the Ibov. d.cedent, you w.r. II joint own.r/ben.flclary of thll account,
If you fe.l thll Infor..tlon II Incorrect, plell. abtlln written correction froe the financial Inltltutlon, attlch II copy to thll for.
and return It to the above addr.'I, Ihll eccount I, taxeble In accordance wIth the Inh.rltance lax lawl of the Co..onwellth of P.nn.ylvanla,
Qu..tionl ..y b. anlwer.d by ceiling (717) 181.8)ll,
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0035715804 Doto 03-30-95
Establhh.d
Account a.lanc.
P.rc.nt T.x.bl.
A.aunt Subjoct to
T.x R.t.
Pot.ntl.1 T.x Du.
1,734.60
50.000
867.30
.06
52.04
TAXPAYER RESPONSE
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSNENT BASED ON THIS NOTICE
10 Inlur. proper credit to your .ccount, two
Il) copl.1 of thll notlc. .ult .cco.peny_your
pay.ent to the Register of willi. Hake check
p.yable to: "Regllt.r of will., Agent".
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HOlE: If t.x p.y.entl .r. ..d. within three
ll) lonthl of the decedent'l d.t. of d.ath,
you .ay deduct a 5~ dllcount of the taM due,
Any inheritance tax due will beco.e delinquent
nine (9) eonthl after the det. of dlath,
To.
PART
ill
[CHECK ]
ONE
BLOCK
ONLY
A, Th. above Infor.atlon end t.x due II corrlct,
I, You .ay choole to re.lt pay.ent to the Register of Will. with two cople. of this notlcl to obtain
a dl.count or avoid Intlre.t, or you .ay check box ftA" and r.turn thl. notice to the R.gl.tlr of
Will. and an official a.......nt will be ISlued by the PA Depart.ent of Revenue,
B. c=J The .bove ....t hal been or will be reported and tax p.ld with the Pennsvlvanla Inherltanc. Tax r.turn
to be filed by the decedent.. r.pre.entatlv"
C. c=J lhe above Infor.atlon I~ncorr.ct and/or d.bts and dlduction. wIre paid by you,
You IU.t coeplete PART ~ and/or PART ~ below,
PART
~
If you Indlc.t. . dlff.r.nt t.x r.t., pie... st.t. your
r.l.tlon.hlp to d.c.d.ntl
OFFICIAL USE ONLY 0 AAF
PA DEPARTMENT OF REVENUE
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DEBTS AND DEDUCTIONS CLAIMED
LINE I. Doto Estobllshod
2. Account a.lenc.
3. P.rcent T.x.bl.
4. AMount Subj.ct to T.x
5. Debt. and D.ductlons
6, AMount Tex.bl.
7. T.x R.t.
e. T.x Du.
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2
3
4
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PART
[!J
DATE PAID
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL IEnter on Lln. S of T.x Conput.tlon)
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p.rjury, I d.cl.r. th.t the f8Ct. I
.y knoMl.dg. and b.ll.f.
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correct
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Under p.n.ltl.. of
co~let. to th. be.t of
TAXPAVER Si-~TliRE.
h.y. r.part.d .boY. .r.
HOME ("//"')' / '
WORK ("/' ) /',;
TELEPHONE NUMBER
end
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OfrlCIAL TAlC ASSESS"[HT with ,",pllCAble lnte,..t b...d on Infor..t1on
,~It'ed by the flnllMlal Inltltutlon.
2. InherltllnCe t.. blea... delinquent nlna looth. IIft.r It.. dICldlnt', date of d..th.
S, A Jalnt account It ta..ble evan though the dacad.nt', n.... .... added .. .. ..II.r 0' conv.nl.nc..
~. Account. (Including lhol. held b.t....n husband ftnd ,,1'.1 which the decudant pUt In Jotnt n.... within on. v..r prior to
cs.ath .r. full., '..abl. .. IrM.'.",
S, 'cCOl.a"lI. ..tabll,hed JointlY b.t....n hulbend and wlf. eor. Ihttn on. yur ,"lor 10 dulh IIr. not t....bl.,
.. Account. held by . dlCldlnt "In trUlt for" another or oth.r. ar. t..abl. lully.
REPORTING INSTRUCTIONS - PART
1
- TAXPAYER RESPONSE
I, BLOCK A . If thl In'or..tlon and co.putatlon In thl notlcl ar. corr.et And deduction. ar. not baing cIAl.ad, pl.c. an "X"
In block "A" 0' Part 1 a' t~ "l..payar R..pon.." ..ctlan, Slun two cap I.. and .ub.lt th.. with your ch.ck for the .~t 0'
tex to tM Ragllter 0' Wills 0' the county Ind1c.ted. The PA Departaant 0' R.venu. will IlIu. .n afflcl.1 .........nl
(far. R[Y.l5~a EX) upon r.c.lpt 0' the r.turn fro. the R.gl.t.r of Will..
Z, ILOCK I - I' the ....t .p.ci,lad on thl. not Ie. h.. b.en or will ba r.part.d .nd t.. p.ld with the Pannsylvanla Inharltenca
la_ Return '1lad by the dacadant'. rapr..ant.tlva. plac. .n "X" In black "B" a' Pftrt I of the -l..p.y.r R..pan.." ..ctlon, Slgn on.
copy end r.turn to the PA Ollp.rt..nt 0' Ravanue, Bureau of Indlvldu.l lau., O.pt 280601, ttarrhburg, PA 11128-0601 In t~
.nvelapa provid.d,
1, BLOCK C - I' the not Ie. Infar.etlan I. Incorrect andlor daductlan. are being clal..d, ch.ck block "C" .nd ca.pl.t. Parts 2 and 1
according to the Inltructlan. b.law. Sign two capl.. and sub.lt the. with your ch.ck far the a.aunt a' ta_ pay.ble to the R.gl.ter
a' Willi 0' the county Indlcatnd. lh. PA O.part..nt of Rav.nue will h.ue IIn official a..el...nt Iror. REY-l548 DC) upon racelpt
a' tha raturn 'ra. the Ragl.t.r 0' will.,
TAX RETURN - PART
2
, TAX COMPUTATION
LINE
1, Entar
NOlE:
tha d.t. the .ccount arlgln.lly w.. ..tabll.hed or tltl.d In the ..nnar ..I.tlng .t data of d.ath,
For a dacadlnt dying aftlr 12/12/82: Account. which the d.cedent put in joint n.... within one (II ye.r 0' de.th .ra
ta_able 'ully .. tranl'.rs. Ilowever. there is M ..clulion not to e_ceed n,ooo per Iran,'eree ragardl... of the value 0'
t~ .ccount or t~ nuab.r of account. hald.
If . doubl. ..t.rl.k (..) appe.r. b.'ar. your flrlt n... In the addr.s. portion of thl. notlc., the '1,000 e.clullon
alr.ady ha. b.en daduct.d fro. the account b.lanc. as reported by the financial In.tltutlon.
1. Ent.r the total bal.nc. 0' the .ccount Including Int.re.t accrued to the data 0' daalh.
1, lh. p.rcent of the account th.t 1. t...ble for .ach lurvlvor I. d.t.r.inad .. 'ollowl:
A. The p.rc.nt ta_abla for joint als.t. ..tabll.h.d aore than on. yaar prior 10 the d.cedent'. daath;
1 DIVIDED BY TOTAL NUHBER OF
JOINT OWNERS
E.aapl.: A joint .I..t r.glst.red
DIVIDED BY rOlAl HUHBEA OF X 100 . PERCENT TAXABLE
SUAVIVINC JOINT OWNERS
in the n... 0' the d.cad.nt and two othar p.r.ons,
1 DIVIDED IY 1 (JOINT DWHEAS) DIVIDED BY 1 (SURVIVORS) . .167 X 100
16.7Z (TAXAILE FOR EACH SURVIVOR)
B, Th. p.rc.nt ta.abl. 'or ....t. cre.ted within on. year of the dec.dant.. daath or accounts own.d by the dec.dent but hald
In trust 'or anotMr Indlvldual(s) (tru.t baneflclarle.):
1 DIVIDED BY lOTAl HUHBER OF SURVIVINC JOIHT
OWNERS DR TRUST BENEFICIAAIES
X lOa . PERCENl lAXABLE
E...ple:
1 DIVIDED
Joint account regl.tered
the dac.dent.
BY 1 (SURVIVORS) . ,50
In the na.. 0' the deced.nt and two othar person. and a.tabllsh.d within one year of death by
X 100
5D~ (lAXABlE FOR EACH SURVIVOR)
4. T~ aaount .ubJect to taw (lJn. 4) Is d.tar.lnad by ~ltlplylng Ihe account b.lanc. (llna l) by the p.rcent ta..bl_ (line 1).
5. Enter the total of the debts and deduction. ll.ted in P.rt 1.
" T.... ...,....... .........1. '11.... '" I. ....,......1...,....... .,............1.... .... of....... ..... ...........1..... '11".. Cl ,.._.... ._.... .....,.... ." .... '11... to'
7, Ent.r the approprlata tax rate (1In. 7) a. detar.lned b;low,
A. For dates of death occurring .ftar 6/10/94, the ta. rate. for tr.n,'ar. to spoulal are a. 'ollaw.:
1. O.ta. 0' death on or aftar 7/1/94 and b.for. 1/1/95 tha r.te I. 1~,
1. Data. 0' d.ath on or after 1/1/95 tran.f.r. to .pousa. will be ta.ed at o~ la. r.ta,
Hot.; For date. 0' death prior to 7/1/94 trans'ar. to .pou.e. .ra ta.able at 6~.
S. Tran,'er. to lln.al de.cendant. Including father, aother, .on. daughter. grandchildren. .on.ln.la.,
deughhr-ln.1aw, .tepchlld and their Issue ar. tauble .t .Ix parcent (6Zl.
C, Trans'ers to all other. Including brother. .I.t.r. unci., aunt, n.phew and nleca .r. la.abl. at fifteen percent (15~).
0, If YOU chang. the ta_ rate, pl.... spacl,y your relatlon.hip to Ihe decedent In the .rea provided.
a, Th. ..aunt of t.x due (1lna a) I. d.ter.lned by auitIplYlng the a.aunt t._able (1In. 61 by Ih. t.. r.t. (line 7),
CLAIMED DEDUCTIONS - PART
3
DEBTS AND DEDUCTIONS CLAIMED
AllowBbla debt. and deductJons .re det.r.lned .. 'allow.:
A. You lag.lly ar. r..pon.lbla for p.y.ent. or the a.tate .ubject to a~lnlstratlon by a per.on.l repr..antatlve I. In.ufflclant
to pay the deductJble It...,
B. You actualh paid the dabts .fter de.th of t~ dKltdent and CWl furnish proa' of p.yaant.
C. Dabt. being clal.ed au.t b. It..lzed fully In Part 1, If additional .pace I. n..dad. ule plain paper 8 Ill" x 11". Proof of
p.~t ..y be raqua.ted by tho PA Dapert,ant of Revanue.
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 ONLY)
PURPOSE Of
NOTICE I
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To fulfill the requln.."tl of S.ctlon 21"'0 of the Inh.rltanu and Elt.t. Ta. Act, Act 21 of 1995. (7Z P,S.
S.ctlon 9UO>>.
D.tach the top portion a' thh Hotlc. and .ubalt with your p.y..nt to the R.ghtar of Wills prlnt.cl on the
r.v.r.. .Id..
-- HIIk. chack or .uney ordar paYiabl. tal AECISTEA Of' WILLS, ACEHl.
A ,.fl.nd of a tax credit, which wu not raqutl.ted an the tax r.turn, uy ba r.qu..t.d by co~l.tJng an "Appllntlon
far Ra'und of Pennlylvanla Inherltanc. IW\d E.t.t. Taxoo (REV-UU). Appllutlon. ar. IvaUabl. at the Dfflu of
the R.gl.t.r of Will., any a' the 21 R.venua DI.trlct Offlca. or by c.lllng the Ip.clal 24-haur an.w.rlng s.rvlc.
~r. for fora. ord.rlngl In penn.ylvanla 1-800-362-2050, out.ld. Pennsylvania and within local
H.rrl.burg ar.a (717) 787-80'4, TOOl (717) 772-2252 (H..rlng IlPalr.d Only).
OIJECTIONSI Any party In Int.r..t not .atl.,led with the appral..aent, allowanc. or dl..llowanc. 0' deduction. or ......eant
of t.x (Including dl.count or Int.r..t) a. shown on thl. Hatlc. .ay obJ.ct within .I.ty (60) day. a' r.calpt of
thh Notlu byl
--written prot..t to the PA D.p.rtaant of R.vanua, lo.rd 0' App...., Dapt. 281021, Harrhburg, PA 17128-1021, OR
.-al.ctlng to h.v. the a.ttar d.t.ralned at the audit of the account of the p.r.onal rapra.antatlva, OR
--..,..1 to the Orphen.' Court
AmUH'"
ISTAATlVE
CORRfCTIONSI
DISCOUNTI
PEHALTV~
INTEREST I
Factual .rror. dl.cov.rad on thl. e....leent Jhould b. addr...ed In writing tOt PA D.part..nt of R.venu.,
Bur.au of Indlvldu.l ,...., ATTHI Po.t A......."t Ravl.w unit, DEPT. 280601, HarrlJburg, PA 17128-0601
Phone (717) 787'"6505. S.. page 5 of the booklat ooln.tructlon. for Inharltanc. Tex A.turn for a Ra.ldant
Dec.dent" (REV-1501) 'or an ..planatlon of a~lnl.tretlvely corr.ctabl. .rror..
If any t.x due I. paid within thr.. (3) calend.r aanth. aft.r the d.cad.nt'. d..th, . flv. p.rcent (5X)
discount of the tax p.ld I. allowed.
The 15% ta. a.na.ty non-p.rtlclpatlon penalty I. coaputad on the total 0' the tax and Int.r..t .......d, end not
p.ld b.for. January 18, 1996, the first d.y .U.r the end of the t.. .an..ty p.rlod. This non-participation
penalty Is appealabla In the .... .ann.,. and In the the .... tI.. p.riod II you would appaal ttMI ta. and Intara.t
that has been .......d a. Indica tad on thl. notlc.,
Int.r..t I. charg.d b.glnnlng with flr.t day of dallnquency, or nln. (,) .unth. and one (1) day
froe the data of d..th, to the d.ta 0' p.yeent. T.... which beea.. d.llnquent be for. Janu.ry 1, 1'82
b.ar Int.ra.t at the rat. of .IK (6~) p.rcent p.r ~ calculated .t . dally rat. of .000164.
All ta... which beca.. dallnqu.nt on or aU.r Janu.ry 1, 1'82 wltl baar Int.r..t .t a rate which will vary 'roa
caland.r y..r to caland.r yaar with th.t rata announced by the PA Dep.rteent 0' Rav.nu.. Th. appliCable
Int.r..t rate. 'or 1982 through 1997 eret
V.ar Intar..t R.t. Dally Inter..t Factor V'llr Intar..t A.te Dalty Int.rast Factor
1982 ZD~ .000SltS 1987 .~ ,OO02U
1983 16~ .00008 1988-1991 II~ ,000301
1984 IU .000301 19'2 .~ ,OODZU
1985 U~ .000356 1993-1994 7~ .000192
1986 I.~ .000Z1" 1995-1991 .~ ,ODD2U
--Int.r..t I. calculated o. '0110..11
INTEREST = BALANCE OF TAX UNPAID X NU"BER OF DAYS DELINQUENT M DAILY INTEREST FACTOR
--Any Hotlca IlIued .U.r the ta. bacoe.. dallnquent will r.ft.ct an Int.re.t c.lculatlon to flftaen US) d.ys
beyond the d.ta 0' the al.a...ant. If payeent I. .ade .ft.r the Int.r..t coeputltlon data .hown on the
Hotlca, additional Intar..t au.t ba calcul.tad.
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