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COHHONwt:AL 111 or P[NNSYLVANIA
DEPARTHENT or REV[NU[
RUREAU OF INOIVIDUAL TAlC[S
DEPT. ~1I0601
HARRISBURG, Pol \l1ll~'ObOI
..)..~~.
rf(li~ ~ .
<,;~. . _ t.
"10l,li'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
, DATE
NO. 21- '\'-
97133914
08-09-97
'h.;~.1 II ,n u-'~.
TYPE OF ACCOUNT
EST. OF EDWARO F FAGAN
S.S, NO. 164-07-3306
DATE OF DEATH 05-31-97
COUNTY CUMBERLAND
SAVINGS
I . CHECK ING
TRUST
X. CERTIF.
TO:
MARYTHERE F MAZZUCA
APT 12
3609 KOHLER PL
CAMP HILL PA 17011
REMIT PAVMENT AND FORMS
REGISTER OF WILLS
CUMBERLAND CD CDURT HOUSE
CARLISLE. PA 17013
HARRIS SAVINGS BANK has provldod tho Oopartl'lont with tho InforlPllltion listod bolow which hl\S boon usod In clliculnting tho
potcantIal tax duo. Thcair records Indicate that at tho donth of tho nbovo docodont. you wllro a joint ownor/bonoflcl<1J'Y of this llccount.
If you feel this Inforllllltion is Incorroct. plOllU obtain wrltton corroction frolll tho financial Institution, attach a COpy to this forlll
and roturn it to tho abovu address. This account 15 toxablo In acc~rdance with tho Inhoritanco Tax Laws of tho COIPIlPlonwealth of Pennsylvanill.
rlllq..tl","" "_1' h~ ...,,,........1 k~' ....11~!":': ~717~ "/!7-S!27.
FILING AND PAYMEN,. INSTRUCTIONS
REVERSE SIDE FOR
04-26-96
To Insuro propor crodlt to your account, two
(2) copies of this notice e1ust accompllny your
pavmont to the RO!Jlstllr of wills, Hako chllck
payable to: "RClglst&r of Wills. Agcant",
COMPLETE PART 1 BELOW .
Account No. 23-92-287622
. . SEE
Date
Established
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rat.
Potential Tax Due
5,332.07
8.333
444.32
.15
66.65
NOTE: If tax pay~ents aro ~ade within threo
(3) I'tonths of the doccadont's data of doath,
you nay deduct a S~ discount of thll tax duo.
Any lnheritancll tax due will bGcome dlllinquunt
nine (9) 1Il0nths aftor thCll datCll of death.
x
x
PART
IT]
TAXPAYER RESPONSE
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT BASED ON THIS NOTICE
[CHECK ]
DNE
BLOCK
ON LV
A. c=J The abovG information and tax duo 1s corroct.
1. You may chooso to remit payment to the Register of Wills with two copies of this notice to obtllin
a discount or avoid intorest, or you may chock box "A" and return this notice to the RogistCllr of
Wills and an offIcial assossment will be issucad by the PA DlIpartmont of Rovenull,
B. c=J Tho above asset has been or will bo roported and tax paid with the Pennsylvania InheritancCll Tax rCllturn
to bca flied by thll decedcant's roprosentatIve,
C. ~ The above informatIon is Incorroct and/or debts and dcaductions WCllrll paid by you.
~ You must cOlllplCllte PART 0 and/Qr PART 0 bClllow.
OFFICIAL USE ONLY 0 AAF
PA DEPARTMENT OF REVENUE
PART If you indicat. a diffe...ant 1a'11 rate, ~l'an state you,'
~ ....lationship to dec.dent: - eLl ~ (J:!~{. -I
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD
LINE 1. Date Established 1 'I - .;{ ~." J t, ) 1 -
2. Account Balance 2 2+-33 ,1= c '1 2
3. Perc.nt Taxable 3 K Z)-,,? 3 3. 3
4. Amount Subject to Tax 4 IJ:L'L.. 3 ;)- 4
5, D.bts and Deductions S .- 0 - 5
6. Amount Taxable 6 t1 'fl(, J;L 6
7. Tax Rate 7 K ' 0 b 7
8. Tax ou. 8 :.J ? (, j- 8
DEBTS AND DEDUCTIONS CLAIMED
PART
~
DESCRIPTION
AMOUNT PAID
DATE PAID
PAVEE
TOTAL (Enter on Line 5 of Tax Computation)
$
Under penalties of perjury, I declare that the facts I
co~p18te to the b.st of my knowledge and belief,
have reported above are true, correct and )
HOME ('117) 73i-/tJ3,;J-()n.v1,/v,,'n I
WORK () ~ -:J g -:17
TELEPHONE NUMBER ""iiJi'i"E'"
~~ '9~ ~ ~ -' '-t 711 ~~,,/VC.i
A A SIGNA RE
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with .,pp!lcnblo IntorA~t hnsod on InforMation
sublllittlJd by thll finnnclnl Institution.
2. tnhllrltllnclI tax bot:ollloS t!alinquont nino I'lonths nftor tho llllcodllnt's dnto uf llollth.
5. A joint nccount Is tnllllblo O\llln though thlil dllclulon"s nllMII loOn. nddod "S ... "'IIUor of convQn!onco.
4. Accounts IlncludlnQ thoSCI hold balloOn" hushnnd IInd wlfoliothlch thll elocotlont pul in Joint n/llllo, within onn ~OM nriar to
d.~th nra fully tnxable liS trlln~fQr5.
5. Acco..mts lIstllbllshlld Jointly balw.un husbnnd nnd w\f. l'Ioro Ihnn nnA yonr "rior to donth i1rQ not trulIlblo.
6. Accounts hold by a docodont "In trust for" nnathor or othClrs nr. tmli'lblll fully,
REPORTING INSTRUCTIONS - PART
1
TAXPAVER RESPONSE
1. BlOCIC A . If tho Information and computation In th~ notice <Ire corroct .1nd deductions <lrG not botng c1almod, plncG an "X"
in block "A" of Part 1 of tha "YnlcpayGr Rosponso" ~actlon. Sign two copias .1nd submit thom with 'lour chock for the 1I1110unt of
tnM to the Reglstor of Wills of the county Indlc~tod. rhe PA Departlllont 01 Rav8nue wjJl issue ~n offlci<ll <l550S51110nt
(Form REV.l~48 EX) upon rGcalpt of the raturn from the Roglster of Wills.
z. BLOCK B _ If tha assat speciflod on this notlca has been or wIll be reported <lnd taM PDld with the Ponnsylvanla Inherltanca
TOM Raturn fllod by the dacodent.s reprountativo, pLnco nn "X" In block "a" of Port I of the "TlIMpayer Rosponso" soction. Sign one
COpy and return to tha PA DopRrtmont of Rovenua, Buroau of Indlvldulll TR'lCClS, Dept 280601, Harrisbur!), PA 17128-0601 in thCl
onvalope provtdad.
3. BLOCK C _ If tha notlCQ Information 15 incorroct andlor daductions arQ baIng clalmCld, check block "C" and complete Parts 2 llnd .5
accordlng to tnu Instruction.. oelow. :.1\111 i...v l.u.,.i",:o ..llU "'l.o....~~ ~:,...~ ..~~;. i"..~ ~~.:.:::; ~::~ ~~:: ::":':=:.....,~ ':'~ ...... ~....~..'Q t.. tl,.. O.."I'ltAr
of Wills of the county Indicahd. Tha PA Dopartmont of Revanue will Issue an official Assessmont (Form REV-1548 EX) upon receipt
of the return frolll the Roglshr of Wills.
TAX RETURN - PART
2
- TAX COMPUTATION
LINE
I. Enter
NOTE:
thCl date the account originallY was ostablishod or titled In the mannor oMIstln9 at date of doath.
For 8 decedClnt dying ~fter 12/12/82: Accounts which the decodont put In joint names within one (ll year of death are
taxable fully as transfors. Howevor, there is an oxclusion not to oxcQed $3,IJOO por transferee regardless of tho valuo of
the account or the numbor of accounts held.
If a double asterisk (__) appears beforo your first namo in tho address portion of this notitQ,' the $3,000 exclusion
alroadY has been doducted from tho account balance as reported by the financial institution.
2. Enter the total balance of the account Including intorest accrued to the date of doath.
3. The percent of the account that is taMable for each survivor Is detormlnod as follows:
A. The percent taMable for joint assets ostablishod ~ore than one year prior to tho decodent's death:
DIVIDED BY TOTAL NUMBER OF
JOINT OWNERS
Example: A joint asset roglstered
DIVIDED BY TOTAL NUMBER OF )( 100 .. PERCENT TA)(ABLE
SURVIVING JOINT OWNERS
in the nama of tho decedent and two other personS.
B. The percent t3~abla for assets created wIthin one year of the decadent.s death or accounts owned by the decedent but held
in trust for another indivldual(s) (trust boneflclarios):
1 DIVIDED ay 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIYORS) .. .167 )( 100 .. 16.7% (TA)(ABLE FOR EACH SURVIVOR)
1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT
OWNERS OR TRUST BENEFICIARIES
)( 100 :IE PERCENT TAXABLE
Exe.ple: J01nt a~count regIstered
the decedent.
1 DIVIDED BY 2 (SURVIVORS) .. .50
in thCl naee of the decedent and two other persons and Qstabli5hCld within one yaar of death by
)( 100
50% (TAXABLE FOR EACH SURVIVOR)
4. Th. a.ount SUbject to tex (lIne 4) is deterlllined by mUltiplying the account balance (line 2) by the parcant taxlIble (I1ne 3).
5. Entor tho total of tho dabts and doductlons l1shd in Part 3.
6. The a.ount taMabla (Iina 6) IS dCltarlllinad bv subtr8ctlng the debts and daductlons {line !lJ troll the 8110unt sutlJoct to taM (line It'.
7. EntClr the appropriate tax rate (line 7) as determlnod below.
A. For dates of death occurring after 6/30/94, tha taM ratas for transfers to spouses are as follows:
1. Datos of oPioth on or aftar 7/1/94 and bafore 1/1/95 tha rate Is 3%.
2. Datas of death on or aftRr 1/1/9S transfers to spouses will be taMCld at 0% taM rate.
Not.: For dates of death prior to 7/1/94 transfers to spouses are tax8ble at 6%.
B. TransfClrs to lineal descendants Including father, mother, son, daughter, grandchildren, son-In-law,
daughter-In-law, stepChild and their issue are taMable at six percent (6%),
C. Transfers to all others including brothClr, slstor, uncle, aunt, nephow and niece are taxable at fifteen percent (15%).
D. If you change the taM rate, plCl8se specify your relationship to tha decodent In the area provided.
8. Tho alllount of tax due ClIne 8) is determined by mult Iply iog thCl amount taxable (line 6) by the taM rate 11 ine 7).
CLAIMED DEDUCTIONS - PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowabl. dabts and daductions are deter.ined a' follows:
A. You lCIgallY arG responsible for paYlllent, or the ostate SUbject to ad.lnistratlon by a porsonal representative is insufficient
to pay the doductible itQtlls.
a. You actually paid the debts after death of tho decedent and can furnish proof of paymont.
C. Debts baing c1aimCld must be Itolllized fully in Part 3. If additional space Is needed, use plain paper 8 112" x 11". Proof of
pay.ent may be roquested by the PA DepartlllClnt of Revenue.
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, TAXPAVER INQUIRV UNIT IN
HARRISBURG AT (717) 787-8327, TDDI (717) 772-2252 (HEARING IMPAIRED ONLY)
~J- C(_:L-q?
C~HHONWEAlTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
OEPT. Z8D6Dl
ttARRISBURG. PA 171l8-0601
~~~.
oJ;.4-r '.
, '.
IS -. ;;)..00-/0
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
NO.
21- q 1- 7;J..!f
97133913
08-09-97
FILE
ACN
DATE
.fY'I~~1 [I I" 1I.1\ I I
TVPE OF ACCOUNT
ROSEMMIE
145 SAINT
ETTERS
F KEEGAN
ANDREWS WAY
PA 17319
EST. OF EDWARD F FAGAN
S.S. NO. 16,,-07-3306
DATE OF DEATH 05-31-97
COUNTY CUMBERLAND .,
J./d..mI'Dl..,
REMIT PAVMENT AND FORMS
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
, 'SAVINGS
F' CHECKING
TRUST
Xl CERTIF .
TO.
HARRIS SAVINGS BANK has provldod tho Ospartlllent with the Infor"lBt!on listed b910w which has barln usod in calculating tho
potontlal tax due. 1h81r rocords Indlcato that at tho dualh of the ~bavB dQcodQnt. you woro a joint ownor/boneficinry of this account.
If you f081 this information is incorroct, pl08SG tlbtaln written corroctlon fralll the finandlll Institution. "ttach a COpy to this form
and return it to tho obovlI address. This account is taxoblll In accordance with thll Inhorltnnc't Tilll !mlll "f: th" CO""I"nnw,",,lth of PlInnsylvanla.
!:l:.::~tl:;;:: ;.;:.:.. !.o.. ..r,.;.,.;.:,..': b" ':'l,.U.-,.. :71,; ;'u1 eo:;:..
COMPLETE PART 1 BELOW ·
Account No. 23-92-287622
II II SEE
Date
Established
REVERSE SIDE FOR
04-26-96
FILING AND PAVMENT INSTRUCTIONS
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
5,332.07
8.333
444.32
.15
66.65
TAXPAYER RESPONSE
FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT BASED
To insura propor crlldlt to your account, two
(2l copias of this noUCO ~luSt accompany your
paymont to tho Register of wills. Hoke chock
payablo to: "Rogister of Wills, Agont",
x
NOTE: If tax paymants are "ade within thrall
(3) months of tho docadllnt's date of dllath,
you may doduct a 5% discount of thll tax duo.
Any Inhorltanco tax dUll will becomll dlllinquent
~inll (9) monthS after thll dato of death.
x
Tax
PART
m
ON THIS NOTICE
[CHECK ]
ONE
BLOCK
ONLY
A. 0 The abovo information and tax duo is corroct.
1. You may chooso to romit paymont to the Reglstor of Wills with two copios of this notico to obtain
a discount or avoid Intorost, or you may chllck box "A" and roturn this noUclI to thll RClgister of
wills and an official assClSsment will be IssuCld by tho PA Dopartmont of Rovonuo,
6. [J Tho abovo assllt has bllon or will bo raportod and tax paid with thCl PClnnsylvania InhoritancCl Tax roturn
to be filed by tho decCldont's reprosentativo.
C. ~ Tho abova Information is incorrect and/or dobts and deductions wore paid by you.
Vou must complotll P~RT [!] and/or PART ~ billow.
PART If you indicate a different tax ~, Ple~~t.te your OFFICIAL USE ONLY OAAF
~ relationship to decedent: A!LU';; t i"-( PA DEPARTMENT OF REVENUE
TA~ RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS ..4D ...-..-----
LINE 1. Date Established 1 1/- 2C,. 9(, 1
2. Account Balance 2 .,.","" .;( . 07 2
3. Percent Taxable 3 K ~.?'?' <: 3
-
4. Amount Subject to Tax 4 'f1t(! . ~?_- 4
5. Debts and Deductions 5 5
.. Amount Taxable . 6
7. Tax Rate 7 X . Clt: 7
8. Tax Due 8 4J,t,.;;'c; 8
PART DEBTS AND DEDUCTIONS CLAIMED
~
DATE PAID PAVEE DESCRIPTION AMOUNT PAID
TOTAL tEnter on line 5 of Tax Computation)
$
Under penalties of perjury, I declare thnt the
complete to the best of my knowledge and belief.
{l.<J4-"~ d-.~ fi---
TAXptVER SIGNATURE v
facts I have reported above are tru., correct
HOME (11/) 95y-fp737
WORK (71'7) 25")-)b g Y
TELEPHONE NUMBER
and
'i. :;L9 j;J)
DATE
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with .1ppllcllblo Intor""t Illltlld on Info"I'lntion
subl'lltted by the financial Institution.
2. Inheritance t8M beea",., delinquent nine "onths ~ftQr tho d.,odont's dnl. of dOlllh.
3. A Joint account Is taxnblo IIvon though the doclldont's nn"'. wns nddad nl n ""ttar 0' conv.nlone..
4. Accounts (Including thon hGld botwlI.n husbllnd nnd wlf., which tho declldon! flut In Joint "1111I111 wllhln one Vllllt' prior to
death are fuliy taxabl_ as transf.rs.
S. Accounts established Jointly botw..n husband nnd wlf. more Ihll" on. yoar prior to cloath IIr. not tn_nbl..
6. Accounts hald by /I dOCldllnt "In trust 'or" IInoth.,. or oth.r. or. t")lobl. 'ully,
REPORTING INSTRUCTIONS - PART
1
TAXPAYER RESPONSE
1. BlOCI( A . If the inforlllation and co..putation in the not Ice Bre correct Bnd deductions are not b.inll c1ailll.d. plac. an "X"
in block "A" of Part I of tho "TalCpayor Ruponu" section. Si~n two copies nnd subllllt the", with your chock 'or thG Mount of
tax to the Register of WJJls of tho county lndlcatBd. rho PA DGpart.Gnt 01 RQvenuo ",JIJ Jssue dn offlcJal dssasslIlent
(Form REV-1548 EXI upon receipt of th. return from the Register of Wills.
2. BLOCK 8 - If the asset specifiod on this notice has beon or will be reported Bnd tax paid with the Pennsylvania Inheritance
Tax Return filod by the (jecedent's repreSlllnhtlve, place .,n "X" In block "S" of Pllrt 1 of the "Till/payor Responu" soctlon. Sign onD
copy and return to the PA Oepllrtmllnt of Rllvenull, BureAU of Individual TltlCes, Dept Z80601, ~tarrisburg, PA 17128-0601 in the
envelope provided.
3. BLOCK C - 11 th. notica Information is incorrect andlor deductions aro bllln; claimed, chock block "C" and cOlllplotA Parts 2 IInd .5
accorotng to tno instructions oeiow. Silltl l." c"~i." a..C; ,s.,t."d~ 0.,...'11 ..itl; ,...!.If :n_=': fer tl...~ :l::::~:"!t =f ~~X ~!!~'~!:l" t~ '!'oil Po!:ht"..
of Wills of the county indicated. The PA Depllrtment of Rllvllnua wIll Issue an official OSSllssment (Form REV-1548 EX) upon rllceipt
of the return fro.. the Rllglster of Wills.
TAX RETURN - PART 2
- TAX COMPUTATION
LINE
1. Enter
NOTE:
thll date thll account origlnlllly was llstablished or tltlod in the manner oxlstlng at datil of death.
For a declldllnt dying after 12/12/82: Accounts which thll decedent put In joint namos within one (II year of death are
taxable fully as transfers. Howevar, there Is an exclusion not to OXClllld 53,000 per transferell rogardlllSS of tho vlllue of
the account or the numbor of accounts held.
If a double asterIsk (M.) appaars before your first nane in the address portion of this notica, the ~3.000 exclusIon
alroady has been dllducted fron the account balancll as rsported by tho fInancial instItution.
2. Entor the total balance of the account including interest accrued to the data of death.
3. The porcent of the account that Is taxable for each survivor Is dotermIned as follows:
A. The pere.nt taxable for joint assets e,tllbllshed more than one year prior to the decedllnt's death:
1 DIVIDED BY TOTAL NUHBER OF
JOINT OWNERS
Example: A joint assat registered
DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE
SURVIVING JOINT OWNERS
In the name of thll decedent and two othor persons.
I DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) . .167 X 100 . 16.7~ (TAXABLE FOR EACH SURVIVOR)
B. The percent ta~able for assets creatlld within one yllar of the decedont.s dasth or accounts owned by the decedent but held
in trust for another Indlvidual(s) (trust beneficiaries):
I DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT
OWNERS OR TRUST BENEFICIARIES
X 100 . PERCENT TAXABLE
Exa.plo: Joint account regIstered in the na..e of the decedent and two othllr persons and estllblished within one y~ar of death by
thl decedent.
1 DIVIDED BY 2 (SURVIVORS) . .50 X laD . 50~ (TAXABLE FOR EACH SURVIVOR)
4. The a.ount SUbject to ta~ (line 4) is dllternlned by nultlplYlng the account balance (lIne 2) by the perclnt tllxable (line 3).
5. Enter th. t(.tlll of the debts IInd deductions listed In Part 3.
6. The a..ount talCable (I1ne 6) Is detllr..Ined by subtracting tho debts and deducUons (line 5) froa th. lI.ount subject to talC (llnl ..J.
7. Enter the appropriate talC rate (IIno 7) as dlltermInad beiow.
A. For dlltes of death occurring after 6/30/94. the talC rllt.s for transfers to spouses ar. as follows:
I. Dates of death on or after 7/1/94 and before 1/1/95 the rate Is 3~.
2. Dates of death on or aftar 1/1/95 transfers to spouses will b. taxed at O~ tllX rat..
Hate: For datos of death prior to 7/1/94 transf.rs to spous., are taxable at 6~.
8. Transfllrs to linllal descendants Includlnll father, mothllr, son, daughtllr. grllndchildren, son-In-law.
daughtllr-In-Iaw, stepchIld and theIr issue are talCablll at six percent (6~).
C. Trllnsfers to all oth.rs inclUding brother, sister, unclll, aunt, nephew and niece are taxablo At fifteen p.rcent (15~).
O. If you change thll tax rate, please spllclfy your relationship to the decedllnt In the araa provldlld.
8. Thll anount of talC due (line 8) Is deterslnlld by mUltiplying the aaount taxablo (linll 6) by the talC rate (lIne 7).
CLAIMEO OEDUCTIONS - PART
3
DEBTS AND OEDUCTIONS CLAIMED
Allowable debts and deductions are detllrsin.d as follows:
A. You legally are responsible for paynent, or the estato subject to adainistration by a Pllrsonal representatIve is insufficIent
to pay the dllductiblo Ite..s.
B. You actually paid the debts aftllr dllath of the docadllnt and clln furnish proof of paynent.
C. Dllbts being claimed must be itllalzed fully In Part 3. If additional spaca is needed, use plain paper 8 1/2" x 11". Proof of
paynent say be rllquested by the PA Dopartment of Revenue.
TAXPAYER ASSISTANCE
IF YOU NEED FURTHER INFORMATION OR ASSISTANCE, CONTACT ANY
REGISTER OF WILLS, P~ 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)
P'~2=07~~ SSN 'h4 07 ~"Oh
NAME OF DECEDENT (LAST) (FIRST) (MI)
I"A(,:;AN I"nWARn I"
DATE OF PAYMENT
c;> lOP 11 C;>C;>7
POSTMARK DATE
_ ~ IPC;> 11 C;>C;>7
COUNTY
rIIMR~R' aNn
DATE OF DEATH
-~.~,..---....~
COMMONWEALTH OF PENNSYlVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG. PA 17128.0601
RECEIVED FROM:
I"
I
1 ROSEMARIE F KEEGAN
I 145 SAINT ANDREWS WAY
I ETTERS. PA 17319
j
r
I
r - - FOLD HERE
i ESTATE INFORMATION:
,
. FILE NUMBER
,
REMARKS ROSE MAR I E F KEEGAN
SEALCHECK# 4115
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
~"I~'t
~~
NO. Af\211696
HEV.1162 EX tll.96)
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
<>71;)3<>13
"'2') 3'<
FOLD HERE --
TOTAL AMOUNT PAID
$25.32
CW
"f<;(;-'::.:" UF "J",":I ~.:':j
<::).. ,J
RECEIVED BY //"I/,-,./.. .;/ ':/1" v' ./1,&
~lARY C. L WI S / //~y.. .I;/1./..)
REGISTER OF WILLS u//.//> /1.-/ (7
,
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PURPOSE OF
NOTICE:.
PAVPEHT:
--.,- -<'" ....._-'"
":c
To fulfIll the requir...nt. of Section 2140 of the Inheritanco end Estate Tax Act, Act 21 of 1995. (72 P.S.
Section 91~O).
Dotach tho top portion
rov.r.. sid..
u "aka chock or oon."
of this Not Ie. and lu~lt with your payaent to the Rogl,t.r of WIll. printed on the
ordor payable to:
REGISTER OF WILLS, AGENT.
REFUND (CRl: A r.fund of a hx credit, whIch wa. not nquutod on the tax return, .ay be r~.stttd by co..otJng DI'I "ApplicsUon
for R.fund of Pennsylvania I~rltanc. and Est.t. Tax" (REV~1313). ApplIcation. ar. available at tho Office of
the Roght.r of Wills, any of ttMI 23 Rovenue Dbt,..lct Offlcn 0,. by callIng thtl .pec,lllll Zit-hour answoring servIce
nuaber. fo~ foro. ordorlng: In Pennsylvania 1-800.362-205D, out. ide Ponnsylvania and within local
Harrisburg aroa (717) 787-8094, TOOl (717) 77Z-ZZSZ (Hearing I~aired Only),
oa.n;CTIOHS: Any party in inter..t not sllthfi.d with the apprehe.ent, allowance or dillllllawance of deduction. or a.......nt
of tax (including discount or interest) a. shown on this Notice .ay obJ.ct within .Ixty (60) day. of receipt of
this Notic. by:
--writt.n prote.t to the PA Depart--.t of Rev~, Board of Appeals, D.pt, 281021, Harrisburg, PA 171Z8-10Z1, OR
--electing to havo the .ett.r d.ter.ln.d at the audit of tho account of the porsonal r.pros.ntatlve, OR
--appeal to the Orphan.' Court
AD"IH-
ISTRATIYE
CORRECTIONS :
DISCOlMT :
PENAL TV:
INTEREST:
Factual .rrors di.cov.red on this a.......nt should bo addr.ssed In wrIting to: PA Depart..nt of Revenu.,
Bur.au of Individual Tax.., ATTN: Po.t A...s..ent R.view Unit, DEPT. 280601, Harri.burg, PA 17128-0601
Phone (117) 787-6505. 5.. page 5 of the bookl.t -In.truction. for I~rltanc' Tax R.turn for a R..ident
D.c.d.nt- (REV-IS01) for an .xplanntion of ad.ini.tratively correctable .rror..
If any tex duti is paid within thr.. (3) calendar MOnth. aftur the decedent'. death, a five percent (5:l)
dlaCCU1t of thll tax paid 11 allowed.
TM 15% tax .......ty non-participation penal tv is COIIIPUt.d on thll total of the tax and int.r..t ........, and not
p.id blfore January 18, 1996, the flr.t day after the end of the tax aane.ty period. Thi. non-p.rtlclpation
penalty i. appealable in the SaH I18nMr and in tho the .... ti.. p.riod as you would appeal ttHI tax and inter..t
that has b..n a..e...d a. indic.ted on this notlc..
Int.rest i. charged ~innina with fir.t day of delinquency, or nine (9) aanth. and one (1) day
fra the date of deeth, to thll dote of pay.ant. Tax.. which bee.. delinquent before January 1, 1982
beer int.r..t at the rat. of .ix (6:l) perc.nt per annul calculated at a dally rata of .000164.
All taxes which bec~' delinquent on or after January 1, 198Z will bear Interest at a rat. which will vary fro.
calendar year to calendar year with that rate announced by the P' Dapart..nt of Revenu.. Th. applicable
int.re.t rates for 1982 throuGh 199& are:
V.ar Inhrast Rat, Daily Int.r.st Factor V... Inhr..t Rat. Dally Inhr..t Factor
19&Z 20% .000548 1987 .~ .000247
1983 1(1% .000438 1988-1991 11% .000:501
1984 11% .000301 1..2 .. .000247
1985 13% ,000356 1993-1994 n .00019Z
1986 10% .000274 1995-1998 9:'. .000247
--Inhre.t is calculat.d .. follows:
INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
.-Any Hotlc. is.ued aft.r the tax b1c~s delinquent will reflect an Int.r..t ca1culatlon to flfteen (15) day.
beyond the date of the a.H.......t. If pa~t is lade after the inter..t cDlllPUtatlon dIIt. shown on the
Notlc., additional int.r.st lUst be calculated.
- I.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG, PA 17128.0601
RECEIVED FROM:
I
MARYTHERESA F MAZZUCA
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
_~'J~9_
~
NO. AA 242 637 REV 116m (11.961
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
97133914
$26.65
5035 MOONLIGHT DRIVE
INDIANAPOLIS, IN 46226
ESTATE INFORMATION:
FILE NUMBER
21-1997-0728
NAME OF DECEDENT (LAST)
FAGAN EDWARD F
DATE OF PAYMENT
1 /09/1998
POSTMARK DATE
0/00/0000
COUNTY
CUMBERLAND
DATE OF DEATH
5/31/1997
REMARKSMARYTHERESA F MAZZUCA
,
FOlD HERE
SSN 164-07-3306
(FIRST;
(MI)
TOTAL AMOUNT PAID
~.26. 65
FOlOtiERE
SEAE'-lECK# 810
/});
RECEIVED BY /$1/1.(,
MARY C. LE. IS
REGISTER F WILLS
DO
FilOGISTU, OF WILI-S
-------------.- ---~- ---- --- --- ------.--.----,....---.--------:.-.
,',.
.....,.
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BUREAU OF INOIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. ZI060l
HARAIS.URa, PA 17126-0601
MARYTHERE F MAZZUCA
APT 12
3609 KOHLER PL
CAMP HILL PA 17011
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'*
C:./
NOTICE OF INHERITANCE TAX
APPRAISEHEHT, ALLOWANCE OR DISALLDWANCE
OF DEDUCTION . AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
tn.IUt II '''lll.m
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN....DC
ACN
02-16-98
FAGAN
05-31-97
21 97-0728
CUMBERLAND
164-07-3306
97133914
AlIOUI"It R..1tted
EDWARD
F
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
Rifv:isira-Eif-AFP--lo3i:97i------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASS~SSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 02-16-98
ESTATE OF FAGAN
EDWARD
F DATE OF DEATH 05-31-97
COUNTY CUMBERLAND
ACN
97133914
FILE NO. 21 97-0728
TAX RETURN WAS:
S.S/D.C. NO. 164-07-3306
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: HARRIS SAVINGS BANK
ACCOUNT NO.
23-92-287622
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (lO TIME CERTIFICATE
DATE ESTABLISHED 04-26-96
Account Bahnce
Percent Taxable X
Amount Subject to Tax
Debts end Deductions
Taxable Amount
Tax Rate X
Tax Due
TAX CREDITS:
PAYMENT
.DATE
01-09-98
RECEIPT
NUMBER
AA242637
5,332.07
0,083
444.32
.00
444.32
.06
26.66
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
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS. AGENT,"
DISCOUNT (+)
INTEREST/PEN PAID (-)
.00
AMOUNT PAID
26,65
26.65
,01
.00
.01
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ·
t IF TOTAL DUE IS LESS THAN fl, NO PAYHENT IS REQUIRED,
IF TOTAL DUE IS REFLECTED AS A "CREDIT" I CAI, YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORK FOR INSTRUCTIONS. I
PURPOSE OF
NOTICE I
PAYMENT:
_<Clll:
To fulfill the r.quir..ent. of s~tion 2140 of the Inh.ritanc. end Est.t. T.x Act, Act 21 of 1995. (12 P.S.
S~tlon 9140 J.
Detl!lch ttt. top portion of th1l Motic. IInd sua.it Mith your p.y.....t to tM R.gilt.r of Willi prlntMi on the
r.v.r.. .IM.
._ HIlk. chKk or ItOMY orclilr p.yetl1. to: REGISTER OF WILLS, AGENT.
A nflmd of a tax cr.dit, which M.' not requll.ted on the tax r.turn, MY be r.qu..t.d by c~l.ting an "Applic.tion
for R.fund of P.nn.ylvani. Inheritance and E.t.t. T.x" (REV.1313). Application. ar. available at the Office of
t~ R.gi.t.r of Will., any of the 23 R.venue Di.trict Offic.. or by calling the .pecial 24-hoUr an'Mering ..rvic.
~ber. for for.. ord.ring: In Penn.y1vani. 1.800.362-2050, out.id. penn.ylvani. and Mithin local
H.rrisburg ar.. (717) 787.8094, TOO' (117) 772-2252 (H.aring Iapaired Only).
OBJECTIONS: Any party in int.re.t not saU.f1.c1 with the apprai..nnt, allowanc. or dhallowenc. of doducUon. or ........"t
of tax (inc1ucUng dbcOWlt or int.r..U .. shOWn en this HoUco I18Y object Mithin Ilxty (60) day. of r~.ipt of
th1l MoUce by:
-.written prot..t to the PA Dep.rtwent af R.v.nue, Board of Appeal., Dept. 281021, HarrisbUrg, PA 1712&-1021, OR
--.lecting to have the ..tt.r Mter.ined .t the ttUd1t of tM account of tna per.onal ropru."t.Uv., OR
--lQPI.l to the Orphan" Court
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUHT:
PENAL TV:
INTEREST:
Factuel arrors d1lcovered on thll ...a...."t shOUld be addr...Mi in writing to: PA DIp.rt.ent of R.venue,
Bur.au of Individual Tax'" ATTN: po.t ,......."t Review unit, DEPT. 280601, Harrisburg, PA 11128.0601
Phone (717) 787-6505. See pegs 5 of the booklet "In.truction. far Inheritanc. T.x R.turn for a Re.ident
Decedent" (REY.1501) far an .xp1anation of ea-lni.trativ.1Y correctable .rror..
If any tax due 11 p.id Mithin thr.. (5) c.1endar IIonth. after the dec....t.. death, a five percent (5iO
discount of the t.x pe1d 11 IIllowed.
1M 15i1: tax ......ty non.p.rt1clpatian penalty 11 COllPUted on the tat.l of thai t..x and int.n.t ....n.Mi, and not
paid b.for. January 18, 1996, the flr.t day aft.r the end of the tax aene.ty period. Thl. non.partlelpation
,.nalty is app..lable in the .... Al'WMr and In the the .... U.. period .. you would appeal the tax and Int-rut
that ha. be.n a.H..1td II' Incllc..tMi an thh notlc..
Int.r..t 1. charged b.ginnlng with fir.t d..y of delInquency, or nine (9) ~th. and one (1) day
frOll the data of death, to the date of pllyaent. Tllx., Mhich tt.c... delinquent before JWlU8ry 1, 1982
bear Inter..t at the rllt. of .ix (62) percent per ~ calcul.ted .t . delly rllte of .000164.
Alltoxe. which beea.. delinquent an or .ft.r January 1, 1982 will bear Int.r..t at II rat. which will vary frOll
calltf"ldllr y.ar to calandar y..r Mith thIIt r.t. anr'IOU1Ced by thfl PA Departeent of R.venue. Thai appllceble
Int.r..t r.t.. far 1982 through 1991 ar.:
V.ar Int.r..t Retll Daily Inter..t Factor V.ar Inter..t Rate Dally Intere.t Factor
1982 20iC .000541 1987 .. .000247
1985 16ie .00008 190-1991 11iC .000301
1984 11ie .000101 199' .. .000247
1985 13iC .000356 1995-1994 T~ .000192
1986 toil: .000274 1995-1998 .~ .0002U
--Inter..t I. calcull!ltad a. fallOW':
INTEREST = BALANCE OF TAX UNPAID X NU"BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
.~AnY Notlc. I..ued aft.r the tllX bleo..' delinquent will r.fl.ct an Inter.at ce1cull!ltlon to fift.en (15) day.
beyond the date of the a......-nt. If pnye.nt 1. .ade aftar the int.r..t coaputlltlon date shown on the
HO~lc., addltlonel Int.r..t .u.t be clllculatad.
">or,' , "
CO~,"I,j""~",,~ OF PENNSYlVANIA
OEPARtHtHt Cf' PEV[HlJE
!UREAU OF INOIVIDUAl TAXES
DEPt. Z80bOl
HARRlS!URC. PA 17126-0&01
:~;},.~'/'
rA~i..~ .
~~.'" t...
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 -9'( - '/,J.'!,
97133914
OB-09-97
11..;\.1 (IIU ""\1
TVPE OF ACCOUIIT
EST. OF EDWARD F FAGA~
5.5. NO. 164-07-3306
DATE OF DEATH 05-31-97
COUNTY CUMBERLAND
SAVltlGS
-
CHECv' UlG
TRUST
X CERTH.
MARVTHERE F MAZZUCA
APT 12
3609 KOHLER PL
CAMP HILL PA 17011
REHIT PAVHENT AND FORHS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
HARRIS SAVINGS BANK h1'lS provldod tho Oop<lrtnont >lith tho inforMtlon \i5tnd bolo,", which htl'J tlQM usod in c.,lcu\,1t!ng thO
'0"'1\0\ I" "0. To'" ,,,o,d, "d\ooto thOt 01 \00 "..to of too ,"0," "oo""t, .,ou 0",0 ., jo\,' oon,,"o,olld..., of '0" "co,"\.
If you fool lnis infornlltlun is incorrllct. pIO.l!>O obtain ..dUlln corraction frol'l thO finnncinl institution. tit Inch II cop'! to this lorn
0" ,0IU," It 1010' .bov" ,"'0". To', "ooun\ " lo"blo \n o"."dono' 0"0 10' InnodlO",O !,,, l'o' of IhO Conn"woolth of Ponn"'von',,.
Ollllo:tln.... ".!' h.. .nc........... k~' ,...1~1..::: '7~"J~ 7!7.!!.':!."'!.
COMPLETE PART 1 BELOW M
Account No. 23-92-287622
M 1I SEE
REVERSE SIDE FOR FILING AND PAVMENT INSTRUCTIONS
04-26-96
to insuro propor crodit to your account. two
t;:J copios of this notico nust acconpany your
p.....nont to tho R091stor or \.lills. Hako chock
paYOlblo to: ":?ogistor of wills, Agont".
Date
Established
x
5,332.07
B.333
444.32
.15
66 .65
TAXPAYER RESPONSE
RESULT IN AN OFFICIAL TAX ASSESSMENT
NOTE: If tOlX paylllonts aro I'lado wi"thlnOthrllll
(3) nonthS of tho dllcodont's dato of doath,
you nay doduct il S% discount of tho tall duo.
Any inhoritilnco tal( duo will bocolIIO dolinquont
nino (C) J nontl1S af tor tho dato of doath.
Account Balanco
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
Tax
PART
T
BASED ON THIS NOTICE
FAILURE TO RESPOND WILL
A.
CHECK
ONE
BLOCK B.
L ON LV
c.
I : Tho <lbovo infornation Md tal( duo is corroct.
---.; 1. Vou nilY cl100S0 to rol'! i t paynnnt to tho Rog i star 0 f \J ills with two cOP ios 0 f this not Ico to obta in
.. discount or avoid IlItoro~t, or yoU nay chock box "AU and rllturn this notico to tho Rogistor of
\.lills and an official ilSsassmont wilt 00 issuod by tho PA Oopartnont of Rovonuo.
I TI111 ilbovn as!:ot hilS boon or will bo rUllortQd ar'ld hll( paid with tho Ponnsylvi'lnia Inheritanco Tall roturn
"--' to bo filod by tho docodont'S rftlJrllS.:lntiltivo.
'".
'f0 Tho ilbo",o information i;;...J.ncorroct ,tndlo~~"bts and doductions ""aro paid by you.
r' Vou Must CO;TIplotn PART L:J <lnd/ar F-ARt ~ billow.
If you indicato il different :..a~: rate, 1}l9.~..e state YOUf'
relationship to decedent: ---'"L-{........L.-Jd~~....l.---.-
PA
OFFICIAL USE ONLY C AAF
DEPARTMENT OF REVENUE
PART
2'
TAX
LINE
x
ON JOINT/TRUST ACCOUNTS
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*'
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 210601
HARRISBURG, PA 11121-0601
NOTICE OF INHERITANCE TAX
APPRAISEnENTl ALLOWANCE OR DISALLOWANCE
OF DEDUCTION., AND ASSESSnENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
lu.n.'II'''IU.'',
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
02-16-98
FAGAN
05-31-97
21 97-0728
CUMBERLAND
164-07-3306
97133914
EDWARD
MARYTHERE F MAZZUCA
APT 12
3609 KDHLER PL
CAMP HILL PA 17011
r
Amount Relit tt.d
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-V:i5~8-Ei(-AFFi-io3-:97i------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX DN JOINTLY HELD OR TRUST ASSETS
DATE 02-16-98
ESTATE OF FAGAN
EDWARD
F DATE OF DEATH 05-31-97
COUNTY
CUMBERLAND
FILE NO. 21 97-0728
TAX RETURN WAS:
S.S/D.C. NO. 164-07-3306
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
97133914
FINANCIAL INSTITUTION: HARRIS SAVINGS BANK
ACCOUNT NO.
23-92-287622
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (lO TIME CERTIFICATE
DATE ESTABLISHED 04-26-96
5,332.07
0.083
Account Balance
Percent Taxable X
Amount SUbject to lax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
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
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
444.32
.00
444.32
.06
26.66
TAX CREDITS:
PAYMENT
DATE
01-09-98
RECEIPT
NUM8ER
AA242637
DISCOUNT (+)
INTEREST/PEN PAID (-)
.00
AMOUNT PAID
26.65
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADOITIONAL INTEREST. .
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL OUE IS REFLECTEO AS A "CREDIT" I CRl, YOU MAY BE DUE A REFUND.
SEE REI/ERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I
26.65
.01
.00
,01 .
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