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Home My WebLink About80-00749 }w.'{~.fi',~.;,;-' ,b~\,,"'<:"".' lie:;,' ~,,""" . \~"l.{:;!" ~~~~::: ~.,., .. :~e~c) Si\~:":." ~.. 7-'. y,;;~:.' ".''" " ;';", ;.,:~,':' ~{j:'~.:. . ~~"~< . \.,:-.",' r .... *;'!(' ~~~?;:,:.:. ,~'~'. ;&,;;'[..?:ji' ~~r~}<i " ~:ili;':)+ i~ ~2(::"/ I,. J7, ' i~'> ~lP- \-'~';'\' ~i;-"; ,,, ~l ~". ~~t~~;".-~; l;'~:;~':" jU-....... ~F~,:..,' .~:::' ~'." ii', t:. ~ ~ ~ ~ m CIJ " 01 ~ t3 .q\ CIJ {\o ~ ~ H ~ 0 e CO ...... I 0 - N . Jl 0 J ~ z '.' .\ 'c.' "::1': :;...--' <.r:: ;,: ',.' .i', ':.;- ,'. ,'., ',' ..';~ . :",-::'~ ''',' ':';; ;1 "':~:~ INSTRUCTIONS ASSETS: TYPE OF ASSET _ Indicate whether the 0550Ct is fcol c~tatCt personal property, transfer or jointly.owned. DESCRIPTION _ List atl asseh owned ..Iely by the decedent or owned jointly with another party or parties os tenants in common or as joint tenants with right of survivorship at Ihe timo of death. Include the decedent's percentage 01 ownership, the nome (s) and relationship to the decedent 01 the surviving joint owna" and tho estimated market valua of tha docedent's Interest as of the date of death. Include intangible personal property titled in tho name 01 the dacedent but payable at death to another party or parties Including but not limited to P.C.D. U.S. Savings Bonds and tentative tfust accounts. Li s' any property transferred by tho decedent within two years of death for which he/she did not receive valuable and udcquotc consideration. Doscribe all real ostate located in Penns-ylvania by lot and hlock number, street address, number of acres and include a general description of the land and buildings, Also, include the book and pogo number in which the deed is recorded and tho C1CDCt title as indicated on the deed. DEBTS & DEDUCTIONS _ Unsatisfied liabilitias incurred by the decedent prior to hislher death ore deductible against his/her to)(able estate. In addition to debts incurred by the decedent, other items arc claimable including the cost of administratian, attorney fees, fiduciary fees, funeral and burial expenses including the cost of a burial lot, tombstone or grave marker. List the dote on which eoch debt waS incurred and/or paid and the nameS of each payee. Provide a brief explanation of the nature of each debt claimed and the amount being claimed Evidence to support the decedent's or the estate's liaIJility for the debts being claimed should be attached to this rcturn A family c)(cmption may bc claimed by a spouse of Q decedent who died domiciled in Pennsylvania. If there is no spouse, or if the spouse has larfeited his/her rights, then any child of the decedent who is a membor of the same household can claim the clCemption. In thc event there is no such spouse ar child, the exemption can be claimed by a parent ar parents wha are members of the same hou sehold as the decedent. -< ~ m r- . m ~ ." :I: 0 Z m z ? ;;; . ~ . ~ )>- z r- ." 0 n )>- m )>- ~ 0 ~ Z )>- 0 0 0 '" 0 0 " n c: 0 -l E r- :a m a m m " z :a )>- :z: :z r- , :z: m -< m -l ? ~ ? m Z V> !i ? -i -< V> m V> V> 0 ? V> -< Z 0 0 :a 3 ? ... .." (")~ . . '< :a'" c::~ m~ ~ ~~ "" :::0 ~ ,,, , :J>7-l ." ",0 ...0 ;; -'" ...,r., 'C . ~: r=J ~ ;.::r: . .- ". . ~.:" ;;; , 0-, ...., . ... n'" -, . , ~)c.r, :c> ': ~-i m '" -< " :.{J m ' . ~ ;To m t;.-: ~ " 0 )>- .;: , 0 "" :a ~ ~ a ~ ,0 , e, n a ?: ~ J! INFORMATION PLACE FOR FILING _ The return is to ba filed in duplicato with the Register of Wills of thc county wherein the decedent resided. TIME FOR FILING _ lhe return is due nine months aher the decedent's death, unless an extension far filing has been applied tor and granted by the Secretary of Reyenue within the nine.month periad. FAILURE TO FILE RETURN _ Section 791 of the 1961 Statute provides that" , . .any person who willfully fails to filc 0 return ar other report required of him shall be personally liable. . .to 0 penalty of 25~o of the tax ultimately found to be due or S 1,000 whichever is the less to be recovered by the Deportment of Revonue os debts of like amount are recovarable by law." NOTE: Fees paid to an estate representative: namely, on execular or administrator, for services performed in ad. ministering an estale is reportable for Pennsylvania Income Tax purposes. This taxable income item shaud be reported on farm PA.40.lndividuallncame Tax Return. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF EXAMINATION OFFICIAL NOTICE OF INHERITANCE TAX ASSESSMENT *' COUNTY FILE NO: "'j ") 1/ '.I .....1 - ,I( I - " DATE / ' :'/'/' "il'./>-/, ), ',J '/J <1'"" /7.";(./ / . i /. ., I. F/ ( ."-...... ,1 (.:-.- TO: ':;./~ "'...~. 'j/~. - 7: 'I. -- "if./ ~'?;;:, ~ ESTATE I " . ,;/ ,.-,,1-/ ~I );, FilE NO. // -';';j . ')./ '1 . , /.. (. 'A y' /~ _LI. , / 7-';' ///rJ / -1 / COUNTY /. ;;' . A f ~ (~ . .. 1/ .'-T' " I A' ~.J~. ' DATE OF DEATH .. / //1/'. I ..~' -:: ~ /'/ '/ 'I . Appraised Va'ue of Estate: Real ESlate & Personal Property + '''''/ "'2' /.'1 , ~_ Jointlv Held PropertylTransfers + ------ Total Gross Estate & /-::: /. :-j;) Total Approved Oeductions ,) L i / .....-r-f! ,; 7; Clear Value of Estate 6 Less: Approved Charitable Exemptions Clear Value of Est8te Subject to Tax & Amount Taxabl. @ 6% Rale $ , --~ / L. ~q? /, j, IB,,'dJio'/LPr(.:/..--<$.-( . //",-r.) ',1--"1'-" I Amount Taxabl. @ 15% Rat. tax due .' {,., L /J Y;....---- '; ~ AI' j. ' TOTAL PENNSYLVANIA INHERITANb.~J0UlUE" C.V~.. _ <7 .--;~ ~? I * '* * * '* '* A five percent discount totaling L- will be granted if the Inheritance Tax is paid bV Less Credits: DATE OF PAYMENT AMOUNT PAID OISCOUNT INTEREST TAX CREDIT $ + $ $ = $ + = + = Interest accrues at the rate of six (6) percent per annum on the unpaid balanco of Inheritance Tax from to date 01 payment. Interest due if paid by is ..,. ,;..- '/ . f'::--~ BALANCE OF PENNSYLVANIA INHERITANCE TAf60E/I'i:i,'i;;/IX: ,..-;/....(,/V""j./ dLI" ;,1 i ;;. ~_ - See Infotmalion on Reverie Side .~-- --- ------. INFORMATION_ To insuro proper credit to ,,'our account. lho nc1l11U of tho milatu and tile number should be clearly prim. cd on the chock or money ordor. This assessment is modo in accordanco with Section 708 of the Inheritanco and Es!nto Tnl( Act of 1961 (72 P,S. ~ 2485.7061, To the extent that inheritance tax is paId within throo (3) months aher the death of tho decedent. 8 discount of five (51 percent is allowed 172 P.S. S 2485.716). Inheritance Tax. othor than tOK on 8 future interest, is due at the date of the decedent's dealh and becomes delinquent at Ihe e,piration of nine (9) months elter the decedent's doOlh (72 P.S. ~ 2465-711). Inheritance Ta, on a futu,a inle,est is poyeble within three (3) months afte, the transfer takes effect in possassion end enjoymant and is delinquent thereefter (72 P,S. S 2485.712). Celculate interest from Ihe delinquent date shown on the face of this form to the dale of actual payment using the following interest table: -------------------- - ---------- --- ---- -------- - -.. -- - - -- - -------- -- -- -- - -- -- 1 month .005 4 months .020 7 months .035 10 months .050 2 months .010 5 months .025 8 months .040 11 months .055 3 months .015 6 mo nths .030 9 months .045 12 months .060 1 days .000 17 11 days .00186 21 days .00352 2 days ,00034 12 days .00203 22 days .00369 3 days .00051 13 days .00220 23 days ,00386 4 days .00068 14 days .00237 24 days ,00403 5 days ,00085 15 d.ys ,00250 25 days .00420 6 days ,00101 16 days .00267 26 days .00437 7 days ,00118 17 days .00284 27 days ,00454 8 days ,00135 18 days .00301 28 days .00471 9 days ,00152 1 9 days .00318 29 days .00488 10 days .00169 20 days .00335 30 days .00500 - ------------- ------------ -- ----- --- - ---- --- --------- -- --------- -----.. Any party in interest. including the Commonwealth and the personal representative, not satisfied with the assessment may object thareto within sixty (60) days after receipt of this Notice as provided by Section 1001 of Ihe Inheritance and Estate To' Act of 1961 (72 P.S. S 2485.1001). Make check or money order payable to: "Register of Wills, Agent" Mail to the address listed below: