HomeMy WebLinkAbout08-13-07
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15056051047
REV-1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
County Code Year
File Number
b<\
01
() ...1. L.t 6
Date of Birth
;{ D 6 32 2 b 0 <7
051'12067
09 69 Lcr2- I
Decedent's Last Name
Suffix
Decedent's First Name
MI
E; T L 6 R
~ltfl.'f
c
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
_ 1. Original Return c:::>
2. Supplemental Return
c:::>
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
c:::> 4. Limited Estate c:::>
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
c:::>
c:::> 6. Decedent Died Testate c:::>
(Attach Copy of Will)
c:::> 9. Litigation Proceeds Received c:::>
D
8. Total Number of Safe Deposit Boxes
c:::>
11. Election to tax under Sec. 9113(A)
(Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
f2.1-/11 ; 5 IE L
E.. i TL Elf
1 I 1
~)D 5
c-
,.,,:0
Firm Name (If Applicable)
REGISTER O~~IJ.!;-S USEONLY
First line of address
1<7]/2
e f< ' oc, E
"
'S f
, ' i 1
Second line of address
Cq
CJI
City or Post Office
State
ZIP Code
DATE FILED
NEw
~utyl8<z:,q LHA)~
PA
1 0 '1 0 I
25
Correspondent's e-mail address: elf T;:: LL (j u c r;;; I/FI>? 126ft.}. A.)~ T
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief.
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATU~F PE..R N RESPONSIBLE FO ING RE.1URN ATE
~ 'L ?i;?/ 0-;
ADDRESS c .
I if /2 5T )lJFt.J (!Umf'3~k{/I/l/tJ PIl /7070 //2S
~ J
SIGNATURE OF PRE PARER OTHER THAN REPRESENTATIVE
DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056051047
15056051047
--.J
d.<<\
-I
15056052048
REV-1500 EX
Decedent's Name:
RECAPITULATION
1. Real estate (Schedule A).
2. Stocks and Bonds (Schedule B) . .
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 3.
4. Mortgages & Notes Receivable (Schedule D) . . . . .
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5.
6. Jointly Owned Property (Schedule F) c:::::> Separate Billing Requested . . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) c:::::> Separate Billing Requested. 7.
8. Total Gross Assets (total Lines 1-7). . . . . . . .
9. Funeral Expenses & Administrative Costs (Schedule H). . . .
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .
. . . . . 10.
11. Total Deductions (total Lines 9 & 10). ..
. . . . . . . . 11
12. Net Value of Estate (Line 8 minus Line 11) . .
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J)
. . . 12.
. . . . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13)
. . . . . 14.
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a}(1.2) X .0_ .
16. Amount of Line 14 taxable
at lineal rate X.O!i5
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
15.
.
16.
.
17.
18.
.
19. TAX DUE. . . . . .
. . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L
15056052048
Decedent's Social Security Number
~ oh 3.2 26.09
o
1 2 J <71-53..6 ( '-I
I 5 It.fj ~.... D
J 36
5 2
b57C
1.
2.
4.
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8.
9.
I
io
9
c" 5.70.~.q9
.c
.()()
,f 3..'1.$'... '~, $
0'..0
8 ,. q ~. 7, 0
. C D
15056052048
c::::>
~
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S .NAME.. " j
t/YlIfA 1 C)~ E,. TL E-/,
STREET ADDRESS 1'.7 ,~/' _ -
/'&'/2 1'6K / IJ ~ c 'S T
File Number
CITY,,: C ( ,.) /1 7 .II
I \J C (..(../ L U fJ1 f~ FP< L 111U ~
1 STATE P;1
ZIP - 25
/7070 /1"
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount 9 t:" ~, c~ 0
3. Interest/Penalty if applicable
D. Interest
E. Penalty
(1)
/J', ~95~ 'le
,
Total Credits ( A + B + C ) (2)
'/00. 90
Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
*"-:-)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5)
(5A)
(5B)
/ 7 2-52, go
.
d
1'7 2 ~ 2. 80
I
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;........................................................................................ D !Xl
b. retain the right to designate who shall use the property transferred or its income; ......................................... D []J
c. retain a reversionary interest; or.................................................................................................................... D [Xl
d. receive the promise for life of either payments, benefits or care? .............................................................. D [Xl
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D [tJ
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D !]
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ D [j]
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (3) percent [72 P.S. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent
[72 PS. S9116 (a) (1.1) (ii)]. The statute does not exemDt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. ~9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV.1509 EX . (1-971
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF I
/l7 /J p..
If an asset was made joint within one year ofthe decedent's date of death, it must be reported on Schedule G.
0,
6: >~ Er?
FILE NUMBER
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. C fl-131"5/Et
E ,- TL- {t'f I ?J 12
/v{ Lv
f3f?iIJG E '57
(l tL 1'17 f5 f IZ L /1-/0 d / !.:J Ii
17070-112-5
;JJ9u a Ii fEr?
B.
c.
JOINTLY-OWNED PROPERTY:
LETTER
ITEM FOR JOINT
NUMBER TENANT
DATE DESCRIPTION OF PROPERTY
MADE ,nclude name of financial institution and bank account number or similar identifying number. Attach
JOINT deed for jointly-held real estate.
DATE OF DEATH
VALUE OF ASSET
%OF
DECO'S
INTEREST
DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
1.
A.
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LIS //0 c;
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TOTAL (Also enter on line 6, Recapitulation) $ -'/.tt /) 8'53, b J..j
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IV
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU DF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO.21
07127687
06-20-2007
RfY-1543 EX AFP (09-00>
EST. OF MARY EITLER
S.S. NO. 206-32-2609
DATE OF DEATH 05-14-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
!Xl SAVINGS
D CHECKING
D TRUST
D CERTIF.
CHRISTEL EITLER
1812 BRIDGE ST
NEW CUMBERLAND PA 17070-1125
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PSECU has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, yoU were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution. attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. Questions ~ay be answered by calling (717) 7a7-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0206322609-1 Date 01-15-1979
Established
Account Balance 1,007.98
Percent Taxable X 50.000
Amount Subject to Tax 503.99
Tax Rate X .045
Potential Tax Due 22.68
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to. "Register of Wills, Agent".
NOTE. If tax payments are made within three
(3) months of the decedent's date of death,
yOU may deduct a 5% discount of the tax due.
Any inheritance tax due will beco~e delinquent
nine (9) months after the date of death.
PART
[!]
TAXPAYER RESPONSE
[CHECK ]
ONE
BLOCK
ONLY
A. [J The above infor~ation and tax due is correct.
1. You ~ay choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or YOU may check box "An and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
B. [J The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
C. [J The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
PART
[!]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
If yoU indicate a different tax rate, please state your
relationship to decedent:
PART
~
TAX
LINE
RETURN - COMPUTATION OF
1. Date Established 1
2. Account Balance 2
3. Percent Taxable 3
4. Amount Subject to Tax 4
5. Debts and Deductions 5
6. Amount Taxable 6
7. Tax Rate 7
8. Tax Due 8
TAX ON JOINT/TRUST ACCOUNTS
X
X
PAYEE
DESCR I PTI ON
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
t
Under penalties of perjury, I declare that the facts
complete to the best of my knowledge and belief.
have reported above are true, correct and
TAXPAYER SIGNATURE
HOME (
WORK (
TELEPHONE
)
)
NUMBER
DATE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRIS8URG, PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO.21
07127685
06-20-2007
REV.1543 EX AFP (09.00)
EST. OF MARY EITLER
S.S. NO. 206-32-2609
DATE OF DEATH 05-14-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
[i] CHECK I NG
D TRUST
D CERTIF.
CHRISTEL EITLER
1812 BRIDGE ST
NEW CUMBERLAND PA 17070-1125
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PSECU has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. Que~tiQns may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0206322609-4 Date
Established
01-15-1979
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Account Balance
Percent Taxable X
Amount Subject to Tax
Tax Rate X
Potential Tax Due
10,348.41
50.000
5,174.21
.045
232.84
TAXPAYER RESPONSE
NOTE: If tax payments are made within three
(3) months of the decedent's date of death,
you may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
PART
[!]
A. [] The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "An and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
[CHECK ]
ONE
BLOCK
ONLY
B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
C. [] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
DEBTS AND DEDUCTIONS CLAIMED
PART
~
TAX RETURN - COMPUTATION
If you indicate a different tax rate, please state your
relationship to decedent:
LINE l. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
PART
~
DATE PAID PAYEE
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3 X
4
5
6
7 X
8
DESCRIPTION
AMOUNT PAID
TOTAL CEnter on Line 5 of Tax Computation)
$
Under penalties of perjury, I declare that the facts
complete to the best of my knowledge and belief.
have reported above are true, correct and
TAXPAYER SIGNATURE
HOME (
WORK (
TELEPHONE
)
)
NUMBER
DATE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG, PA 17128-0601
'*
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO.21
07127683
06-20-2007
REV-1543 EX AFP (09-DO)
EST. OF MARY EITLER
S.S. NO. 206-32-2609
DATE OF DEATH 05-14-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
[Xl CERTIF.
CHRISTEL EITLER
1812 BRIDGE ST
NEW CUMBERLAND PA 17070-1125
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PSECU has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, YOU were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0206322609C51 Date 01-15-1979
Established
Account Balance 56,088.90
Percent Taxable X 50.000
Amount Subject to Tax 28,044.45
Tax Rate X .045
Potential Tax Due 1,262.00
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
NOTE: If tax payments are made within three
(3) months of the decedent's date of death,
you may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
PART
ill
TAXPAYER RESPONSE
[CHECK ]
ONE
BLOCK
ONLY
A. [] The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or yoU may check box "An and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
C. [] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
PART
!3J
TAX RETURN - COMPUTATION
If YOU indicate a different tax rate, please state your
relationship to decedent:
DEBTS AND DEDUCTIONS CLAIMED
OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established
2. Account Balance 2
3. Percent Taxable 3
4. Amount Subject to Tax 4
5. Debts and Deductions 5
6. Amount Taxable 6
7. Tax Rate 7
8. Tax Due 8
PART
[!J
DATE PAID PAYEE
X
X
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
$
Under penalties of perjury, I declare that the facts
complete to the best of my knowledge and belief.
have reported above are true, correct and
TAXPAYER SIGNATURE
HOME (
WORK (
TELEPHONE
)
)
NUMBER
DATE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
'*
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO.21
07127686
06-20-2007
REV-1543 EX AFP (09-00)
EST. OF MARY EITLER
S.S. NO. 206-32-2609
DATE OF DEATH 05-14-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
[Xl CERTIF.
CHRISTEL EITLER
1812 BRIDGE ST
NEW CUMBERLAND PA 17070-1125
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PSECU has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this infor.ation is incorrect, please obtain written correction from the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of PennsYlvania. Questions may be answered by calling (717) 787-8327.
Account No. o2063226o9C52
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
01-15-1979
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
PART
[f]
Date
Established
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
x
38,227.25
50.000
19,113.63
.045
860.11
TAXPAYER RESPONSE
NOTE: If tax payments are made within three
(3) months of the decedent's date of death,
yoU may deduct a 57. discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
x
[CHECK]
ONE
BLOCK
ONLY
A. [J The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "An and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
8. [J The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
C. [J The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
2
3 X
4
5
6
7 X
8
PART
~
TAX
If you indicate a different tax rate, please state your
relationship to decedent:
RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
PART
[!]
DATE PAID
PAYEE
DEBTS AND DEDUCTIONS CLAIMED
DESCR I PTI ON
AMOUNT PAID
TOTAL CEnter on Line 5 of Tax Computation)
$
Under penalties of perjury, I declare that the facts
complete to the best of my knowledge and belief.
TAXPAYER SIGNATURE
have reported above are true, correct and
HOME (
WORK (
TELEPHONE
)
)
NUMBER
DATE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG, PA 1712B-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21
07127684
06-20-2007
REV-1543 EX AFP (09-00)
EST. OF MARY EITLER
S.S. NO. 206-32-2609
DATE OF DEATH 05-14-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECK I NG
o TRUST
[Xl CERTIF.
CHRISTEL EITLER
1812 BRIDGE ST
NEW CUMBERLAND PA 17070-1125
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PSECU has provided the DepartMent with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the ComMonwealth
of Pennsylvania. Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0206322609C50
Date
Established
01-15-1979
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
x
35,215.79
50.000
17,607.90
.045
792.36
TAXPAYER RESPONSE
NOTE: If tax paYMents are made within three
(3) months of the decedent's date of death,
yoU may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
x
PART
[!J
A. [] The above information and tax due is correct.
1. You may choose to re.it payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "AU and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
[CHECK ]
ONE
BLOCK
ONLY
B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
C. [] The above inforMation is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
DEBTS AND DEDUCTIONS CLAIMED
PART If you indicate a different tax rate, please state your
~ relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established
2. Account Balance 2
3. Percent Taxable 3
4. Amount Subject to Tax 4
5. Debts and Deductions 5
6. Amount Taxable 6
7. Tax Rate 7
8. Tax Due 8
PART
~
DATE PAID PAYEE
x
x
DESCR I PTI ON
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
$
Under penalties of perjury, I declare that the facts
complete to the best of my knowledge and belief.
have reported above are true, correct and
TAXPAYER SIGNATURE
HOME (
WORK (
TELEPHONE
)
)
NUMBER
DATE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
*
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO.21
07129229
06-28-2007
REY~1543 EX AFP (09-00>
EST. OF MARY EITLER
S.S. NO. 206-32-2609
DATE OF DEATH 05-14-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
D CHECKING
D TRUST
IX] CERTIF.
CHRISTEL EITLER
1812 BRIDGE ST
NEW CUMBERLAND PA 17070
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MEMBERS 1ST FCU has p~ovided the Depa~tment with the info~mation listed below which has been used in
calculating the potential tax due. Thei~ ~eco~ds indicate that at the death of the above decedent, you we~e a joint owne~/beneficia~y of
this account. If YOU feel this info~mation is inco~~ect, please obtain w~itten co~~ection f~om the financial institution. attach a copy
to this fo~m and ~etu~n it to the above add~ess. This account is taxable in acco~dance with the Inhe~itance Tax Laws of the Commonwealth
of Pennsylvania. Questions may be answe~ed by calling (717) 787-8327.
COMPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 175990 -46
Date 01-02-2004
Established
To insure proper credit to your account, two
(2) copies of this notice must accompany you~
payment to the Registe~ of Wills. Make check
payable to: IIRegister of Wills, Agent".
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
37,454.64
X 50.000
18,727.32
X .045
842.73
TAXPAYER RESPONSE
NOTE: If tax payments a~e made within th~ee
(3) months of the decedent's date of death,
you may deduct a 5% discount of the tax due.
Any inhe~itance tax due will become delinquent
nine (9) months afte~ the date of death.
PART
[!]
A. [J The above info~.ation and tax due is co~~ect.
1. You may choose to ~emit payment to the Registe~ of Wills with two copies of this notice to obtain
a discount or avoid interest, or yoU may check box "An and return this notice to the Register of
Wills and an official assessment will be issued by the PA Depa~tment of Revenue.
[CHECK ]
ONE
BLOCK
ONLY
B. [J The above asset has been o~ will be ~epo~ted and tax paid with the Pennsylvania Inhe~itance Tax ~etu~n
to be filed by the decedent's ~ep~esentative.
C. [J The above info~mation is inco~~ect and/o~ debts and deductions we~e paid by you.
You must complete PART ~ and/o~ PART ~ below.
PART If you indicate a diffe~ent tax ~ate, please state you~
~ relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
DEBTS AND DEDUCTIONS CLAIMED
LINE l. Date Established
2. Account Balance 2
3. Percent Taxable 3
4. Amount Subject to Tax 4
5. Debts and Deductions 5
6. Amount Taxable 6
7. Tax Rate 7
8. Tax Due 8
PART
[!]
DATE PAID PAYEE
X
X
DESCR I PTI ON
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
$
Unde~ penalties of perjury, I declare that the facts
complete to the best of my knowledge and belief.
have ~eported above are true, correct and
TAXPAYER SIGNATURE
HOME (
WORK (
TELEPHONE
)
)
NUMBER
DATE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG, PA 1712B-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21
07132249
07-26-2007
REV-lS43 EX AFP (09-00>
EST. OF MARY 0 EITLER
S.S. NO. 206-32-2609
DATE OF DEATH 05-14-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
D CHECKING
o TRUST
[Xl CERTIF.
CHRISTEL EITLER
1812 BRIDGE ST
NEW CUMBERLAND PA 17070
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PNC BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, yoU were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. Questions may be answered by calling (717) 7B7-8327.
COMPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 31100213636 Date 07-05-2001
Established
Account Balance 46,285.23
Percent Taxable X 50.000
Amount Subject to Tax 23,142.62
Tax Rate X .045
Potential Tax Due 1,041.42
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: IIRegister of Wills, Agent".
NOTE: If tax payments are made within three
(3) months of the decedent's date of death,
you may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
PART
ill
TAXPAYER RESPONSE
A. D The
1.
above information and tax due is correct.
You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or yoU may check box nA" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
[CHECK ]
ONE
BLOCK
ONLY
B. D The above asset has been or will be reported and tax paid with the PennSYlvania Inheritance Tax return
to be filed by the decedent's representative.
c. D The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
If you indicate a different tax rate, please state your
relationship to decedent:
DEBTS AND DEDUCTIONS CLAIMED
PART
@]
TAX
RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1- Date Established
2. Account Balance 2
3. Percent Taxable 3
4. Amount Subject to Tax 4
S. Debts and Deductions 5
6. Amount Taxable 6
7. Tax Rate 7
8. Tax Due 8
PART
[!J
DATE PAID PAYEE
X
X
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
$
Under penalties of perjury, I declare that the facts
complete to the best of my knOWledge and belief.
have reported above are true, correct and
TAXPAYER SIGNATURE
HOME (
WORK (
TELEPHONE
)
)
NUMBER
DATE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
'*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO.21
07132250
07-26-2007
REV-1543 EX AFP (09-00)
EST. OF MARY 0 EITLER
S.S. NO. 206-32-2609
DATE OF DEATH 05-14-2007
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
[i] CERTIF.
CHRISTEL EITLER
1812 BRIDGE ST
NEW CUMBERLAND PA 17070
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PNC BANK has pl"ovided the Depal"tment with the infol"mation listed below which has been used in
calculating the potential tax due. Theil" I"ecol"ds indicate that at the death of the above decedent, yoU wel"e a joint ownel"/beneficial"Y of
this account. If yoU feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this fOl"m and I"etul"n it to the above addl"ess. This account is taxable in accol"dance with the Inhel"itance Tax Laws of the Commonwealth
of Pennsylvania. Questions mav be answel"ed by calling (717) 787-8327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 31700278103 Date 11-22-2005
Established
Account Balance 21,462.05
Pel"cent Taxable X 50.000
Amount Subject to Tax 10,731.03
Tax Rate X .045
Potential Tax Due 482.90
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Registel" of Wills. Make check
payable to: "Register of Wills, Agent".
NOTE: If tax payments al"e made within thl"ee
(3) months of the decedent's date of death,
YOU may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months aftel" the date of death.
PART
[!]
TAXPAYER RESPONSE
A. D The
1.
above information and tax due is correct.
You may choose to I"emit payment to the Registel" of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "An and return this notice to the Register of
Wills and an official assessment will be issued by the PA Depal"tment of Revenue.
[CHECK]
ONE
BLOCK
ONLY
B. [] The above asset has been 01" will be I"epol"ted and tax paid with the Pennsylvania Inhel"itance Tax I"etul"n
to be filed by the decedent's I"epl"esentative.
c. [] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/ol" PART ~ below.
If yoU indicate a diffel"ent tax I"ate, please state YOUI'
I"elationship to decedent:
PART
[!]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PART
~
TAX
LINE
RETURN - COMPUTATION OF
1. Date Established 1
2. Account Balance 2
3. Pel"cent Taxable 3
4. Amount Subject to Tax 4
5. Debts and Deductions 5
6 . Amount Taxable 6
7. Tax Rate 7
8 . Tax Due 8
TAX ON JOINT/TRUST ACCOUNTS
X
X
PAYEE
DESCRIPTION
AMOUNT PAID
TOTAL (Entel" on Line 5 of Tax Computation)
$
Undel" penalties of pel"jul"Y, I declal"e that the facts
complete to the best of my knowledge and belief.
have I"epol"ted above al"e tl"ue, cOl"l"ect and
TAXPAYER SIGNATURE
HOME (
WORK (
TELEPHONE
)
)
NUMBER
DATE
-
REV-1511 EX+ (10-06)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
m4Af
LJ.
c!l' rc.- f,f'
FILE NUMBER
Debts of decedent must be reported on Schedule l
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
1.
~"
-..JI:E
/l 77/l(Yt/E-/J
5' (1 ,;/ p J {i L f
If LIS+/IV (.;.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Add ress
City
State _Zip
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
State _ Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
(If more space is needed, insert additional sheets of the same size)
TOTAL (Also enter on line 9, Recapitulation) $ /5" / ~ 3" 80
/
Schedule H
Funeral Expenses & Administrative Costs
Estate of: Mary O. Eider
Item Description Amount
Number
A. Funeral Expenses:
1. Musselman Funeral Home - Funeral Costs 14,155.00
2. Pealers Flowers - Comer Casket Spray 90.10
3. Bon-Ton - Funeral Attire for Decedent 84.49
4. Resurrection Cemetery - Burial 800.00
B. Administrative Costs:
1. Division of Vital Records - Short Death Certificate 9.00
2. Postage Costs 5.21
Total 15,143.80
REV-1512 EX+ (12-03)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF !
//7/J-A ~
.
0,
E,-rLE,?
FILE NUMBER
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
~.
JEC
.4 T/ /J(YIft'.J
SCVJ!F,6UiE' .I Lls//IVcC.
I
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
/38': ~s
Schedule I
Debts of Decedent, Mortgage Liabilities & Liens
Estate of: Mary O. Eitler
Item Number Description Value at Date of Death
1. Associated Cardiologists - Office Visit & Pacemaker Analysis 131.00
(residual cost not covered by health insurance)
2. Quantum Imaging - CT Head/Brain Scan at Holy Spirit 7.85
(residual cost not covered by health insurance)
Total 138.85
RECEIPT FOR PAYMENT
GLENDA FARNER STRASBAUGH
Cumberland County - Register Of wills
One Courthouse Square
Carlisle, PA 17013
Recetpt Date:
Rece::J-pt Time:
Recelpt No. :
8/10/2007
12:26:07
1049496
EITLER MARY 0
Estate File No. :
Paid By Remarks:
2007-00745
CHRISTEL M EITLER
DM
------------------------ Receipt Distribution ------------------------
Fee/Tax Description Payment Amount
INH TAX RETURN 15.00
----------------
Check# 4405 $15.00
Total Received......... $15.00
Payee Name
CUMBERLAND COUNTY GENERAL FUN
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