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Home My WebLink About05-05-08 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 RECOROO> - c ,.. -.. "9-00> FILE NO. ACN DATE INFORMATION NOTICE AND TAXPAYER RESPONSE 21 -6?f,. 049~ 08114999 04-10-2008 EST. OF PAUL S DLUGOLECKI S.S. NO. DATE OF DEATH 01-06-2008 COUNTY CUMBERLAND TYPE OF ACCOUNT D SAVINGS o CHECK I NG D TRUST [XJ CERTI F . ZOOI MY -5 A" II: ..9 CllRK OF 0fft'W4~ COURl '" i:QJ:'&:I ANn co.~ PA DLWwttt't'f "-,,' " RD CASIMIR 621 MOYER SOUDERTON PA 18964 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEHBERS 1ST FCU has pr-ovided the Depar-t.ent with the info,...ation listed below which has been used in calculating the potential tax due. Their- r-ecor-ds indicate that at the death of the above decedent. lfOU wer-e a joint owner-/beneficiar-y of this account. If yoU feel this infor-.ation is incor-r-ect. please obtain wr-itten correction fro. the financial institution, attach a copy to this fo,... and r-eturn it to the above address. This account is taxable in accor-dance with the Inher-itance Tax laws of the Co..onwealth cf Pon~~~lYania. Questions ..yb. answer-ed by calling (717) 787-83~7. COMPLETE PART 1 BELOW Account No. 7502-46 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART [!] . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Date 11-15-2006 Established x 50,552.11 5.000 2,527.61 .045 113.74 TAXPAYER RESPONSE To insure proper- cr-edit to your- account, two (2) copies of this notice .ust acco.PlIny your- pay..nt to the Register- of Wills. Make check payable tOI "Register- of Wills, Agent". x NOTE: If tax paY.ents are .ade within thr-ee (3) .onths of the decedent's date of death. YOU .ay deduct a 5" discount of the tax due. Any inher-itance tax due will beco.e delinquent nine (9) aonths after- the date of death. [CHECK ] ONE BLOCK ONLY he above infor.ation and tax due is corr-ect. 1. You.lIY choose to r-e.it pay.ent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest. or yoU ..y check box "A" and return this notice to the Register- of Wills and an official assess.ent will be issued by the PA Depar-t..nt of Revenue. B. D The above asset has been or- will be reported and tax paid with the Pe'1nsylvania Inheritance Tax return to be filed by the decedent's r-epr-esentative. C. c=J The above infor.ation is incorrect and/or debts and deductions were paid by you. You .ust co.plete PART [!] and/or PART ~ below. 1 2 3 X 4 5 6 7 X 8 If you indicate a dlfferent tax rate, please state your relatlonship to decedent: PART [!] TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Dat~ ~stabll$had 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Allount Taxable 7. Tax Rate 8. Tax Due PART [!J DATE PAID PAYEE DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID I TOTAL CEnter on Llne 5 of Tax Computation) . Under penal es cO.Ple~~he b, t XPAYER SIGNATURE have ~eported above HOME (V~) WORK (~) (3t.-f TELEPHONE NUMBER ~ De)~ declare that the facts I and bellef. GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on infoNlation sub.itted by the financial institution. 2. Inheritance tax beco.es delinquent nine .onths after the decedent's date of death. 3. A joint account is taxable even though the decedent's naae was added as a aatter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint na.es within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife .ore than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS PART 1 TAXPAYER RESPONSE 1. BLOCK A - If the infor.ation and co.putation in the notice are correct and deductions are not being clai.ed, place an '~" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and sub.it thea with your check for the aIIount of tax to the Register of Wills of the county indicated. The PA Departaent of Revenue will issue an official assess.ent (For. REV-1548 EX) upon receipt of the return fro. the Register of Wills. 2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one copy and return to the PA Depart.ent of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice infoNlation is incorrect and/or deductions are being claiaed, check block "C" and co.plete Parts 2 and 3 according to the instructions below. Sign two copies and sub.it thea with your check for the a.ount of tax payable to the Register of Wills of the county indicated. The PA Departaent of Revenue will issue an official assessaent (Fora REV-1548 EX) upon receipt of the return fro. the Register of Wills. TAX RETURN PART 2 TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the aanner existing at date of death. NOTE: For a decedent dying after 12/12182: Accounts which the decedent put in joint naaes within one (1) year of death are taxable fully as transfers. However, ther. is an exclusion not to exceed .3,000 per transferee regardless of the value of the account or the nu.ber of accounts held. If a double asterisk (..) appears before your first na.e in the address portion of this notice, the .3,000 exclusion already has been deducted fro. the account balance as reported by the financial institution. 2. Enter the total balance of the account inCluding interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is deteNlined as follows: A. The percent taxable for joint assets established .ore than one year prior to the decedent's death: DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Exa.ple: A joint asset regist~red in the na.. of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 16.7X (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS DR TRUST BENEFICIARIES X 100 PERCENT TAXABLE Exa.ple: Joint account registered in the naae of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) = .50 X 100 50X (TAXABLE FOR EACH SURVIVOR) 4. The a.ount subject to tax (line 4) is deter.ined by .ultiplying the account balance (line 2) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. &. The a.ount taxable (line ,) is deter.ined bY subtracting the debts and deductions (line 5) fro. the a.ount subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as deter.ined below. p ounger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is OX. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in co..on with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. Date of De.th Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3X 6X 15X 15X 01/01/95 to 06/30/00 OX 6" 15X 15" 07/01/00 to present OX 4.5"* 12" 15" .The tax rate i. osed on the net value of transfers fro. a deceased child twenty-one years of age or y CLAIMED DEDUCTIONS PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are deterained as follows: A. You legallY are responsible for pay.ent, or the estate SUbject to ad.inistration by a personal representative is insufficient to pay the deductible ite.s. B. You actually paid the debts after death of the decedent and can furnish proof of pay.ent. C. Debts being c1ai.ed .ust be i te.ized fullY in Part 3. If additional space is needed, use plain paper 8 1/2" x 11". Proof of pay.ent .ay be requested by the PA Depart.ent of Revenue. -- t008 MAY -5 A1'\'" '+9 ~~ CASIMIR DlUGOlECKI CUM6E.RLAND CO.. PA 621 MOYER RD SOUDERTON PA 18964 COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0&01 INFORMATION NOTICE '. \. AND tG~~AYER RESPONSE \ C' FILE NO. 21- 6~ ~ Cf9y ACN 08115003 DATE 04-10-2008 TYPE OF ACCOUNT D SAVINGS o CHECKING D TRUST [Xl CERTI F . ;EST. OF PAUL S DlUGOlECKI S.S. NO. DATE OF DEATH 01-06-2008 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS TO: REGISTER OF WIllS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST Feu has provided the DepartMent with the info....ation listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, :vou were a joint owner/beneficiary of this account. If you feel this info....ation is incorrect, please obtain written correction frOM the financial institution, attach a COpy to this fo.... and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co..onwealth of Pennsylvania. Question$.~ be answered by calling '717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 7502-45 Date 09-01-1964 EstabUshed Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART [!] x 6,567.86 5.000 328.39 .045 14.78 TAXPAYER RESPONSE To insure pr'oper credit to your account, two (2) copies of this notice .ust acco.pany your paYMent to t:he Register of Wills. Make check payable tOI "Register of Wills, Agent". x NOTE I If tax pay.ents are .ade within three (3) Months of the decedent's date of death, you May deduct a 5X discount of the tax due. Any inheritance tax due will beCOMe delinquent nine (9) Months after the date of death. [CHECK ] ONE BLOCK ONLY A. ~ve inforMation and tax due is correct. 1. You May choose to re.it pay.ent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or YOU .ay check box "A" and return this notice to the Register of Wills and an official assess.ent will be issued by the PA Depart.ent 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. r=J The above infor.ation is incorrect and/or debts and deductions were paid by you. You Must COMPlete PART 0 and/or PART @] below. 1 2 3 X 4 5 , 7 X 8 If you indicate a different tax rate, please state your relationship to decedent: PART l!I TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LUU:: 1. Date EstablIshed 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions ,. Amount Taxable 7. Tax Rate 8. Tax Due PART [!] DATE PAID PAYEE DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax ComputatIon) ..," . perjury, I declare that the facts my n l,dge and belief. have reported abovel are true, correct al)."Z7 HOME (Z,I r ) ?ZI ~t:?2A) 7 ,1 ~ WORK (800 ) f~~ I( ~3 0' TELEPHONE NUMBER DATE ~~ GENERAL INFORMATION 1. FAILURE TO RESPOND WI LL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on inforMation submitted by the financial institution. 2. Inheritance tax beCOMes delinquent nine Months after the decedent's date of death. 3. A ioint account is taxable even though the decedent's naMe was added as a .atter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in ioint naMes within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife .ore than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS PART 1 TAXPAYER RESPONSE 1. BLOCK A . If the infor.ation and cOMPutation in the notice are correct and deductions are not being claiMed, place an "X" in block "A" of Part I of the "Taxpayer Response" section. Sign two copies and sub.it theM with your check for the ..ount of tax to the Register of Wills of the county indicated. The PA DepartMent of Revenue will issue an official assess.ent (For. REV-15Q8 EX) upon receipt of the return frOM the Register of Wills. 2. BLOCK B . If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one COPY and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept 280601, HarriSburg, PA 17128-0601 in the envelope provided. 3. BLOCK C . If the notice inforMation is incorrect and/or deductions are being claiMed, check block "C" and co.plete Parts 2 and 3 according to the instructions below. Sign two copies and submit the. with your check for the aMount of tax payable to the Register of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official asseSSMent (ForM REV-I548 EX) upon receipt of the return frOM the Register of Wills. TAX RETURN PART 2 TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the Manner eXisting at date of death. NOTE I For a decedent dYing after 12/12182: Accounts which the decedent put in joint naMes within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed .3,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (..) appears before your first na.e in the address portion of this notice, the .3,000 exclusion already has been deducted frOM the account balance as reported by the financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is deterMined as follows: A. The percent taxable for joint assets established More than one year prior to the decedent's death: DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS exaMPle, A joint asset registered in the naMe of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 16.7X (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust benefiCiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE exaMPle: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) = .50 X 100 50X (TAXABLE FOR EACH SURVIVOR) 4. The aMount subject to tax (line 4> is deterMined by Multiplying the account balance (line 2) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The aMount taxable (line 6) is deterained by subtracting the debts and deductions (line 5) frOM the aMount subject to tax (line q). 7. Enter the appropriate tax rate (line 7) as deter.ined below. -The tax rate lMPosed on the net value of transfers frOM a deceased Chl1d 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 ox. The lineal class of heirs includes urandparents, parents, children, and 11neal descendents. "Children" includes natural children whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants.. "Siblings" are defined as individuals who have at least one parent in COM.on with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. Date of Death SpDuse Lineal Sibling Collateral 07/01/94 to 12/31/94 3X 'X 15X 15X 01/01/95 tD 06/30/00 OX 6X 15X 15X 07/01/00 to present OX 4.5X* 12X 15X CLAIMED DEDUCTIONS PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are deter.ined as follows: A. You leuallY are responsible for paYMent, or the estate subject to ad.inistration by a personal representative is insufficient to pay the deductible ite.s. B. You actually paid the debts after death of the decedent and can furnish proof of pay.ent. C. Debts being clai.ed .ust be ite.ized fullY in Part 3. If additional space is needed, Use plain paper 8 1/2" x 11". Proof of payment May be requested by the PA DepartMent of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 --_.~ * INFORMATION NOTICE AND ',:~/\~ tED <!~trER RESPONSE REV-lSlill EX ~h6i. 'J:. i ,#, (\ FILE NO.21 -0"6. Ljqf... ACN 08115011 ~ DATE 04-10-2008 TYPE OF ACCOUNT D SAYINGS o CHECK I NG D TRUST lXJ CERTIF. 2888 HAY -5 AM H,J:ti... OF PAUL S ItLUGOLECKI s"!~. NO. ~ DATE OF DEATH 01-06-2008 Q/fWiN'S ~COUNTY CUHIERLAND ClJMBE:Rt..AND CO TPA I~EMIT PAYMENT AND FORMS TO: ., REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CASIMIR DLUGOLECKI 621 MOYER RD SOUDERTON PA 18964 MEMBERS 1ST FCU has provided the Depart.ent with the info~ation listed be-low 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 fro. the financial institution, attach a copy to this fo~ and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co..onwealth of Pennsylvania. Questions.ay be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 7502-40 Date 11- 08-2003 EstabUshed To insure PI~oper credit to your account, two (2) copies of this notice .ust acco.pany your pay.ent to 1:he Register of Wills. Make check payable to: "Register of Wills, Agent". Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART [!] 20,400.59 X 5.000 1,020.03 X .045 45.90 TAXPAYER RESPONSE NOTE: If tax pay.ents are .ade within three (3) .onths elf the decedent's date of death, yOU .ay deduct a 5" discount of the tax due. Any inheritance tax due will beco.e delinquent nine (9) .onths after the date of death. [CHECK ] ONE BLOCK ONLY he above infor.ation and tax due is correct. 1. You.ay choose to re.it pay.ent to the Register of Wills with tW~1 copies of this notice to obtain a discount or avoid interest, or YOU .ay check box "A" and return, this notice to the Register of Wills and an official assess.ent will be issued by the PA Depart.ent of Revenue. B. c=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. [:] The above infor.ation is incorrect and/or debts and deductions were paid by you. You .ust co.plete PART ~ and/or PART [!] below. 1 2 3 X 4 5 6 7 X 8 If you indicate a different tax rate, please state your relationship to decedent: PART [!l TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS 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 DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) Under pen~~es of perjury, I declare that the facts I co..rt.,;o th"-.!J~.. ond b.U.f. TAXPAYER SIGNATURE have reported.."above HOME (Z,/J ) WORK (BOo) l1Zr TELEPHONE NUMBER GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on inforMation submitted by the financial institution. 2. Inheritance tax becoMes delinquent nine Months after the decedent's date of death. 3. A joint account is taxable .ven though the decedent's naMe was added as a .atter of convenience. 4. Accounts (including those h.ld between husband and wife) which the decedent put in joint names within one y.ar prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife .ore than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fUllY. REPORTING INSTRUCTIONS PART 1 TAXPAYER RESPONSE 1. BLOCK A - If the infor.ation and co.putation in the notice are correct and deductions are not being clai.ed, place an '~.. in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and sub.it theM with your check for the Hount of tax to the Register of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official assess.ent (For. REV-1548 EX) upon receipt of the return fro. the Register of Wills. 2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one COpy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept 280601. Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice infOrMation is incorrect andlor deductions are being clai.ed. check block "C" and co.plete Parts 2 and 3 according to the instructions below. Sign two copies and subMit the. with your check for the a.ount of tax payable to the Register of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official asseSSMent (For. REV-1548 EX) upon receipt of the return fro. the Register of Wills. TAX RETURN - PART 2 TAX COMPUTATION LINE 1. Enter the date the account originallY was established or titled in the Manner existing at date of death. NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in joint naMes within one (1) Year of death are taxable fully as transfers. How.ver. there is an exclusion not to .xceed .3,000 per transferee regardless of the value of the account or the nUMber of accounts held. If a double ast.risk (--) appears before your first naMe in the address portion of this notice, the .3,000 exclusion already has been deducted fro. the account balance as reported by the financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. Th. percent of the account that is taxable for each survivor is deter.ined as follows: A. The percent taxable for joint assets established .ore than one year prior to the decedent's death: DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS ExHPle: A joint ass.t r.gistered in the naMe of the decedent and two oth.r persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 16.7X (TAXABLE FOR EACH SURVIVOR) B. Th. percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust ben.ficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE Exa.ple: Joint account registered in the name of the decedent and two other persons and established within one year of death by the dec.dent. 1 DIVIDED BY 2 (SURVIVORS) = .50 X 100 SOX (TAXABLE FOR EACH SURVIVOR) ~. Th. a.ount subject to tax (line 4) is d.t.....ined by .ultiplying the account balance (lin. 2) by the percent taxable (lin. 3). S. Enter the total of the debts and d.ductions listed in Part 3. 6. The aMount taxable (lin. ,) is d.t.....in.d by subtracting the debts and deductions (line 5) fro. the a.ount subject to tax (line ~). 7. Enter the appropriate tax rat. (lin. 7) as det.r.ined below. -Th. tax rate i.pos.d on the net value of transf.rs fro. a deceas.d chIld twenty-one y.ars 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 OX. Th. lineal class of heirs includes grandpar.nts, parents, children, and lineal descendents. "Children" includ.s natural childr.n wheth.r or not they have be.n adopt.d by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and th.ir d.scend.nts, whether or not th.y have been adopted by others, adopted d.scendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at l.ast one parent in CO.Mon with the d.cedent. whether by blood or adoption. The "Collateral" class of heirs includes all other b.neficiaries. Date of Death Spouse Lineal Sibl1ng Collateral 07/01/94 to 12/31/94 3X 'X 15X 15X 01/01/95 to 06/30/00 OX 6" 15X 15X 07/01/00 to present OX 4.5"* 12X 15" CLAIMED DEDUCTIONS PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are deter.ined as follows: A. You legally are responsible for pay.ent, or the estate SUbject to ad.inistration by a personal representative is insufficient to pay the deductible ite.s. B. You actuallY paid the debts after death of the decedent and can furnish proof of pay.ent. C. Debts being clai.ed .ust be ite.ized fully in Part 3. If additional space is needed, us. plain paper 8 1/2" x 11". Proof of paYMent .ay be requested by the PA Depart.ent of Revenue. COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 '* INFORMATION NOTICE '.. .'. . .' 'AND _'r-..::l~: ED or-~~YE~ RESPONSE i-lr::r~J(' t,J'"' (~r \ m . " REV-l541 EX AFPl~j Li u ": : ~. FILE NO. 21- 08. 4q ~ ACN 08115017 DATE 04-10-2008 TYPE OF ACCOUNT D SAVINGS [i] CHECK I NG D TRUST D CERTIF. 2008 HAY -5 AM" E.... OF PAUL S ))LUGOLECKI S~S. NO~ ClERKOF. DATE OF DEATH ll1-06-2008 ORPHAN'S COURrCOUNTY CUMBERLAND ()JM8ER[)j", CO., PA CASIMIR DLUGOLECKI 621 MOYER RD SOUDERTON PA 18964 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1 ST Feu has p..ovided the Depa..t.ent with the infOrMation listed bIllow which has been used in calculating the potential tax due. Their ..eco..ds indicate that at the death of the above decedent, you we..e a joint owne../beneficiary of this account. If you fe.l this info....tion is inco.....ct, pleas. obtain w..itten co....ection f..o. the financial institution, attach a cOpy to this fo... and ..etu..n it to the above address. This account is taxable in acco..dance with the Inheritance Tax Laws of the COM.onwealth of PennsYlvania. Questions.ay be.answ....d by calling (717) 787-8327. COMPLETE PART 1 BELOW Account No. 7502 -11 Account Balance Percent Taxable Amount Subject to Tax Tax Rate PotentIal Tax Due PART [!] IE IE IE SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Date 08-09-1984 EstabUshed x 5,300.31 5.000 265.02 .045 11.93 TAXPAYER RESPONSE To insure proper c...dit to you.. account, two (2) copies ,of this notice .ust acco.pany your pay.ent to the Register of Wills. Make check payable tOt "Registe.. of Wills, Agent". x NOTE: If tax pay..nts a... .ade within th..ee (3) Months of the decedent's date of death, you .ay deduct a 5X discount of the tax du.. Any inhe..itance tax due will beCOMe delinquent nine (9) .orlths afte.. the date of death. he above infOrMation and tax due is co....ect. 1. You.ay choose to ....it pay.ent to the R.giste.. of Wills with tWCI copi.s of this notice to obtain a discount 0.. avoid inte..est, or you .ay ch.ck box "A" and ..etu..n this notice to the Regist... of Wills and an official asseSSMent will be issued by the PA Depart..nt of Revenue. [CHECK ] ONE BLOCK ONLY B. r=J Th. above asset has be.n 0.. will be ..epo..ted and tax paid with the PennsYlvania Inheritance Tax ..eturn to b. filed by the decedent's rep..esentativ.. C. c=l The above info...ation is inco.....ct andlor d.bts and d.ductions we... paid by you. You .ust co.plete PART 0 andlo.. PART ~ b.low. 1 2 3 X 4 5 6 7 X 8 If you indicate a different tax rate, please state your relationshIp to decedent: PART ~ TAX 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 DESCRIPTION AMOUNT PAID I TOTAL (Enter on LIne 5 of Tax ComputatIon) . that the facts I bel1ef. roct ono// ~ 1/ {) f3 DATE \{'1 Under penaltIes compL'~o the bIt have reported above are true, c HOME (tiS-) 'J'7;I -- q Z () WORK (BOP) (91.,,-'~ 306, TELEPHONE NUMBER GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on inforntion sub.itted by the financial institution. 2. Inheritance tax beco.es delinquent nine .onths after the decedent's date of death. 3. A joint account is taxable even though the decedent's na.e was added as a .atter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint na.es within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife .ore than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the infor.ation and co.putation in the notice are correct and deductions are not being clai.ed, place an ,~" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and sub.it the. with your check for the a.ount of tax to the Register of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official assess.ent (For. REV-1S~8 EX) upon receipt of the return fro. the Register of Wills. 2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed bY the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one COpy and return to the PA Depart.ent of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice inforllation is incorrect and/or deductions are being claiaed, check block "C" and co.p1ete Parts 2 and 3 according to the instructions below. Sign two copies and sub.it the. with your check for the a.ount of tax payable to the Register of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official assess.ent (For. REV-1S~8 EX) upon receipt of the return fro. the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the .anner existing at date of death. NOTE: For a decedent dying after 12/12182: Accounts which the decedent put in joint na.es within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed .3,000 per transferee regardless of the value of the account or the nu.ber of accounts held. If a double asterisk (a a) appears before your first na.e in the address portion of this notice, the .3,000 exclusion already has been deducted fro. the account balance as reported by the financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is deter.ined as follows: A. The percent taxable for joint assets established .ore than one year prior to the decedent's death: DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Exa.ple: A joint asset registered in the na.e of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS> DIVIDED BY 2 (SURVIVORS) = .167 X 100 16.7X (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE ExaMPle: Joint account registered in the naMe of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) = .50 X 100 SOX (TAXABLE FOR EACH SURVIVOR> 4. The a.ount subject to tax (line 4) is deterained by .ultiplying the account balance (line 2) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The a.ount taxable (line 6) is deter.ined by subtracting the debts and deductions (line 5) fro. the a.ount subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as deter.ined below. -The tax rate l.posed on the net value of transfers fro. 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 OX. The lineal class of heirs inclUdes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in co..on with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. Date of Death Spouse Lineal SiblIng Collateral 07/01/94 to 12/31/94 3% 6% 15X 15% 01/01/95 to 06/30/00 0% ,% 15X 15% 07/01/00 to present ox 4.5%. 12% 15% CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are deter.ined as follows: A. You legally are responsible for pay.ent, or the estate subject to administration by a personal representative is insufficient to pay the deductible ite.s. B. You actually paid the debts after death of the decedent and can furnish proof of pay..nt. e. Debts being clai.ed .ust be ite.ized fullY in Part 3. If additional space is needed, use plain paper 8 1/2" x 11". Proof of pay.ent .ay be requested by the PA Depart.ent of Revenue. COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 .D OF ~' FORMATION NOTICE ! .' 0:= AND '. IE-HI"'> -K; lAth. f?l,' PAYER RESPONSE If~ vI I , l.Vli.....) REV-154a EX AFP C09-80) FILE NO. 21.. 08' .. l/qy ACN 08115021 DATE 04-10-2008 CASIMIR DLUGOLECKI 621 MOYER RD SOUDERTON 2008 HAY -5 AM lis 5&& ' ~ST. OF PAUL S DLUGOLECKI S.S. NO. . ~ DATE OF DEATH 01-06-2008 CUMBERlAND CO;. A\ COUNTY CUMBERLAND REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 TYPE OF ACCOUNT [i] SAVINGS o CHECK I NG o TRUST o CERTIF. PA 18964 MEMBERS 1ST FCU has provided the Depart.ent with the info~ation listed bolow which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a ioint owner/beneficiary of this account. If you feel this infor.ation is incorrect, please obtain written correction fr~ the financial institution, attach a COpy to this fo~ and return it to the above address. This account is taxable in accordance with the Ir.heritance Tax Laws of the Co..oowealth of PennsYlvania. Questions .ay be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW Account No. 7502-00 I( I( I( SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Date 09- 01-1964 x 74,677.58 5.000 3,733.88 .045 168.02 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice .ust acco.pany your pay.ent to the Register of Wills. Make check payable to: "Register of Wills, Agent". Establ1shed Account Balance Percent Taxable AMount SUbject to Tax Tax Rate Potential Tax Due x NOTE: If tllX pay.ents are .ade within three (3) .onths Clf the decedent's date of death, yOU .ay deduct a 5X discount of the tax due. Any inheritance tax due will bec~e delinquent nine (9) .ooths after the date of death. PART [!] The above infor.ation and tax due is correct. 1. You.ay choose to re.it pay.ent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you .ay check box "A" and return this notice to the Register of Wills and an official assess.ent will be issued by the PA Depart.,ent of Revenue. [CHECK ] ONE BLOCK ONLY B. c:l 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. c=l The above infor.ation is incorrect and/or debts and deductions were paid by you. You .ust co.plete PART ~ and/or PART ~ below. 3 4 5 6 7 8 x If you indicate a dIfferent tax rate, please state your relationship to decedent: PART ~ TAX RETURN - COMPUTATION 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 OF TAX ON JOINT/TRUST ACCOUNTS 1 2 x PART [!) DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation). , have r.porte~bove are true. correct an~/~1I'b ~ HOME ('lIS ) .,7.A - 9Z 07 71"v WORK c800 ) e'L .2VG, ~ TELEPHONE NUMBER DATE Under penalties of .'."Ll;:, thOy' .. TAXPAYER SIGNATURE I declare that the facts 9 and bel1ef. GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on infor.ation sub.itted by the financial institution. 2. Inheritance tax beco.es delinquent nine .onths after the decedent's date of death. 3. A joint account is taxable even though the decedent's name was ad~ed as a matter of-convenience. 4. Accounts (including those held between husband and wife) which' the decedent put in joint n..es within one Year prior to death are fullY taxable as transfers. 5. Accounts established jointly between husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an '~" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and sub.it the. with your check for the Hount of tax to the Register of Wills of the county indicated. The PA DepartMent of Revenue will issue an official assess.ent (For. REV-15~8 EX) upon receipt of the return frOM the Register of Wills. 2. BLOCK 8 - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in block "8" of Part 1 of the "Taxpayer Response" section. Sign one copy and return to the PA DepartMent of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice infOrMation is incorrect and/or deductions are being claimed, check block "C" and co.plete Parts 2 and 3 according to the instructions below. Sign two copies and submit the. with your check for the a.ount of tax payable to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assess.ent (Form REV-1548 EX) upon receipt of the return fro. the Register of Wills. TAX RETURN PART 2 TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the .anner existing at date of death. NOTE: For a decedent dying after 12/1Z/82: Accounts which the decedent put in joint names within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed .3,000 per transferee regardless of the value of the account or the nu.ber of accounts held. If a double asterisk (..) appears before your first na.e in the address portion of this notice, the $3,000 exclusion already has been deducted fro. the account balance as reported by the financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established aore than one year prior to the decedent's death: DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS ExHPler A joint asset registered in the na.e of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 1&.7X (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE exaMPle: Joint account registered in the naae of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) = .50 X 100 50X (TAXABLE FOR EACH SURVIVOR) 4. The a.ount subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The aaount taxable (line 6) is deter.ined by subtracting the debts and deductions (line 5) fro. the a.ount subject to tax Cline 4). 7. Enter the appropriate tax rate (line 7) as determined below. .The tax rate I.posed on the net value of transfers fro. 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 OX. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others. adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in coaaon with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. Date of Death Spouse Lineal Sibling Collater-al 07/01/94 to 12/31/94 3r. 6r. 15r. 15% 01/01/95 to 06/30/00 OX 6r. 15X 15X 07/01/00 to pr-esent Or. 4.5r.* 12X 15X CLAIMED DEDUCTIONS PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are deterMined as follows: A. You legally are responsible for pay.ent, or the estate subject to administration by a personal representative is insufficient to pay the deductible iteas. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being clai.ed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 1/2" x U". Proof of pay.ent May be requested by the PA Department of Revenue. COMHO*EAl TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 * ~~tr6~RMAT1NODN NOTICE I;' '~,1l'1"4XPAYER RESPONSE I H; ~'"i FILE NO. 21- c> <6. LJ9Ct ACN 08115007 DATE 04-10-2008 REV-1543 EX I#P (09-00) 888 HA Y -5 AH II: 5" EST. OF PAUL S DLUGOlECKI ClERK OF S. S. NO. ~'S COURT DATE OF DEATH 01-06-2008 CUMBERlANfj CO., ~ COUNTY CUM.BERlAND TYPE OF ACCOUNT o SAYINGS o CHECK I NG D TRUST [i] CERTIF. CASIMIR DLUGOLECKI 621 MOYER RD SOUDERTON PA 18964 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1 ST FCU has provided the Depart.ent with the info,..ation 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 fro. the financial institution, attach a copy to this fo,.. and return it to the above address. This account is taxable in accordance with the Inheritance Tax lBWs of the Co..oowealth of Pennsylvania. Questions ..y.be answered by calUnsr (717) 787-8327. COMPLETE PART 1 BELOW Account No. 7502-43 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART [!] IE IE IE SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Date 06-09-1997 EstabUshed To insure p,roper credit to your account, two (2) copies of this notice .ust acco.pany your pay.ent to the Register of Wills. Make cheek payable to I "Register of Wills, Agent". x 24,331.70 5.000 1,216.59 .045 54.75 TAXPAYER RESPONSE NOTE I If tax pay.ents are .ade within three (3) .onths of the decedent's date of death, you .ay deduct a 5" discount of ttM'tax due. Any inheri t;lnce tax due will beco.e delinquent nine (9) .onths after the date of death. x The above tnfor.ation and tax due is correct. 1. You.ay choose to re.it pay.ent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you .ay check box "A" and return this notice to the Register of Wills and an official assess.ent will be issued by the PA DepartMent of Revenue. [CHECK ] ONE BLOCK ONLY B. c=l 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 info,..ation is incorrect and/or debts and deductions were paid by you. You .ust co.plete PART ~ and/or PART ~ below. 1 2 3 X 4 5 6 7 X 8 If you indicate a different tax rate, please state your relationship to decedent: PART [!] TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Est.bli~hed 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 DESCRIPTION AMOUNT PAID . Under penalties comJiete t~he best L'IA 1;.. TAXPAYER SIGNATU E TOTAL (Enter on Line 5 of Tax Computation) perjury, I declare that the facts I y ~owledge and belief. have reported above are true, correct an~/"7 HOME (Z If;:) "12.,./ - if 7., l) I l/ WORK ((JOO ) f/?.Jj -' 3 t) " TELEPHONE NUMBER DATE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on infor.ation submitted by the financial institution. 2. Inheritance tax beco.es delinquent nine .onths after the decedent's date of death. 3. A ioint account is taxable even though the decedent's naMe was added as a .atter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint na.es within one year prior to death are fullY taxable as transfers. 5. Accounts established jointly between husband and wife .ore than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS PART 1 TAXPAYER RESPONSE 1. BLOCK A - If the infor.ation and co.putaUon in the notice are correct and deductions are not being clai.ed, place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and sub.it the. with your check for the ..ount of tax to the Register of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official assess.ent (For. REV-1548 EX) upon receipt of the return fro. the Register of Wills. 2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an ''X'' in block "B" of Part 1 of the "Taxpayer Response" section. Sign one cOPY and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice infor.Btion is incorrect and/or deductions are being clai.ed, check block "c" and COMPlete Parts 2 and 3 according to the instructions below. Sign two copies and sub.it the. with your check for the a.ount of tax payable to the Register of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official assess.ent (Form REV-1548 EX) upon receipt of the return fro. the Register of Wills. TAX RETURN PART 2 TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the .anner existing at date of death. NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in joint n..es within one ~1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed .3,000 per transferee regardless of the value of the account or the nu.ber of accounts held. If a double asterisk (..) appears before your first na.e in the address portion of this notice, the $3,000 exclusion already has been deducted fro. the account balance as reported by the financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is dete~ined as follows: A. The percent taxable for joint assets established aore than one year prior to the decedent's death: DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Ex..plel A joint asset registered in the na.e of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS> DIVIDED BY 2 (SURVIVORS) = .167 X 100 16.7% (TAXABLE FOR EACH SURVIVOR> B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE Exa.ple: Joint account registered in the naae of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS> = .50 X 100 5D% (TAXABLE FOR EACH SURVIVOR) 4. The a.ount subject to tax {line 4> is dete~ined by aultiplying the account balance (line 2) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The ..ount taxable (line 6) is deter.ined by subtracting the debts and deductions (line 5) fro. the aaount subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as deterained below. Oat. of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3%" 6%" 15%" 15% 01/01/95 to 06/30/00 O%" 6%" IS%" 15%" 07/01/00 to present 0% 4.5%* 12%" 15% >>The tax rate i.posed on the net value of transfers froa a deceased child twenty-one years of age or Y ounger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is OX. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in co..on with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are deter.ined as follows: A. You legally are responsible for pay.ent, or the estate subject to ad.inistration by a personal representative is insufficient to pay the deductible iteas. B. You actually paid the debts after death of the decedent and can furnish proof of pay.ent. C. Debts being clai.ed .ust be iteaized fully in Part 3. If additional space is needed, use plain paper 8 1/2" x 11". Proof of pay.ent .ay be requested by the PA Depart.ent of Revenue. CDHHOtlrlEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280'01 HARRISBURG, PA 17128-0'01 INFORMATION NOTICE Y AND E OFTAXPAYER RESPONSE FILE NO. 21- G'8'. LJg~ ACN 08115010 DATE 04-10-2008 ~, A.4..,J TYPE OF ACCOUNT D SAVINGS o CHECK I NG D TRUST [Xl CERTIF. 2008 HAY -5 AH II s 57 . EST. OF PAUL S DLUGOLECKI S.S. NO. DATE OF DEATH 01-06-2008 COUNTY CUMBERLAND ClERK OF ORPHAN'S COURT STASIA DLUGOLEc&UM8€RLAND CO., PA 307 MONROE ST MECHANICSBURG PA 17055 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1 ST FCU has provided the Deparbent with the infor.ation 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 info~ation is incorrect, please obtain written correction fro. the financial institution, attach a copy to this fo~ and return it to the above address. This account is taxable in accordance with the II~heritance Tax Laws of the Co..onNealth of Pennsylvania. Questions .aY be answered by callin~ (717) 787-8327. COMPLETE PART 1 BELOW Account No. 7502-40 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART l!I . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Date 11- 08 -2003 Established To insure proper credit to your account, two (2) copies of this notice .ust acc~pany your pay.ent to the Register of Wills. Make check payable to: "Register of Wills, Agent". x 20,400.59 5.000 1,020.03 .00 .00 TAXPAYER RESPONSE NOTE: If tax pay.ents are .ade within three (3) .onths of the decedent's date of death, YOU .ay deduct a 5X discount of the tax due. Any inheritance tax due will beco.e delinquent nine (9) .onths after the date of death. x The above infor.ation and tax due is correct. 1. You.ay choose to re.it pay.ent to the Register of Wills with twel copies of this notice to obtain a discount or avoid interest, or you .ay check box "A" and return this notice to the Register of Wills and an official assess.ent will be issued by the PA Depart~ent of Revenue. [CHECK ] ONE BLOCK ONLY B. c=l 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 infor.ation is incorrect and/or debts and deductions were paid by you. You .ust co.plete PART 0 and/or PART ~ below. I 2 3 X 4 5 6 7 X 8 If you indicate a different tax rate, please state your relationship to decedent: PART ~ TAX 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 DESCRIPTION AMOUNT PAID I TOTAL (Enter on line 5 of Tax Computation) I . Under penalties of complete to the best of I h.y. r..orh_ .bo.. ar. trua, .orr.!.it an_J 7"]7 of) HOME ('1/1) ---1 (,L, - ~'1v i 7 f/ II WORK ( ) TELEPHONE NUMBER DATE that the facts and belief. ~ GENERAL INFORMATION 1. FAI LURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest bued on infor.ation subMitted by the financial institution. 2. Inheritance tax beco.es delinquent nine Months after the decedent's date of death. 3. A joint account is taxable even though the decedent's na.e was added as a Matter of convenience. 4. Accounts (including those held between husband and wife> which the decedent put in joint na.es within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife More than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER ,RESPONSE 1. BLOCK A - If the infor.ation and COMPutation in the notice are correct and deductions are not being clai.ed, place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and sub. it theM with your check for the a.ount of tax to the Register of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official assess.ent (ForM REV-1548 EX> upon receipt of the return frOM the Register of Wills. 2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one cOPY and return to the PA Depart.ent of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice inforMation is incorrect and/or deductions are being clai.ed, check block "C" and COMPlete Parts 2 and 3 according to the instructions below. Sign two copies and subMit theM with your check for the aMount of tax payable to the Register of Wills of the county indicated. The PA DepartMent of Revenue will issue an official asseSSMent (ForM REV-1548 EX> upon receipt of the return frOM the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the Manner existing at date of death. NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in joint naMes within one (1) year of death are taxable fullY as transfers. However, there is an exclusion not to exceed .3,000 per transferee regardless of the value of the account or the nUMber of accounts held. If a double asterisk (-_> appears before your first naMe in the address portion of this notice, the $3,000 exclusion already has been deducted frOM the account balance as reported by the financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is dete,..ined as follows: A. The percent taxable for joint assets established .ore than one year prior to the decedent's death: DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS exaMPle. A joint asset registered in the naMe of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS> = .167 X 100 16.7X (TAXABLE FOR EACH SURVIVOR> B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s> (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE exaMPle. Joint account registered in the na.e of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) = .50 X 100 = 50X (TAXABLE FOR EACH SURVIVOR> 4. The ..aunt subject to tax (line 4> is dete,..ined by .ultiplying the account balance (line 2> by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The aMount taxable (line 6> is deterMined by subtracting the debts and deductions (line 5> fro. the aMount subject to tax (line q>. 7. Enter the appropriate tax rate (line 7> as deterMined below. -The tax rate iMPosed on the net value of transfers fro. 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 OX. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether or not theY have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in COM. on with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are deterMined as follows: A. You legally are responSible for paYMent, or the estate subject to adMinistration by a personal representative is insufficient to pay the deductible iteMS. B. You actually paid the debts after death of the decedent and can furnish proof of payMent. C. Debts being clai.ed Must be iteMized fullY in Part 3. If additional space is needed, use plain paper 8 1/2" x 11". Proof of pay.ent May be requested by the PA DepartMent of Revenue. COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 ~-----r * INFORMATION NOTICE , AND Me . F ICE OFAXPAYER RESPONSE Dr.{~ ~l "'1':1:; J"" Mil! C' ~~!.ttir(Ou.) 'it:"") FILE NO. ACN DATE 21-0~ - 49G 08115002 04-10-2008 CLERK OF ORPHAN'S COURT ~DCO..I\ STASIA DLUGOLECKI 307 MONROE ST HECHANICSBURG PA 17055 2088 "AY -5 AM II: 58 TYPE OF ACCOUNT D SAYINGS o CHECKING D TRUST IX] CERTI F . EST. OF PAUL S DLUGOLECKI S.S. NO. DATE OF DEATH 01-06-2008 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 15T FCU has p..ovid.d the Depart.ent with the info,..ation listed below which has been us.d in calculatinu the pot.ntial tax due. Their ..eco..ds indicat. that at the death of the above decedent, yo~were a joint own.r/beneficiary of this account. If yoU f.el this infor.ation is inco....ect, pleas. obtain writt.n co.....ction f..o. the financial institution. attach a copy to this fo,.. and retu..n it to the above add..ess. This .ccount is tax.ble in accordance with the Inheritance Tax Laws of the Co..onwealth of P.nnsYlv.nia. Questjons ..y be .nswered bY calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account Na. 7502-45 Date 09-01-1964 Account Balance Percent Taxable Amount Subject ta Tax Tax Rate Potential Tax Due PART [!] Established To insure Il,roper c..edit to your account. two (2) copies of this notice .ust acco.pany you.. p.y.ent to the Registe.. of Wills. Make check payable tOI "Register of Wills, Agent". x 6,567.86 5.000 328.39 .00 .00 TAXPAYER RESPONSE NOTEI If tax p~ents are .ade within three (3) .onths 'lIf the decedent's d.te of death. yOU .ay dedlJct a 5,. discount of the tax due. Any inheritance tax due will bec~e delinqu.nt nine (9) .onths after the d.te of death. x [CHECK ] ONE BLOCK ONLY Th. above info....tion and tax due is cor..ect. 1. You.ay choose to re.it pay.ent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you .ay check box "A" and returru this notice to the Register of Wills and an official asses~ent will be issued by the PA Depart_ent of Revenue. B. c=J The above asset has been or will be reported .nd tax paid with the PennsYlvania Inheritance Tax return to be filed by the decedent's representative. C. c=J The .bove infor.ation is incorrect and/or debts and deductions were p,ilid by you. You .ust co.plete PART ~ and/or PART [!] below. 1 2 3 X 4 5 6 7 X 8 If you indicate a different tax rate, please state yaur relationshIp to decedent: PART ~ TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS lINe 1. Date Establlshad 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 [!J DATE PAID PAYEE DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I . perjury, I declare that the facts my knowledge and belief. 0"11"[,7 O:J DATE have reported above are tr~e. correct HOME (']/1) '7 (,& " ~ 1 t- WORK ( ) TELEPHONE NUMBER GENERAL INFORMATION 1. FAI LURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on infor.ation sub.itted by the financial institution. 2. Inheritance tax beco.es delinquent nine .onths after the decedent's date of death. 3. A joint account is taxable even though the decedent's n..e was added as a .atter of convenience. 4. Accounts (including those held between husband and wife) which th.~decedent put in joint na.es within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife .ore than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 TAXPAYER RESPONSE 1. BLOCK A . If the infor.ation and c~putation in the notice are correct and deductions are not being clai.ed, place an .~" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and sub.it the. with your check for the Mount of tax to the Register of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official assess.ent (For. REV-1548 EX) upon receipt of the return fro. the Register of Wills. 2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an '~" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one cOPY and return to the PA Depart.ent of Revenue, Bureau of Individual Taxes, Dept 280601. Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice info,..ation is incorrect and/or deductions are being clai.ed, check block "C" and co.plate Parts 2 and 3 according to the instructions below. Sign two copies and sub.it the. with your check for the a.ount of tax payable to the Register of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official assess.ent (For. REV-1548 EX) upon receipt of the return fro. the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the .anner existing at date of death. NOTE: For a decedent dying after 12/12182; Accounts which the decedent put in joint na.es within one (1) year of death are taxable fully as transfers. However. there is an exclusion not to exceed .3.000 per transferee regardless of the value of the account or the nu.ber of accounts held. If a double asterisk (..) appears before your first na.e in the address portion of this notice. the $3.000 exclusion already has been deducted fro. the account balance as reported by the financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is deter.ined as follows: A. The percent taxable for joint assets established More than one year prior to the decedent's death I DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 ~ PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Exa.plel A joint asset registered in the na.. of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 16.7X (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 ~ PERCENT TAXABLE exaMPle: Joint account registered in the na.e of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) = .50 X 100 SOX (TAXABLE FOR EACH SURVIVOR) 4. The a.ount SUbject to tax (line 4) is deter.ined by .ultiplying the account balance (line 2) by the percent taxable (line 3). S. Enter the total of the debts and deductions listed in Part 3. 6. The ..ount taxable (line 6) is deter.ined by subtracting the debts and deductions (line S) fro. the aMount subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as deter.ined below. .The tax rate I.posed on the net value of transfers fro. 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 OX. The lineal class of heirs includes grandparents, parents. children. and lineal descendents. "Children" includes natural children whether or not they have been adopted by others. adopted children and step children. "lineal descendents" includes all children of the natural parents and their descendents. whether or not they have been adopted by others. adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in co..on with the decedent. whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are deterMined as follows: A. You legally are responsible for pay.ent. or the estate subject to ad.inistration by a personal representative is insufficient to pay the deductible iteMS. B. You actually paid the debts after death of the decedent and can furnish proof of pay.ent. C. Debts being clai.ed Must be ite.ized fully in Part 3. If additional space is needed. use plain paper 8 1/2" x 11". Proof of pay.ent May be requested by the PA Depart.ent of Revenue. -_.._--~~~.............."....~ - -~~. COMMOt61EAl TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280'01 HARRISBURG, PA 17128-0'01 _f Olt'.......... i .~ '.... t ' . REY-1S~3 EX ~ llJ"J;J INFORMATION NOTICE f'\rr.Jllr: AND ~r~~YER RESPONSE (Ir:. \,4fl1 t (' VI .VIL. '\ FILE NO. 21 - 0 <g' . 49 (" ACN 08115016 DATE 04-10-2008 STASIA DLUGOLECKI 307 MONROE ST MECHANICSBURG 2008 HAY -5 AH II: fiaT. OF PAUL S DLUGOLECKI S.S. NO. CLERK OF DATE OF DEATH 01-06-2008 CUQAPH4N'S COURT COUNTY CUMBERLAND ~D CO.. flI\ REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 TYPE OF ACCOUNT o SAVINGS [i] CHECKING o TRUST o CERTIF. PA 17055 MEMBERS 1ST FCU has provided the Deparbent with the infol"llation listed b<tlow which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a ioint owner/beneficiary of this account. If you f.e1 this infor.ation is incorrect, please obtain written correction fr~ the financial institution, attach a COpy to this fOI"ll and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Coaaonwea1th of PennsYlvania. Questions aaw be answered by calling (717) 787-R~27. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Date 08-09-1984 Establbhed x 5,300.31 5.000 265.02 .00 .00 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice aust acco.pany your payaent to the Register of Wills. Make check payable to: "Register of Wills, Agent". Account No. 7502-11 Account Balance Percent Taxable AMount Subject to Tax Tax Rate Potential Tax Due x NOTE: If tax payaents are aade within three (3) aonths of the decedent's date of death, you aay deduct a 5X discount of the tax due. Any inheritance tax due will becoae delinquent nine (9) .onths after the date of death. PART f!] The above infor.ation and tax due is correct. 1. You.ay choose to re.it pay.ent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you .ay check box "A" and return this notice to the Register of Wills and an official assessaent will be issued by the PA Depart.ent of Revenue. [CHECK ] ONE BLOCK ONLY B. c:J The above asset has be.n or will be reported and tax paid with the PennsYlvania Inheritance Tax return to be filed bY the decedent's representative. C. 0 The above infora.tion is incorrect and/or debts and deductions were pI,id by you. You .ust co.plete PART 0 and/or PART ~ below. x PART [!J TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS If you indicate a different tax rate, please state your relationship to decedent: I.INE 1. Date Establ1st.ed 2. Account Balance 2 3. Percent Taxable 3 4. Amount Subject to Tax 4 5. Debts and Deductions 5 ,. Amount Taxable , 7. Tax Rate 7 8. Tax Due 8 PART (!] DATE PAID PAYEE x DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) . on"'//21/08 perjury, I declare that the facts I my knowledge and belief. have reported above are true, correct HOME (~ '1) 1 (,{, ".. f;'1 Z7 WORK ( ) TELEPHONE NUMBER DATE \\lY\ GENERAL INFORMATION 1. FAIl.URE TO RESPOND WIl.L RESUl.T IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on infor.ation sub.itted by the financial institution. 2. Inheritance tax beco.es delinquent nine .onths after the decedent's date of death. 3. A joint account is taxable even though the decedent's naMe was added as a Matter of convenience. 4. Accounts (including those held between husband and wife) which ~he decedent put in joint na.es within one year prior to death are fully taxable as transfers. S. Accounts established jointlY between husband and wife .ore than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fUlly. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the inforMation and COMPutation in the notice are correct and deductions are not being clai.ed, place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and subMit the. with your check for the ..ount of tax to the Register of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official asseSSMent (For. REV-1548 EX) upon receipt of the return fro. the Register of Wills. 2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one cOPY and return to the PA Depart.ent of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice inforMation is incorrect and/or deductions are being claiMed, check block "C" and COMPlete Parts 2 and 3 according to the instructions below. Sign two copies and subMit the. with your check for the a.ount of tax payable to the Register of Wills of the county indicated. The PA DepartMent of Revenue will issue an official assess.ent (ForM REV-1S48 EX) upon receipt of the return fro. the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the Manner existing at date of death. NOTE: For a decedent dying after 12/1Z/82: Accounts which the decedent put in joint n..es within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed .3,000 per transferee regardless of the value of the account or the nUMber of accounts held. If a double asterisk (xx) appears before your first naMe in the address portion of this notice, the .3,000 exclusion already has been deducted frOM the account balance as reported by the financial institution. 2. Enter the total balance of the account inclUding interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is deterMined as follows: A. The percent taxable for joint assets established .ore than one year prior to the decedent's death: DIVIDED BV TOTAL NUMBER OF DIVIDED BV TOTAL NUMBER OF X 100 = PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS exaMPle: A ioint asset registered in the naMe of the decedent and two other persons. 1 DIVIDED BV 3 (JOINT OWNERS) DIVIDED BV 2 (SURVIVORS) = .167 X 100 16.7X (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): DIVIDED BV TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 = PERCENT TAXABLE exaMPle: Joint account registered in the naMe of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BV 2 (SURVIVORS) = .50 X 100 50X (TAXABLE FOR EACH SURVIVOR) 4. The aMount SUbject to tax (line 4) is deterMined by Multiplying the account balance (line 2) by the percent taxable (line 3). S. Enter the total of the debts and deductions listed in Part 3. 6. The aMount taxable (11ne 6) is deterMined by subtracting the debts and deductions (line 5) frOM the aMount subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as deterMined below. Date of Death Spouse Lineal SIbling Collater-al 07/01/94 to 12/31/94 3% IS% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to pr-8sent 0% I 4.5%* 12% 15% xThe tax rate i.posed on the net value of transfers frOM a deceased child twenty-one years of aue or y ounger at death to or- for the use of a natural parent, an adoptive parent, or a stepparent of the child is OX. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in CO.Mon with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are deter.ined as follows: A. Vou legally are responsible for pay.ent, or the estate subject to ad.inistration by a personal representative is insufficient to pay the deductible ite.s. B. Vou actually paid the debts after death of the decedent and can furnish proof of payM.nt. C. Debts being claiMed .ust be iteMized fully in Part 3. If addi tional space is needed J use plain paper 8 1/2" x 11". Proof of paYMent .ay be requested by the PA DepartMent of Revenue. COMHOtl1lEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 * INFORMATION NOTICE ...1' ,,.,.... AND . ,,.. i I:) D OFfQIf}YER RESPONSE ;...Ii..Gi<'l' H'" 0'" H ' " i t1 . . " II... . ""jll ',! (>i 1lEV-154S EX """.. I '1', i~' ) FILE NO. ACN DATE 21 -08" 49~ 08114998 04-10-2008 STASIA DLUGOLECKI 307 MONROE ST MECHANICSBURG PA 17055 Z888 HAY -5 AM II: It. OF PAUL S DLUGOLECKI S.S. NO. QERK OF DATE OF DEATH 01-06-2008 (./l!:fi!!~ GO.Rr COUIITY CUMBERLAND WUfYfOO1wJD 00..- PA REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 TYPE OF ACCOUNT D SAVINGS D CHECKING D TRUST [i] CERTIF. MEMBERS 1ST FCU has provided the Depart.ent with the info...ation listed blJ10w 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 fro. the financial institution, attach a copy to this fo... and return it to the above address. This account is taxable in accordance with the Irlheritance Tax Laws of the Co..oowealth of p.nnsYlva~ia. Question~.ay ~e answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 7502-46 Date 11-15-2006 Account Balance Percent Taxable AMount Subject to Tax Tax Rate Potential Tax Due x 50,552.11 5.000 2,527.61 .00 .00 TAXPAYER RESPONSE To insure plr"oper credit to your account. two (2) copies of this notice .ust acc~pany your pay.ent to 1the Register of Wills. Make check payable tOI "Register of Wills, Agent", Established x NOTE: If tax pay.ents are .ade within three (3) .onths ellf the decedent's date of death. you .ay deduct a 5% discount of the tax due. Any inheritance tax due will beco.e delinquent nine (9) .onths after the date of death. PART [!] The above info...ation and tax due is correct, 1. You.ay choose to re.lt pay.ent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest. or you .ay check box "A" and return this notice to the Register of Wills and an official assess.ent will be issued by the PA Depart..nt of Revenue. [CHECK ] ONE BLOCK ONLY 8. 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 infor.ation is incorrect andlor debts and deductions were paid by you. You .ust co.plate PART 0 andlor PART 0 below. PART ~ TAX RETURN - COMPUTATION LINE 1. Dat. 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 OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 4 5 6 7 8 x If you indicate a different tax rate, please state your relationship to decedent: x PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax COMPutation) . Under penalties of perjury, I declare that the facts lete to the best of my knowledge and belief. ~ have reported above ,gre trge, correct HOME ('1/1 ) 1 (, ~ - ~ r z 7 WORK ( ) TELEPHONE NUMBER an~ /27 loB ~ DATE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on inforMation subMitted by the financial institution. 2. Inheritance tax becoMes delinquent nine Months after the decedent's date of death. 3. A joint account is taxable even though the decedent's n~e was added as a Matter of convenience. ~. Accounts (including those held between husband and wife) which the decedent put in joint naMes within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife .ore than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the inforMation and co.putation in the notice are correct and deductions are not being claiMed, place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and sub.it the. with your check for the a.ount of tax to the Register of Wills of the county indicated. The PA DepartMent of Revenue will issue an official assess.ent (For. REV-1548 EX) upon receipt of the return fro. the Register of Wills. 2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one copy and return to the PA Depart.ent of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice infOrMation is incorrect and/or deductions are being claiMed, check block "C" and COMPlete Parts 2 and 3 according to the instructions below. Sign two copies and sub.it the. with your check for the aMount of tax payable to the Register of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official assessaent (For. REV-1548 EX) upon receipt of the return fro. the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the Manner existing at date of death. NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in ioint na.es within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed .3,000 per transferee regardless of the value of the account or the nu.ber of accounts held. If a double asterisk (--) appears before your first na.e in the address portion of this notice, the +3,000 exclusion alreadY has been deducted fro. the account balance as reported by the financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is deter.ined as follows: A. The percent taxable for joint assets established .ore than one year prior to the decedent's death: DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Exa.ple: A joint asset registered in the na.e of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 16.7~ (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE Exa.ple: Joint account registered in the na.. of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) = .50 X 100 SOX (TAXABLE FOR EACH SURVIVOR) ~. The a.ount subject to tax (line 4) is deter.ined by .ultiplying the account balance (line 2) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The a.ount taxable (line 6) is deter.ined by subtracting the debts and deductions (line 5) fro. the a.ount subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as deterained below. -The tax rate i.posed on the net value of transfers fro. 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 OX. The lineal class of heirs includes grandparents, parents, children. and lineal descendents. "Children" includes natural children whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in co.. on with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4.5%* 12% 15% CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are deter.ined as follows: A. You legally are responsible for pay.ent, or the estate subject to ad.inistratlon by a personal representative is insufficient to p.v the deductible ite.s. B. You actually paid the debts after death of the decedent and can furnish proof of pay.ent. C. Debts being clai.ed .ust be ite.ized fully in Part 3. If additional space is needed, use plain paper 8 1/2" x II". Proof of pay.ent .~ be requested by the PA Depart.ent of Revenue. COHHOMlIEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *D .. REv-l~ii1oi 288BHAr-s AHI/IS8EST. OF PAUL S DLUGOLECKI 5.5. NO. ~. OF. . DATE OF DEATH 01-06-2008 ~S~ COUNTY CUMBERLAND CUMBERf.A~ ex)' 5TA5IA DLUGOLECKI- .,- ~ 307 MONROE 5T MECHANICSBURG INFORMATION NOTICE AND lCf~PAYER RESPONSE ltl" {: FILE NO. 21 - C8 " 49y ACN 08115006 DATE 04-10-2008 TYPE OF ACCOUNT o SAVINGS o CHECKING D TRUST [Xl CERTIF. PA 17055 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has provided the Oepart..nt with the infol'llation 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 ioint owner/beneficiary of this account. If YOU feel this infor.ation is incorrect, please obtain written correction fro. the financial institution, attach a copy to this fol'll and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co..onwealth uf PennSYlvania. Question~.ay be answeroc! by calling (717) 787-83~7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Da te 0 6 - 0 9 - 1 997 Established Account No. 7502-43 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due x 24,331.70 5.000 1,216.59 .00 .00 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice .ust acco.pany your pay.ent to the Register of Wills. Make check payable tOI "Register of Wills, Agent". x NOTE I If tax pay.ents are .ade within three (3) .onths of the decedent's date of death, YOU .ay deduct a SX discount of the tax due. Any inheritance tax due will beeo.e delinquent nine (9) .onths after the date of death. PART [I he above infor.ation and tax due is correct. 1. You.ay choose to re.it pay.ent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you .ay check box "A" and returrl this notice to the Register of Wills and an official assess.ent will be issued by the PA Depart.ent of Revenue. [CHECK ] ONE BLOCK ONLY 8. c:J The above asset has be.n or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. C. c:J The above infor.ation is incorrect andlor debts and deductions were paid by yOU. You .ust co.plete PART ~ andlor PART ~ below. PART (!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED If you indicate a different tax rate, please state your relationship to decedent: PART ~ TAX RETURN - COMPUTATION 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 OF TAX ON JOINT/TRUST ACCOUNTS 1 2 x 3 4 5 6 7 8 x PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) . Under penalties to the best perjury, I declare that the facts knowledge and belief. -~ have reported HOME ( 1/7 WORK ( TELEPHONE a.ove ''''.0 t';JJ."q,..t ) 7(.,(, b'f . ) NUMBER and I / ~/~7/0a '. DATE .~ GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on inforMation subMitted by the financial institution. 2. Inheritance tax becoMes delinquent nine .onths after the decedent's date of death. 3. A joint account is taxable even though the decedent's na.e was added as a .atter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint na.es within one Year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife .ore than one year prior to death are not taxable. &. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the infor.ation and co.putation in the notice are correct and deductions are not being clai.ed, place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and sub.it the. with your check for the a.ount of tax to the Register of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official assess.ent (For. REV-1548 EX> upon receipt of the return fro. the Register of Wills. 2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative. place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one copy and return to the PA DepartMent of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice infor.ation is incorrect and/or deductions are being clai.ed. check block "C" and co.pleta Parts 2 and 3 according to the instructions below. Sign two copies and sub.it the. with your check for the a.ount of tax payable to the Register of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official assess.ent (For. REV-1S48 EX> upon receipt of the return frOM the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the Manner existing at date of death. NOTE: For a decedent dYing after 12/12/821 Accounts which the decedent put in joint na.es within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed .3.000 per transferee regardless of the value of the account or the nu.ber of accounts held. If a double asterisk (--) appears before your first na.e in the address portion of this notice. the .3,000 exclusion already has been deducted fro. the account balance as reported by the financial institution. 2. Enter the total balance of the account inclUding interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is deterMined as follows: A. The percent taxable for joint assets established .ore than one year prior to the decedent's deathl DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Ex..plel A joint asset registered in the na.e of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS> DIVIDED BY 2 (SURVIVORS> = .167 X 100 16.7X (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries)l 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE Exa.ple: Joint account registered in the na.e of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) = .50 X 100 50X (TAXABLE FOR EACH SURVIVOR> 4. The a.ount subject to tax (line 4) is deterMined by .ultiplying the account balance (line 2> by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The a.ount taxable (line 6) is deter.ined by SUbtracting the debts and deductions (line 5> frOM the a.ount subject to tax (line 4>. 7. Enter the appropriate tKK rate (line 7) as deter.ined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3X 6X 1SX 1SX 01/01/95 to 06/30/00 OX 6X 1SX 15% 07/01/00 to present 0% 4.5%* 12% 15% -The tax rate i.posed on the net value of transfers fro. a deceased child twenty-one years of age or y ounger at death to or for the use of a natural parent, an adoptive parent. or a stepparent of the child is OX. The lineal class of heirs includes grandparents. parents, children. and lineal descendents. "Children" includes natural children whether or not they have been adopted by others. adopted children and step children. "Lineal descendents" includes all children of the natural parents and their descendents. whether or not they have been adopted by others. adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in co..on with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are deter_ined as follows: A. You legally are responsible for pay.ent, or the estate SUbject to ad.inistration by a personal representative is insufficient to pay the deductible ite.s. B. You actually paid the debts after death of the decedent and can furnish proof of pay.ent. C. Debts being claiMed .ust be ite.ized fully in Part 3. If additional spaCe is needed, use plain paper 8 1/2" x 11". Proof of pay.ent .ay be requested by the PA Depart.ent of Revenue. ~ I 00 ..-.~ ~~~ (Q- ~ .,.1 (t.- i1i. 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