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HomeMy WebLinkAbout05-21-08COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: SLEBODNICK PAUL F 7663 LONG PINE DR SPRINGFIELD, VA 22151 -------- fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) NO. CD 009774 ACN ASSESSMENT AMOUNT CONTROL NUMBER ESTATE INFORMATION: ssN: 2o4-is-soli FILE NUMBER: 2108-0562 DECEDENT NAME: SLEBODNICK JOHN P DATE OF PAYMENT: 05/23/2008 POSTMARK DATE: 05/21 /2008 COUNTY: CUMBERLAND DATE OF DEATH: 1 2/25/2007 REMARKS: SLEBODNICK PAUL CHECK# 6330 SEAL 08121264 ~ 5636.53 TOTAL AMOUNT PAID: INITIALS: AKK 5636.53 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER cJF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES A N D DEPT. 280601 HARRISBURG, PA 17128-0601 TAXP AY E R RESPONSE: REV-1543 EX AFP (09-00) FILE N0. 21 ACN 08121264 DATE 05-13-2008 TYPE OF ACCOUNT EST. OF JOHN P SLEBODNICK ^ SAVINGS S.S. N0. 204-16-8031 ^ CHECKING DATE OF DEATH 12-25-2007 ^ rRUST COUNTY CUMBERLAND ~ CERTIF. 12EMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PAUL F SLEBODNICK 7663 LONG PINE DR SPRINGFIELD VA 22151 M&T BANK has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a ioint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. puestions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 31003915937973 Date 02-28-2006 To insure proper credit to your account two Account Balance Established C2) copies of this notice must accompany your 84,869.36 payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If 'tax payments are made within three Amount Subject to Tax 14, 145.18 (3) months of the decedent's date of death, Tax Rate X , 0(frj you may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent Potential Tax Due 636.53 nine C9) months after the date of death. PART TAXPAYER RESPONSE :::::Cty1t:!L.I:~:F~~.'-'L""::~"!'i9:~::~:G~~fi'13131i..;li1'F~ i......;1CE I~'~ F~ { ;'7" _'E~i_ ;1f~~i~ i::~i~"t~"'!`#~ T ~k~{~: 'TA~iF ~ ~A~'i:1Ci:E"~.~L'l~ii'~L"1iTc: 'tE 6:%!;~"':[~::: #'fii::~:'E:E1~fi:+@~::~:Y~Ef'E`T:[`~1':~::: 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 A. ^ The above information and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of C H E C K Wills and an official assessment will be issued by the PA Department of Revenue. ONE B L 0 C K B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ^ and/or PART ^ below. PART If you indicate a different tax rate, please state your ;::;: ~;::;;;;ss:~ :~ :~ :~ :::: ~ :::::::::::::::::::::::::::::: :::::::::::::::::::::::::: .:: :::::::::::::::::::::::::::::. relationshi P to decedent: .............................w.a......wa,.~w...ii~":~:w~ ~ ~;w,r ~ is~t`i~ary[~'.+i?~, PART DEBTS AND DEDUCTIONS CLAIMED TOTAL (Enter on Line 5 of Tax Computation) 6 Under penalties of perjury, I declare that the facts I have reported at~ove are tr ue , correct and com thgy ~~ ~ of knowledge and belief. HOME C~~J.) / .j ~ / , e~ / / -5 WORK ( ;1 ~~~ OCR TAXPAYER IGNATURE TELEPHONE NUMBER DATE' OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 DATE PAID PAYEE DESCRIPTION AMOUNT PAID 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 name was added as a matter of convenience. 4. 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 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 "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1549 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 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 83,000 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 83,000 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: 1 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 = 16.7% (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 X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50% (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 determined by subtracting the debts and deductions (line 5) from the amount subject to tax Cline 4). 7. Enter the appropriate tax rate (line 7) as determined below. ^The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0%. 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 common 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 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 claimed must be itemized 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. 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% r ,~ _; ~rt ~%~y ~~~ e ~ ~ i ~ ,~ ~ ~ ~ ~~t ~ t~` ~~,-r ,;, i~~ b'; Cu.' ~~ :~, N ~~ ~~ 5 ~ r+ ~ ,~' `}_ ~~ ~O ~ ~ J Q ~ ~7 ~ p [ ryry W [~ ~ J ~ ~ t!) m ~ J (~ ~ ~ ~ m N .~ON 'c m 6 q G ~ O y Vl ® Y ~;s~ -~~~ ~~w .:.s l~~t {' ~ t . ~, ~,:~ 1, 4t COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: SLEBODNICK PAUL F 7663 LONG PINE DR SPRINGFIELD, VA 22151 told PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: Ssrv: 204-~ 6-so3i FILE NUMBER: 2108-0562 DECEDENT NAME: SLEBODNICK JOHN P DATE OF PAYMENT: 05/23/2008 POSTMARK DATE: 05/21 /2008 COUNTY: CUMBERLAND DATE OF DEATH: 1 2/25/2007 REV-1162 EX111-961 NO. CD 009775 ACN ASSESSMEN-~ AMOUNT CONTROL NUMBER 08121262 ~ S 1, 942.92 TOTAL AMOUNT PAID: REMARKS: SLEBODNICK PAUL CHECK# 6331 SEAL INITIALS: AKK S 1, 942.92 RECEIVED BY: GLENDA F,4RNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AN D DEPT. 280601 TAXPAYER RESPONSI= HARRISBURG, PA 17128-0601 REV-1543 EX I1FP (09-00) FILE N0. 21 ACN 08121262 DATE 05-13-2008 ** PAUL F SLEBODNICK 7663 LONG PINE DR SPRINGFIELD VA 22151 TYPE OF ACCOUNT EST. OF JOHN P S~LEBODNICK ® SAVINGS S.S. N0. 204-16-8031 ~ CHECKING DATE OF DEATH ].2-25-2007 ~ TRUST COUNTY CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARL]:SLE, PA 17013 M&T BANK has provided the Department with the information listed t~elow which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from they financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by callin0 (717) 787-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 15004215021061 Date 03-15-2007 Established Account Balance Percent Taxable 86,352.11 x 50.000 To insure proper credit to your account, two (2) copies of this notice must accompany your payment to the Register of Wills. Make check payable ta: "Register of Wills, Agent". NOTE: If tax payments are made within three Amount Subject to Tax 43, 176.06 (3) months of the decedent's date of death, Tax Rate X .045 you may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent Potential Tax Due 1 , 942.92 nine C9) months after the date of death. PART TAXPAYER RESPONSE 1 ::: FkII.IIIFt~ 'TD _ ~ ~~~, P~lN~i.. ~ I~ L ~ E~ t~~.fi::;~.::. I! E F I~ IA~.:::T~ ~ A~~ E~~~ EI'T HAS E~ IIH fiN ~ S ~:pfil:~:E:. A. ~ The above information and tax due is correct. 1. You may choose to remit payment to the Register of Wills with 'two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. C ONE B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ~ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. PART If you indicate a different tax rate, please state your relationship to decedent: 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. lax Due OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID AXPA LEPHONE NUMBER TOTAL CEnter on Line 5 of Tax Computation) S m Under penalties of perjury, I declare that the facts I have reported abov~ey are true,~/correct and ~: _ ~o the b st o Y knowledge and belief. HOME C~n.)~ ) / ~~ ~/ -~/ ~.'~a~'.,!///jj' WORK ( ) ~L *~ y 1~ L GENERAL INFORMATION FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. Inheritance tax becomes delinquent nine months after the decedent's date of death. A joint account is taxable even though the decedent's name was added as a matter of convenience. Accounts (including those held between husband and wife) which the decedent Dut in joint names within one year prior to death are fully taxable as transfers. Accounts established jointly between husband and wife more 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 BLOCK A - If the information and computation 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 submit them with your check for the amount of tax 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. 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. 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 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 53,000 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 53,000 exclusion already has been deducted from the account balance as reported by the financial institution. Enter the total balance of the account including interest accrued to the date of death. 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: 1 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 = 16.7% (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 X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES 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 = 50% (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4) is determined by multiplying the account balance Cline 2) by the percent taxable Cline 3). Enter the total of the debts and deductions listed in Part 3. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4). Enter the appropriate tax rate (line 7) as determined below. 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% *The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0%. 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 common 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 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 claimed must be itemized 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. ~'~; . - '-~.k~ >+d i5 r + 'n. ti '~-'~ t ' A ~. i`'?; :y 1 ..+" .~ r `` k .+ ` ... ... r+ `~ ,ry) ~~ Y •~~ ,O ~© ,L ~~ ~~ G~ t/ t ~~ i ~ ~N ~ '> h~~ ~~ . v .1 '~~, 1 4i 'i) i,~ `i jY .~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0 601 RECEIVED FROM: SLEBODNICK PAUL F 7663 LONG PINE DR SPRINGFIELD, VA 22151 fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: ssN: 2o4-i 6-soar FILE NUMBER: 2108-0562 DECEDENT NAME: SLEBODNICK JOHN P DATE OF PAYMENT: 05/23/2008 POSTMARK DATE: 05/21 /2008 COUNTY: CUMBERLAND DATE OF DEATH: 1 2/25/2007 ACN ASSESSMENI~ CONTROL NUMBER REV-1162 EX(11-96) NO. CD 009776 AMOUNT 08121266 ~ 534.00 TOTAL AMOUNT PAID: REMARKS: SLEBODNICK PAUL CHECK# 6329 SEAL INITIALS: AKK RECEIVED BY: 534.00 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMDNWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE BUREAU DF INDIVIDUAL TAXES AN D DEPT. 280601 HARRISBURG, PA 171za-8601 TAXPAYER R E S P O N Slc REV-1543 EX AFP (U9-UU1 PAUL F SLEBODNICK 7663 LONG PINE DR SPRINGFIELD VA 22151 FILE N0. 21• l~b '~ ACN 08121266 DATE 05-13-2008 TYPE OF ACCOUNT EST. OF JOHN P SLEBODNICK ^ SAVINGS S.S. N0. 204-16-8031 ®CHECKING DATE OF DEATH 12-25-2007 ^ TRUST COUNTY CUMBERLAND ^ CERTIF. F2EMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT H OUSE CARLISLE, PA 17013 M8T BANK has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If You feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of Pennsylvania. puestions may be answered by calling C717) 787-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 79454976 Date 05-28-1977 To insure proper credit to your account, two Established (2) copies of this notice must accompany your Account Balance 4,532.84 payment to 'the Register of Wills. Make check payable to: "Register of Wills, Agent". Percent Taxable X 16.667 NOTE: If tax payments are made within three Amount Subject to TaX 755.49 (3) months of the decedent's date of death, TaX Rate X .045 you may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent Potential Tax Due 34.00 nine (9) months after the date of death. PART TAXPAYER RESPONSE ^ _; ~ w ~~: mya~::::°rt'f ;i ~s-aC1~s~~fru~~:;~I~I:T S: ~ ::~€C ~:[1€[::~F';€i!F.~l~::a~ ~.~:~:T~"'C E f ;'Tik'SE~; ik~4-R€~aO~llfl ~Tii T~;~ ~t~:~i~~:[i~~~~ ~f~l:~;:'t"N~T:!~~:: #1:~~E`~`i~"~E °~ A. l71 The above information and tax due is correct. L~J 1. You may choose to remit payment to the Register of Wills with tw~~ copies of this notice to obtain CHECK a discount or avoid interest, or you may check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. C ONE B L 0 C K B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be tiled by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART 2^ and/or PART 3^ below. If you indicate a different tax rate, please state your •~ ~~~•~~~ ~~~~ ~°~°° ~ ~ :°: :°:°:°:°°~°:°:°:°: PART ;iii'i€€si;i~i':i€i€ssiiiii€i€i€s €i~i~i~iAii'is~'~"`fs[i.~~::::`::'€;t:~:~?:; P :`':': iii iii':s[':[':iiiE'i;s€iii;'si:t~ t:sis ~::s:s~ :::~ : ~: _s _:s:::~ i:s: ~~:-~:::~ ~: ~:::::::: ~::.::.:.::: 1 io sh' to decedent: re at n i :::::::::::::::: - 'iii ~`•_'=~~':';'~ ~~ ~ ~~€~ ~~ : ~ ~ ~ ~i{?~ i€~ ~ ~. TAX RETURN COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS ;~-~{~~`'`°°~~'°°~_':::: .: :_:.. :.:_.• __••..:_:..• _.•_•• n« ~ , „ate Established I ~~;:: ...... .................................................................... ................ ....: ~r.:.......:„... i:::::::'::_:~ _....,;e_e_:_:::~i~ :: ~ei~ :~ ~ i<::^~~'-~~~ ...: '~ ~ _isii;'S:::3^i:~::<:ariii;::s;. 2 . Account B a 1 a n c e 2 ~ €~ i'~~~.,°i:;.;.;,: ;:` ' : ~;.;.::;-~ r+ '~ ..: . :......:.....:... .- .. ::..........._.. .................. ......_..............r:: .. 3 . Percent T a x a b 1 e 3 X ::::::::::::::::::.:::~ ;:;:;:, :::;:;,;:::~ :.;:,:;:;:~ ::;:~ : ;~ :.....:....... ;:;:~ :~::::::;:....::;:;:~ ;:;:;:>::,:; :, ou t Sub ect to Tax 4 4. Am n €si€siiii[ ~~ psi€6~si€=. ~ii~ ~ i€'i~ [ ^;~t~'€i':= ~ =~i ~ :.:i~iz':i= =iii':;`: s€ 5. Debts and Deductions 5 _~iir' o t a b 6 6. Am un T xa le .................................................................._.. ........................... .~;~::ss: ..............................................._............................................................ 7. Tax Rate 7 X iii~ziziSiiiii` :..:..:...........-,.::::-:.,.,.,.,.,::. ;:;:'::;:;:;:;:;:t;~;:__;;,;:;~~~:~i<p:;;~,:;~~::; 8 . Tax Due 8 ::::::::::: ~::_ : ~ :,.,.:,,.,.,,::, ...... :::.......,~.:::::.::::::, ,::,-:::-::,:-:::~ ::::.:::::..:::.: PART DEBTS AND DEDUCTIONS CLAIMED a DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) 8 Under penalties of per]ury, I declare that the facts I have reported above are trute~,~,/coCrrect and e o st f` knowledge and belief. HOME ~~~) Y~~ ` / / }~ WORK C ) ~~ . ~ " TAXPAYER SIGNATURE TELEPHONE NUMBER DAT 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 taz becomes delinquent nine months 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 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 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 "X" in block "A" of Part 1 of the "Tax paver Response" section. Sign two copies and submit them with your check for the amount of tax 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. 2. BLDCK 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 "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 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 C~*) appears before your first name in the address portion of this notice, the 53,000 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: 1 DIVIDED BY TOTAL NUMBER DF 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 BV 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 X 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50% (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 determined by subtracting the debts and deductions (line 5) from the amount subject to tax Cline 4). 7. Enter the appropriate tax rate Cline 7) as determined below. xThe tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0%. 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 common 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 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 claimed must be itemized 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. 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% y¢ i ~~a F 7.~(.qk< j• $${{fff R tt 3 F. ~: ~ 9 2'-. ~ c~ v ) s' r r ~ `@ *~ ~'~ ~ r "'; Cl '~ 117T Q~{'i r ~tt~ CUB`. r=< , r ~;~ y ,I~ f.?.- C~} .~ ~:J ..,. ~^' !i`~i ~~ J J o w ~ c n W m ~o~ 9=< aa~ m @~ N O LL. J C . (+i .~ ~ ,8 L OW. 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