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HomeMy WebLinkAbout06-25-08COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-961 DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 009942 TEWELL BRENDA C 326 CANDLELIGHT DRIVE MECHANICSBURG, PA 17055 ACN ASSESSMENT AMOUNT CONTROL NUMBER fold ESTATE INFORMATION: ssN: ~ FILE NUMBER: 2108-0255 DECEDENT NAME: GAWRONSKf WINNONA WELS DATE OF PAYMENT: 0~~!~908 Co,Zt~ ~O~n~~ POSTMARK DATE: 06/25/2008 COUNTY: CUMBERLAND DATE OF DEATH: 03/04/2008 REMARKS: BRENDA TEWELL SEAL CHECK# 2954 08125167 ~ $190.93 TOTAL AMOUNT PAID: S 190.93 INITIALS: AKK RECEIVED BY: GLENDA EARNER STRASRAUC;H REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE I N F O R MAT I O N N O T I C E BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 08-0255 DEPT. 280601 ACN 08125167 HARRISBURG, PA 171zB-B6gl TAX P AY E R R E S P O N S E DATE 06-04-2008 REV-1543 E% AFP C09-V9) TYPE OF ACCOUNT EST. OF WINNONA P GAWRONSKI ^ SAVINGS $.$. N0. ^ CHECKING DATE OF DEATH 03-04-2008 ^ TRUST COUNTY CUMBERLAND ~ CERTIF. RE',MIT PAYMENT AND FORMS T0: BRENDA C TEWELL REGISTER OF WILLS 326 CANDLELIGHT DR CUMBERLAND CO COURT HOUSE MECHANICSBURG PA 17055-8012 CARLISLE, PA 17013 PSECU has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS IUTAL (Enter on Line 5 of Tax Computation:) $ Under penalties of perjury, I declare that the facts I have reported above are true, correct and compl~l, to top the be of knowledge and belief. HOME C'/'~ ) ~~« ° v'Z 7'~ y r~'-L~l-a1~!.~ ~~ \ .~<-c,.-~C~ W O R K ('~~ '7 ) `7 c~ :~ - ? ~ ~~ 3 G ~j o TAXPAYER SIGNATURE TELEPHONE NUMBER 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 ]oint 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 ioint 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-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 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-1549 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 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 Dercent taxable for .joint assets established more than one near 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) Ctrust 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) 4. The amount subject to tax Cline 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 Cline 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. 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% ,.a ..~,;ia r..ont.,-on 15% o .,oa of aae or v ounger at .one ~ 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. P~~ F•+• Sd~ i~~ E ~~F z"'t o-~• s a aU `~/~ 3 ry 1 0 "\ n n ~~3 ~~ ~^ ~. ~~ ~ :.C_~ 0 ~~ '~. _ ~~ ~ ~~, "`vvv Lnn, ~ ,~ ~ ~~ <~~ ~~ ~~ ~~ ~. ~, ~~ ~~ -- ~~: ;,,: ~ - ~`'J v'~ - _ ,~ :~: F W ~- _ -r C,7 -: i COMMONWEALTH Of PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT TEWELL BRENDA C 326 CANDLELIGHT DRIVE MECHANICSBURG, PA 17055 fold ESTATE INFORMATION: sSN: FILE NUMBER: 2108-0255 DECEDENT NAME: GAWRONSKI WINNONA WELS DATE OF PAYMENT: rim `~~ / 7f1C1S2 (~'~(Q l a$~l POSTMARK DATE: 06/25/2008 couNTY: CUMBERLAND DATE OF DEATH: 03/04/2008 ACN ASSESSMENT CONTROL NUMBER AMOUNT 08125170 ~ $25.15 TOTAL AMOUNT PAID: REMARKS: BRENDA TEWELL CHECK# 2956 SEAL INITIALS: AKK $25.15 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REV-1162 EX(11-96) N0. CD 009943 REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1543 EX AFp (09-00) BRENDA C TEWELL 326 CANDLELIGHT DR MECHANICSBURG PA 17055 INFORMATION NOTICE FILE N0. 21 08-0255 TAXPAYERNRESPONSE AcN 08125170 DATE 06-04-2008 TYPE OF ACCOUNT EST. OF WINNONA P GAWRONSKI S.S. N0. ® SAVINGS DATE OF DEATH 03-04-2008 ^ CHECKING COUNTY ^ rRUSr CUMIBERLAND ^ CERTIF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PSECU calculating the potential tax due. Their recordsvindicate that ratethewdeathhofltherabovendecedenttielow which has been used in this account. If you feel this information i s incorrect, please obtain written to this form and return it to the above address. This account is tax of Pennsylvani bl correction from the financial institutio t a 1 w r n n, a a tach a copy e in accordance with the Inheritance a. Questions may be answered by calling (717) 787-8327. Tax Laws of the Commonwealth COMPLETE PART 1 BELOW ~ * * SEE REVERSE SIDE FOR FILING AND PAYMENT Account No. 0192149726-57 Date INSTRUCTIONS 08-04-1996 Established Account Balanc To insure proper credit to your account, two t2) copies of this notice e 1 , 117.76 Percent Taxabl must accompany your payment to the Register of Wills. Make check e X 50.000 payable to: "Register of Wills, Agent". Amount Subject to Tax 5 5 8.8 $ Tax Rate X NOTE: If tax payments are made within three (3) months of the d ' Potential TaX Due • 045 ecedent s date of death, you may deduct a 5% discount of the tax due 25.1 5 PART . Any inheritance tax due will become delinquent nine (9) months aft er the date of death. 1 :;~ . ::::::.:::::::: TAXPAYER RESPONSE __ .................:.:::::::::. A• The above information and tax due i :.::::::::::::::::::~::~~::::~~iiF€5:'":':'?.e'S:"!€~ ~~:~;=~sSi;r~;~;pi€€ ~ ~ .~~ ~ ~ ~~~~~ ~~~~~~ aiAiFdi€E< `<'i ~i ~ ~ ~~~~~'~~~ CHECK s correct. 1. You may choose to remit payment to the Register of a discount o Wills with tw 0 N E r avoid interest, or you may check box Wills and an offici l o copies of this notice "A" and return thi to obtain C BLOCK a assessment will be issued by s notice to the Re the PA Department of R gister of B. ^ Th b evenue. 0 N L Y e a ove asset has been or will be reported and tax paid with the Penns to be filed by the dec l d ' e ent s representative. y vania Inheritance Tax return 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: ~-'~ ~--~""`°"°"`°"'""~ '_F[P[:EF[FittE;[;;:;F[:i:[FEiS~ i:s!sCCl~!3e!tr.[~i~;a:; ........ 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 PART 0 DATE PAID PAYEE OF TAX ON JOINT/TRUST ACCOUNTS 2 3_~ 4 5 6 7 X 8 DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION `~' ==-°a ~.. ~, } AMBUNT PAID t TOTAL CEnter on Line 5 of Tax Computation) Under penalties of $ perjury, I declare that the facts I have reported above are true, correct and co to to the best o~¢Y-knowledge and belief. ~ ~ ~•' HOME C'7i ~7 ) '~'~o l _ _ v~ 3 ~/ TA AYER SIGNATURE WORK (7/~ ) ~ ~~y~ TELEPHONE NUMBER DATE GENERAL INFORMATION I. 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 REY-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 tiled 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 C1) 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 C**3 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 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) 4. The amount subject to tax Cline 4) is determined by multiplying the account balance Cline 2) by the percent taxable Cline 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 Cline 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 Collateral 07/01/94 to 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 O% 6% 15% 15% 07/01/00 to present 0% 4.5%~ 12% 15% *fhe tax rate imposetl on the net value of transfers from a deceased child twenty-one years of age or younger at death to or far 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 ^epartment of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT TEWELL BRENDA C 326 CANDLELIGHT DRIVE MECHANICSBURG, PA 17055 fold ESTATE INFORMATION: sSN: FILE NUMBER: 2108-0255 DECEDENT NAME: NNONA WELS GAWRONSKI WI DATE OF PAYMENT: i E~fraL~Sf-2~68 (.Q IZ(9 ~©s~' POSTMARK DATE: 06/25/2008 couNTY: CUMBERLAND DATE OF DEATH: 03/04/2008 ACN ASSESSMENT CONTROL NUMBER AMOUNT 08125169 ~ $223.55 TOTAL AMOUNT PAID: REMARKS: BRENDA TEWELL CHECK# 2957 SEAL INITIALS: AKK $223.55 RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REV-1162EX(11-96) NO. CD 009944 REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE I N F O R M AT I O N N O T'I C E BUREAU OF INDIVIDUAL TAXES A N D DEPT. 260681 TAXPAYER RESPONSE HARRISBURG, PA 17128-0601 REV-15G3 EX 0.FP tog-o0) FILE N0. 21 08-0255 ACN 08125169 DATE 06-04-2008 BRENDA C TEWELL 326 CANDLELIGHT DR MECHANICSBURG PA 17D55 TYPE OF ACCOUNT EST. OF WINNONA P GAWRONSKI ® SAVINGS S.S. N0. ~ CHECKING DATE OF DEATH 03-04-20D8 ~ TRUST COUNTY CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PSECU has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a ,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. Questions may be answered by calling 0717) 787-8327. COMPLETE PART I BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0192149726-S1 Date 08-04-1996 To insure groper credit to your account, two Established <2) copies of this notice must accompany your payment to the Register of Wills. Make check Account Balance 9 ~ 935.76 payable to: "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax 4 ~ 967.88 C3) months of the decedent's date of death, Tax Rate X .045 you may deduct a 5% discount of the tax due. Anv inheritance tax due will become delinquent Potential Tax Due 223.55 nine C9) months after the date of death. PART TAXPAYER RESPONSE ~~ ;: :.: ~:.:;:~ ,:..:~ .... F.F~:O.~AL.....~" J~~E~~1;E~4"C;:s~h~:~~#;>..'E'~1I3 . ;~T~:~~:i` :;a~ ~:,,: ; ~ ~~>:.: !<;: It1±ID.....1~~IrL.,...~E~.D~.°t°:..LN:::.:.~ .................._...... 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 H. ~ 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 a 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 b. Amount Taxable 7. Tax Rate 8. Tax Due PART a DEBTS AND DEDUCTIONS CLAIMED TOTAL (Enter on Line 5 of Tax Computation) ~ Under penalties of perjury, I declare that the facts I have reported above /are true, correct and comp a to the best f my knowledge and belief. HOME C'~/`~ ) ~`L' ~.1 WORK C !' ) ~;;-~~~~ c?. ~ ~ Tn VFR ST(~NATI F TELEPHONE NUMBER "~ OF TAX ON JOINT/TRUST ACCOUNTS 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 apvlicable 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 REY-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 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 Z - 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 C1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed S3,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk C~~) avpears before your first name in the address portion of this notice, the S3,000 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: I DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE JOINT IXVNERS 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) 8. 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 Cs) (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 versons and established within one near of death by 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 Cline 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 {line 4). 7. 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 aarent 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 B 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 1 7 1 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT TEWELL BRENDA C 326 CANDLELIGHT DRIVE MECHANICSBURG, PA 17055 - fold ESTATE INFORMATION: SSN: FILE NUMBER: 2108-0255 DECEDENT NAME: GAWRONSKI WINNON A WELS DATE OF PAYMENT: / ~-~f ~~ l ~~^4 (p (Z (o~O~ !Ri'~ POSTMARK DATE: 06/25/2008 couNTY: CUMBERLAND DATE OF DEATH: 03/04/2008 REV-1162 EX(11-96) NO. CD 009945 ACN ASSESSMENT AMOUNT CONTROL NUMBER 08125168 ( 510.10 TOTAL AMOUNT PAID: REMARKS: BRENDA TEWELL CHECK# 2955 SEAL INITIALS: AKK RECEIVED BY: 510.10 GLENDA FARNE:R STRASBAUGH REGISTER OF V11~ILLS REGISTER OF WILLS COMMUNWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE I N F O R MAT I O N N O ~~ I C E FILE NU BUREAU OF INDIVIDUAL TAXES AND . 21 08-0255 DEPT. 280601 HARRISBURG, PA 17126-0601 TAXPAYER R E S P OIN S E ACN 081 25168 REV-1545 EX AFP (04-44) DATE 06- 04-2008 TYPE OF ACCOUNT EST. OF WINNONA P GAWRONSKI ^ SAVINGS S.S. N0. ® CHECKING DATE OF DEATH 03-04-2008 ^ TRUST COUNTY CUMBERLAND ^ CERTIF. REMIT PAYMENT AND FORMS T0: BRENDA C TEWELL REG]tSTER OF WILLS 326 CANDLELIGHT DR CUMBERLAND CO COURT HOUSE MECHANICSBURG PA 17055 CARLISLE, PA 17013 PSECU 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 ownerlbeneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by calling C717) 767-8327. COMPLETE PART 1 BELOW ~ * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0142149726-CK Date 08-04-1986 To insure proper credit to your account, two Established C2) copies of this notice must accompany your 4 4 8 . 7 1 payment to the Register of Wills. Make check Account Balance payable to: "Register of Wills, Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax 224.36 C3) months of the decedent`s date of death> TeX Rate X .045 you may deduct a 5i discount of the tax due. Any inheritance tax due will become delinquent Potential TdX DUe 10 • 10 nine (9) months after the date of death. PART TAXPAYER RESPONSE :.:: :. _`::°~.::. ~..T~::;;~!#Il~1~i;:;:II.;~::::1~:E:~tILT.. ~i_..,AN ~.~1FE ~~I~kt'C'AX.:A~~~~~:~N'~''=BAS ~ _ .: ; 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 C 0 N E ~ Wills and an official assessment will be issued by the PA Department of Revenue. B L 0 C K H. ^ 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 a 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. Tax Due PART OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 DEBTS AND DEDUCTIONS CLAIMED iuiA~ Linter on Line 5 of Tax Computation) S Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to/the best o~ kno/wledge and belief. HOME C ~fs""'7 ) ~~~`cr~U~ ~/ S/ c~ itE~~fi ~ ~--~-G~~/ WORK C -7i °7 ) 7a' ~"-- ~ ) `~ - J ^ , '~ C~ 4~ TAXPAYER SIGNATURE TFI FPN()NF NIIMRFR DATE PAID PAYEE DESCRIPTION AMOUNT PAID GENERAL INFORMATION L, 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 REY-1548 EX) upon receipt of the return from the Register of Wills. Z. 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 comvlete 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 REY-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 ono (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 C*^) 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 = 16.75; (TAXABLE FOR EACH SURVIVOR) 8. 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 versons and established within one near of death by 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 Cline 33. 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 (line 4). 7. Enter the appropriate tax rate (line 7) as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/44 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 paver B 1/2" x 11". Proof of payment may be requested by the PA Department of Revenue. TA~4~AY~R ASS I STA~t~~ I ~ Yf~I# ~tE~li P~fT7'H~R . I N~tJftMA'C I:tiN .031' ASS I ~T At1~E~ C~f?}TAI«`C' : AtdY f+t£4~` I {s' T~#Z OF W It, 3.~ r PA .~J~3'A1~~M~NT :D~ iZ~:VEN~3~. IkI~TIZ,I~T t?~FIC~ ~3R GA~..i. ~~E BU3~~Ait Q~ INI1I;~fZDi1A~ TAXES. `f~4XPA~ER INt}~#IRY::t3NI~" TN HA:#?RTS~1132G A'F I71;~1 787-837. ~~#2VIC 3;03 ~AXAAY~~tS YJITH S3"EGdAL ~t~Ai~ING:;ANR :~P~AKI~VG 3V~~~J~t ..:I-SE3R~+~7~34~Q ..LTT 4.Ni.Y3a