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COHHONNEALTH OF PENNSYLVANZA
DEPARTNENT OF REVENUE
BUREAU OF ZNDZVZDUAL TAXES
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
REV-15d5 EX AFP (09-60)
ZNFORHATZON NOTZCE
AND
TAXPAYER RESPONSE
FZLE NO. Z1"¢~
ACN 01150879
DATE 11-08-2001
CAROL L REATH
q5 HILLEN LN
CHAMBERSBURG
Recorded. Office o~
Register of Wills EST. OF ANNA M 60ODYEAR
S.S. NO. 20q-01-8805
DATE OF DEATH 08-17-2001
'02 JAN 16 ~1:4qOOHTY CUMBERLAND
Clerk .~,; ............. L, ourt
PA 17z0~tlrnberland Co,, PA
TYPE OF ACCOUNT
E~SAVINGS
~]CHECKINO
[]TRUST
[~CERTIF.
REHIT,PAYHENT AND FORHS TO:
REGISTER OF NILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
ORRSTONN BANK has p~ovided the IJepartaent with the information listed belo~ wl~-ch Cas been used-in
calculating the potential tax due. Their records indicate that at the death of t,.he above decedent) you were a joint owner/beneficiary of
this account. Tf you feel this information is incorrect, please obtain ~ritten correction from the financial institution, attach a copy
to this fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
COMPLETE PART 1 BELON ~ ~( ~( SEE, REVERSE STDE FOR FTLZNG AND 'PAYMENT TNSTRUCTTONS
Accoun~ No. 520381 Da~e 01-09-198q
Established
Accoun~ Balance 1,ZOZ.8q
Percen~ Taxable X 50.000
Amoun~ Subjec~ ~o Tax 601.q2
Tax Re~e X .15
"Po~en~ial Tax Due .9§.Z1
To insure proper credit to your account, t,o
(Z) copies of this notice must accompany your
payment to the Register of Nills. Hake check
payable to: "Register of Nills~ Agent".
NOTE: If tax payments are made aithin three
(3) months of the decedent's date of death,
you may deduct a SX discount of the tax due.
Any inheritance tax due will become delinquent
nine*'(9) months after the date of dehth.
PART TAXPAYER RESPONSE .
BLOCK
ONLY
A. ~ The above information and tax due is correct.
L_J
1. You may choose to rem'it .'payment to the Register of Hills with tan copies of this notice to obtain
a discount or avoid interest, ar you may check box ."A" end-.return this notice to the Regzster of
I~ills and an official assessment will be issued by the PA Department of Revenue.
B. ~ The above asset has been or ~ill be reported and tax paid with the Pennsylvania Tnheritanca Tax return
to be filed by the decedent's representative.
C. ~ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART JZI and/or PART I$1 beloa.
PART If you indica*e e differen* *ex,re*e, ,p~aasa s~a~e your
~. Accoun* Balance
3. Percen~ Taxable 3
~. Amount Subje¢~
$. Oeb~s and Deductions 5 - ~ 3.~
6. Amoun~ Taxable 6 ~1~,~
7. Tax Ra~e 7 X
8. Tax Due 8 /f,~
PART DEBTS AND' DEDUCTZONS"CLAZMED .....
DATE PATe ..... ' '' AMOUNT PAID
- TOTAL (Enter on Line S of Tax Compu*e*ion)
Under penalties of perjury, T declare ~ha~ ~he fec~s T have reported above are ~rue, correc~ and
comple~e~o ~he bes~__/~°f my knowledge and belief. HOME C"-/)"7 ) ~..~,,.~-' ~-~..~/'
TAXPAYER S[~NATURE /~_~_ /~ TELEPHONE NUHSER DATE
'*: " 6ENERAL INFORMATION
1. FAILURE TO R~SPOND #ICL RESULT iN AN OFFICIAL TAX AS$[sSHENT, with applicable interest based on 'information
submitted by the financial institution. ., ·
2. Inheritance tax becomes delinquent nine months after~tha decedent's date of death.
5. A joint account is taxable even though the dacedent's name was added as a matter of convenience.
4. Accounts (including those held between husband and wife) which the decedent put ]n joint names within one year prior to
· death '~e fully taxable as transfers. ''
S. Ace~un~ established jointly '~at~e~a~ husband and alfa more than one year prior 'to death are not taxable.
6. AEcdunt~ held by a decedent "in trust for" another or others~,are taxable fu]ly.
BLOCK A - If the information and ~o~putat]o~,in tho not]ce are correct and deductions a~a not being c[~]eed~' place an "X"' ",'
]n black "A" of Part l.of tho "Taxpayer Response" section. Sign two copies and submit t~em u]th your check for the amount of?
tax to the Register'of N]lls of the ~ounty indicated. The PA Department of Revenue ~]½~issue an official assessment
(Form REV-iS48 EX) upon receipt of the return from tho Register of NiXls.
Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax pa]d with the Pennsy]van]a inheritance
Tax Return filed by the dacedent's represontative~ place an "X" in block "B" of Part ! of the "Taxpayer Response" section. Sign one
copy and return to the PA Department of Revenue, Bureau of [ndiv]dua! Taxas~ Dapt Z&060!, Harrisburg, PA ITlZe-060! in the
envelope provided.
$. BLOCK C - If the notica'Jnformat]on is incorrect and/or deductions are be]ng' claimed, check block."C" and complete Parts Z and
according to the instructions balo~. Sign t~o copies and subeit them w]th your 'check for the amount of tax payab!e to the Register
of Nills ~f the county indicated.' ~he PA Department of Revenue ~ill issue an official assessment (Form REV-1548 EX) upon receipt
· of the return from the Register of ~ills. ,, :~ ...... _,. '
TAX RETURN -'PART. Z - TAX.COMPUTATION
LINE "
l. Enter the date the account orig]naI!Y was astab]]shed or titled ]n the manner ex!sting at date of death.
NOTE: For a decedent dying after IZ/!Z/BZ: Accounts ~h]ch the decedent put in joint names within one (!) year of death ara
taxable fully as transfers. Ho~aver,~th'are is'an exclusion not to exceed $5,0~g per transferee regardless of the value of
the account or the numbe~ of accounts' held.
Zfa double asterisk (N~) appears before your first name in the address portion of this not]ce, the $5,000 exc!us]on
already has been deducted from the account balance as-reported by the financ]a! inst]tutJofl.
Z. Enter tho tote! balance of ,the account including interest accrued to the date of death.
5. The percent of,the account.,that ]s taxable for each survivor ]s determined as fei!ems:
A.. The percent taxabIa..for:jo]nt, assats established more than one year prior to the decedent's death:
' 1:. DIVIDED BY TOTAL NUNBER 'OF ' DIVIDED BY *' ~OTAL NUHBER'OF' ~i X. ZO0* '="'PERCENT TAXABLE
.... : ,JOIN%,ONNERS. 'SURVIVING JOINT'OHNERS
':" Example: A joint a~se~'registered ]n the nameofthe-decedent and'two Other persons: ,-.. ::<'i' *':.-,*,., ;... ~.:-
'..*;'~,*DiVZDE6 By ] [u~NT:-~NNERS)DIVIDED BY'*Z'(suRvIVORS~ ~ .i~7' X 100 = 16.7Z (TAXABLE FOR EACH SURVZVOR)
B.The percent thimble:for asse~s created N]th]~ Onayaar o'f the d~cadent'~ death or accounts owned bY thC'decedent but held
in trust-for'anather']~d]vJdual(s) ('trust beneficiaries): .
! DIVIDED BY TOTAL'NURBER OF SURVIVING JOINT X !~o = PERCENT TAXABLE
·ONNERS aR .TRUST BENEFICIARIES . .. : - .,;,
Example: Joint account registered in the name of the dec'eden~ and t~o other ~ersons and established aithin cna year of death by
the decedent.
! DIVIDED BY Z (SURVIVORS) = .50 X !00 = 50X.(TAXABLE FOR EACH SURV[VDR)
The amount subject to tax (line 43 ]s determined by multiplying the account balance (line Z) by the percent taxab]e (line ~).
5.Enter the total of the debts and deductions listed ]n Part 5.~
6.The amount taxable (line 6,) [s~cleterm]ned by subtracting the debts and d~ductjons(llne 5) from the amount subject to tax (line
7.Enter the appropriata"tax'rate (l'lne 7) as daterainad-baloa.*-- -----'-<a - - -- *- -'
::.__.Da~a,..of~Dea~h_~_ .... __LSpousB ..... I__ ~Aneal--?_ S/bling Ce!la'era!.
07/01/9q ~o 12/31/9q
01/01/95 ~o 06/30/00 , OX 6X 15Z 15X
07/01/00 to proson~ 0Z
' aTha tax rate imposed on the net value of iran;fa; younger at
death to or for the usa of a'natural parent, *an adoptive parent, or a stepparent of the child ]s OZ.
The lineal class of heirs includes grandparents, parents, childl~an, and lin'emi descendents. "Children" includes natural' children
~hather or not they have been adopted by others, adopted children and step children. "L]naal 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 ~ho have at least one' parent ]n common ~]th the decedent, whether by blood.
or adopt]on. The "Col!ateral" class of heirs includes all other beneficiaries.
CLAIMED DEDUCTIONS' ~- PART "$ '- 'DEBTS-AND DEDUCTIONS 'CLAIMED
Allo.abl~' 'deets and dbductions are determined as follow~ ' ' .......
A. · You' legally ar~ ~e~onsible for payment, 'o~ ~he ~St~te. Sg~ject tO administration by a ~ers°nal representative is JnsuffJcien~
to pay'the deductibZe, items. ', /~ * ~- :
~. 'Yo~ 'actUallY* paid the debts after death:of the decedent and ~an, ~rnJsh p~oo~, p~ payment'.. .*. ~* ' ....
C.. Debts.being claimed must be jtemized,~ully Jn .~art 5. [~ additional space,is needed~ use plain paper 8 l/Z" x 11'';' P~oo~ o~
. payment may be requested by ~e PA Depar~ent of Reven~e.,~ , · ~ , . ., , , .
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
REV-1162 EX(11-96)
CD 000761
REATH CAROL L
45 HILLEN LANE
CHAMBERSBURG, PA
17201
........ fold
ESTATE INFORMATION: SSN: 204-01-8805
FILE NUMBER: 21-2002- 0054
DECEDENT NAME: GOODYEAR ANNA M
01 / 16/200.2
DATE OF PAYMENT:
POSTMARK DATE: 01/1 0/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 08/1 7/2001
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
01150879 $18.79
TOTAL AMOUNT PAID'
$18.79
REMARKS: CAROL LREATH
SEAL
CHECK#4556
INITIALS: AC
RECEIVED BY'
MARY C. LEWIS
REGISTER OE WILLS
REGISTER OF WILLS
I- Jo
BUREAU OF TNDIVIDUAL TAXES
INHERTTANCE TAX DXVXSTON
DEPT. 280601
HARRTSBURG, PA 17128-0601
CONHONHEALTH ,OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISENENT. ALLONANCE OR DISALLONANCE
OF DEDUCTION~, AND ASSESSHENT OF TAX ON
· JOINTLY HELD OR TRUST ASSETS
'02 Ii&Y 24 :55
CAROL L REATH
45 HILLEN LN
CHAMBER SBURC~,~:~8(k-- ~"A' %I 7 201 ':i'
.......... , RA
REV-15q8 EX &FP (01-02)
'BATE 05-Z7-ZOOZ
ESTATE OF GOODYEAR ANNA
BATE OF BEATH 08-17-2001
FILE NUNBER 21 02-0054
COUNTY CUHBERLAND
SSN/DC 204-01-8805
ACN 01150879
HAKE CHECK PAYABLE AND RENIT PAYHENT TO:
REGISTER OF HILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORBS ""~
REV-1548 EX AFP (01-02)
NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOHANCE OR BISALLOHANCE OF
BEBUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELB OR TRUST ASSETS
· BATE 05-27-2002 ,
ESTATE OF GOODYEAR ANNA H DATE OF DEATH 08-17-2001 COUNTY CUHBERLAND
FILE NO. 21 0Z-0054 S.S/D.C. NO. Z04-01-8805 ACN 01150879
TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORNATION
FINANCIAL INSTITUTION: ORRSTOWN BANK ACCOUNT NO. 520581
TYPE OF ACCOUNT: ( ) SAVINGS (~ CHECKING ( ) TRUST ( ) TIHE CERTIFICATE
DATE ESTABLISHED 01-09-1984
Account Balance 1,202.84
Percent Taxable X 0.500
Amount Subject to Tax 601.42
Debts and Deduct/ons - 185.89
Taxable Amount 417.55
Tax Rate X .45
Tax Due 18.79
NOTE:
To INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBHIT THE
UPPER PORTION OF THIS NOTICE
HITH YOUR TAX PAYHENT TO THE
REGISTER OF NILLS AT THE
ABOVE ADDRESS. HAKE CHECK
*OR HONEY ORBER PAYABLE TO:
**REGISTER OF HILLS, AGENT.,
TAX CRED'rTS: .
PAYHENT RECEIPT DISCOUNT (+)
DATE NUHBER INTEREST/PEN PAID (-) ANOUNT PAID
01-10-2002 CD000761 .00 18.79
TOTAL TAX CREBIT
BALANCE OF TAX BUE
INTEREST AND PEN.
TOTAL BUE
18.79
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR ZNSTRUCTZONS. )
.00
.00
.00
PURPOSE OF
NOTICE:
PAYNENT:
REFUND (CR):
OBJECTIONS:
ADNIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:'
INTEREST:
To ~ulfi11 the requirements of Section 21~0 of the Inheritance and Estate Tax Act, Act Z~ of ZOO0. (71 P.S.
Section 91q0).
Detach the top portlon of ~his Notice and submit mith your p~yment to the Register of gills printed on the
reverse side.
-- Hake check or money order payable to: REGISTER OF gILLS, AGENT. -.
A refund of a tax credit, ahich mas not requested on .the tax.return, may be requested by.completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315).~ Applications ara available at the Office Of
the Register of Nills, any of the Z$ Revenue District Offices or by calling the s~ecial Iq-hour ansmering service
for forms ordering: 1-800-561-Z050; services ~or taxpayers eith SpeciaZ hearing and or speaking needs:
1-800-~7=5010 (TT only).
Any party in interest not satisfied mith the appraisement, allowance, or disallowance cf deductions or assessment
of tax (including discount or interest) as shamn on this Notice may object aithin sixty (60) days of receipt of
this Notice by:' .'
--aritten protest to the PA Department of Revenue, Board of Appeals, Dept. ZalOZI, Harrisburg, PA 171za-IOZ1; OR
--electing to have the matter determined at the ~udit of ~he account of the personal representative,. OR
--appeal to the Orphans' Court. . .
Factual errors discovered an bis assessment should be addressed in eriting to: PA Department of Revenue,'
Bureau of Individual Taxes, ATTN: Post Assessment Reviem Unit, DEPT. 180601, Harrisburg, PA 17118-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for InheEitanca~Tax Return for a Resident ..
Decedent" (REVelS01) for an explanation of administratively correctable errors.
If any tax due is paid aithin three (5) calendar months after the decedent's death, a five percent (51)
discount of the tax paid is a11oeed.
The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period' as you mould appe~l the tax and interest
that has been assessed as indicated on this notice. . -
Interest is charged beginning mith first day of delinquency, or nine (9) months and one (1) day
from the date o'f death, to the date cf payment. Taxes Which became delinquent before January 1, 1981
bear interest .at the rate of six (61) percent per annum calculated at a daily rate of .00016~.
All. taxes ehich became delinquent on or after January 1, 1982 aill bear interest et a rate ahich esl1 vary from
calendar year to calendar year eith that rate announced by the PA Department of Revenue. The applicable
interest rates for 1981 through 2002 are:
Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Facto~
1981 ZOZ'
1985. 161
198q
1985 151
1986 101
1987 91
1988-1991 .111
'--Intara~t
.0005q8 1992 92
.000q58 1995-199fi 71
.000301 1995-1998 92
.000556 1999 ' 71
.00o27~ 2000 aZ
.O00Zq7 2001 9Z
.000501 - ZOOZ 61
is calculated as folloes:
INTEREST = BALANCE OF TAX UNPAID
.OOOZ~7
.000192
.000119
.0002~7
-- .00016~'
' X .NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
-CAny Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days
beyond the date of the assessment.. If payment is made after the interest computation date shown on the
Notice, additional interest must be caXculated.