HomeMy WebLinkAbout04-0354COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 003803
HEBERLIG MARTHA A
104 MEETING HOUSE RD
CARLISLE, PA 17013
........ fold
ESTATE INFORMATION: SSN: 189-18-6188
FILE NUMBER: 2104-0354
DECEDENT NAME: BROWN MARTHA A
DATE OF PAYMENT: 04/13/2004
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 11 / 10/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
04113154 $17.16
REMARKS:
...... SEAL
CHECK# 9637
TOTAL AMOUNT PAID'
$17.16
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
HEBERLIG MARTHA A
104 MEETING HOUSE RD
CARLISLE, PA 17013
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 003814
........ fold
ESTATE INFORMATION: SSN: 189-18-6188
FILE NUMBER: 2104-0354
DECEDENT NAME: BROWN MARTHA A
DATE OF PAYMENT: 04/13/2004
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 11 / 10/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
04113153 $17.16
REMARKS:
TOTAL AMOUNT PAID'
$17.16
SEAL
CHECK# 3237
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COHHONNEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 28O601
HARRISBURG, PA 17128-0601
REV-I,qS EX AFP (09-00)
MARTHA A HEBERLIG
lOq MEETING HOUSE RD
CARLISLE PA
~2:24
ZNFORHATZON NOTICE
AND
TAXPAYER RESPONSE
I FILE NO. 21 O~- '~
ACN 0q11515~
DATE Oq-O2-200q
TYPE OF ACCOUNT
EST. OF MARTHA A BROHN [] SAVINGS
S.S. NO. 189-18-6189 [] CHECKING
DATE OF DEATH 11-10-200:3 [] TRUST
COUNTY CUMBERLAND [] CERTIF.
REHIT PAYHENT AND FORHS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
NAYPOINT BANK has provided the Department Hith the Information listed belch Hhich has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you Here a joint oHner/benaficiary of
this account. If ycu feel this inforiation is incorrect, please obtain Hrittan correction from the financial Institution, attach a copy
to this form end return it to tho above address. This account is taxable in accordance Hith the Inheritance Tax Laws of the CommonHealth
of Pennsylvania. Questions may be answered by calling (717) 787-8327.
COMPLETE FART ! BELOW x # # SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONs
Account No. 1700017255 Data 06-02-199~
Established
Account Balance 2,287.98
Percent Taxable X 16.667
Amount SubSect to Tax 581.:3q
Tax Rata X .15
Potent/al Tax Duo 57.Z0
To insure proper credit to your account, tho
(2) copies of this notice must accompany your
payment to tho Register of Hills. Hake check
payable to: "Register of Hills, Agent".
NOTE: If tax payments arm made HithJn three
(S) months of the decedant's date of death,
you may deduct a 5Z discount of the tax due.
Any inheritance tax due Hill become delinquent
nine (9) months after the date oF death.
PART
TAX
LINE
PART TAXPAYER RESPONSE
A. D The above information and tax due is correct.
l. You may choose to remit payment to the Reglster of Hills Hith tho copies of this notice to obtain
CHECK -~ a discount or avoid interest, ar you may check box "A' and return this notice to the Register Of
ONE Hills and an official assessment Hill be issued by the PA Department of Revenue.
BLOCK J B. [] The above asset has been or HIll be reported end tax paid Hith the Pennsylvania Inheritance Tax return
ONLY to be filed by the dacadent's representative.
C. []The above information Is incorrect and/or debts and deductions Hers paid by you.
You oust colplete PART [] and/or PART [] belcH.
relationship to decedent: ~U.~C~Z'
RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
PART
DATE PAID
1. Data Established I - 06~02=199~r ~-
¢. Amou.~ Subjec~ ~o Tax q }~1. ~[~
S. Debts and Deductions S O, O0
8. Tax Due 8 ~?.~(~
DEBTS AND DEDUCTIONS CLAZHEa
PAYEE
DESCRIPTION AMOUNT PAID
TOTAL (Enter on L/ne 5 of Tax Computation) $
Under poneltlos of perjury, ! declare that tho facts ! have reported above ara true, cprrect and
WORK ( )
TAXPAVER SI6NATURE TELEPHONE NUMBER DATE
GENERAL INFORMATION
1, FAXLURE TO RESPOND WILL RESULT ~N AN OFFICIAL TAX ASSESSNENT with applicable in[crest based on information
submitted by the financial institution.
Z. Inheritance tax becomes delinquent nine months after the docadent's date cf death.
3. A Joint account is taxable oven though tho docadant's name was added as a matter of convert[anco.
4. Accounts (including those held between husband and alfa) ahich the decedent put in joint names aithin one year prior to
death are fully taxable as transfers.
S. 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 I - TAXPAYER RESPONSE
1. BLOCK A - If the information end camputat[on in the notice are correct and deductions ara not being claimed, place an
in block "A" of Part I of tho "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. Tho PA Department of Revenue will issue an official assessment
(Form REV-ZSfi8 EX) upon receipt of tho return from the Register of Wills.
Z. BLOCK B - If tho asset specified cn this notice has been or will ba reported and tax paid with tho Pennsylvania Inheritance
Tax Return filed by the decedant's representative, place an "X" in block "B" of Part I of the "Taxpayer Response" sect[on. Sign one
copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept Z80601; 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 end 3
according to the instructions boloa. Sign two copies and suboit thee with your check for the amount of tax payabIa to the Register
of Wills of the county indicated. The PA Department of Revenue ail1 issue an officiaI assessment (Form REV-ISqB EX) upon receipt
of the return from tho Register of Wills.
TAX RETURN - PART Z - TAX COMPUTAT/ON
LINE
1. Enter the date the account originally was established or titled in the Donner existing at date of death.
NOTE: For a decedent dying after 12/12/8Z: Accounts which the decedent put tn Joint names within one (1) year of death are
taxable fully as transfers. However, there is an axctusion not to exceed $3,000 per transferee regardless of the vaIuo of
the account or tho number of accounts held.
If a doubIe asterisk (xN) appears before your first name in tho address portion of this notice, the $3,000 exclusion
aIready has been deducted from the account balance as reported by the financial institution.
Z. Enter the total balance of the account including interest accrued to the date of death.
3. Tho 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 decadent's death:
I DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE
JOINT OWNERS SURVIVING JOINT OWNERS
Example: A Joint asset ragJstared in the naaa of the decedent and two other persons.
I DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) ' .167 X 100 " 16.7Z (TAXABLE FOR EACH SURVIVOR)
B. The percent taxable for assets created within one year of the decadont's death or accounts oanod by the decedent but held
in trust for another individual(s) (trust beneficiaries):
I DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE
OWNERS OR TRUST BENEFICIARIES
Example: Joint account registered in tho name of the decedent and two other persons end established within one year of death by
tho decedent.
I DXVIDED BY Z (SURVIVORS) = .SO X log = SOX (TAXABLE FOR EACH SURVIVOR)
4. The amount subject to tax (line 4) is determined by multiplying tho 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 (line 6) is determined by subtracting tho debts and deductions (line 5) from the amount subject to tax (line
7. Enter tho appropriate tax rate (line 7) as determined below..
De~e of Death Spouse 'Lineal Sibling Collateral
07/01/9q* ~o 12/31/94 3X 6X lax
01/01/95 ~co 06/30/00 OX 6X 15X 1EX
07/01/00 ~o presen~ OX
~ .~- --~
younger at
~The tax rate imposed E
death to or for the usa of a natural parent, an adoptive parent, or a stepparent of the child is OX.
The lineal class Df heirs includes grandparents; parents, children, and lineal descendents. "Children" lncIudes natural children
whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes a11 children of the
natural parents end their descendents) whether or not they have been adopted by others, adopted descendents and their descendents
end step-descendants. "Siblings" ere defined as individuals who have at least one parent in common with the decedent, whether by blood
or adoption. The "ColIateraI" cIess of heirs incIudes eli other beneficiaries.
CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED
AllowabIe debts and deductions ere determined as follows:
A. You IagaIlY are responsibIe for payment, or the estate subject to adlinistration by a personal representative Is insufficient
to pay the deductible items.
B. You actuoIIy paid the debts after death of the decedent and can furnish proof of payment.
C. Debts being cIaimed must be itemized fuIIy in Part 3. If additional space ls needed; use ploin paper 8 l/Z" xll". Proof of
p&y;ant may be requested by the PA Department of Revenue.
COHMONgEALTH OF PENNSYLVANIA
BEPARTHENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. Z&06Ol
HARRISBURG, PA 1712&-0601
J ZNFORHATZON NOTTCE
AND
TAXPAYER RESPONSE
REV-ZEq5 EX AFP (09-DO)
FZLE NO. 21 ~q ~5~
ACH 0q113153
DATE Oq-Ol-2OOq
~.g '.~ST. OF MARTHA A BROWN
S.S. NO. 189-18-6189
DATE OF DEATH 11-10-2005
~P~ 13 PZ~Cr'(~l~T¥ CUMBERLAND
BETTY M WAGGONER
2100 ENOLA RD
CARLISLE PA 17015
TYPE OF ACCOUNT
[] SAVINGS
[] CHECKING
[] TRUST
[] CERTIF.
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
NAYPO/NT BANK has provided the Department aith the in~oraation listed baloN 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 oHner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financia! institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax LaHs of the Commonwealth
of Pennsylvania. guestJons ~ay ho answered by ce!]Jn~ (717) 787-8~77.
COMPLETE PART I BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT /NSTRUCTZONS
Account No. 1700017255 Date 06-02-199q
Es~:ablishad
Accoun~ Balance Z, 287.98
Percen~ Taxable X 16.667
Amoun'~ Sub~ec~ 'J:o Tax ~81 .~
Tax Ra~e X .15
Potential Tax Due 57. Z0
To insure proper credit to your account, two
(Z) copies of this notice must accompany your
payment to the Register of Mills. Make check
payable to: "Register of Nills, Agent".
NOTE: If tax payments ara made within three
(3) months of the decmdant's date of death,
you amy deduct a 5X discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
PART TAXPAYER RESPONSE
A. r-~ The above information and tax due is correct.
L--J
l. You may choose to remit payment to the Register of Mills with two cop[es of this notice to obtain
a discount or avoid intsrast, or you may check box "A" and return this notice to the Register of
CHECK -~ Mills and an official assessment will ba issued by the PA Department of Revenue.
ONE
BLOCK a. [] The above asset has been or will be reported and tax paid Pith the Pennsylvania Inheritance Tax return
ONLY to be filed by the decedent's representative.
C. ~ The above information is incorrect and/or debts and deductions Hera paid by you.
You must complete PART ~ and/or PART--]~1 belcH.
PART
TAX
L/NE
you /nd/ca~e a d/fferan~ ~ax re~e, please s~e~a your
rele~ionshlp ~o decedent:
RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
1. Da~e Established 1 ~'O~--/C~
2. Accou.~ Balance 2 ~.~?, q~ '
3. Percen* Taxable 3 X I ~G~
q. A.oun* Subjec* *o Tax q ~ ~ I. ~1
E. Debts and Deductions
6. Aeoun~ Taxable
7. Tax Ra~e
8. Tax Due
6
7 X
8
/ "2, i~
PART
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE DESCRIPTION AMOUNT PAID
TOTAL (Enter on Line S of Tax Compumat/on) $
Under penalties of perSury, / declare ~ha~ ~he fac~s I have reported above are ~rue, corrac~ and
coeple*e *o *ha be,* of my knowledge end belief. HOME c ?17
, ~/~, ~ 6~~ WORK (
TAXP~ER S~6NATUE~ TELEPHONE NUMBER DATE
BUREAU OF INDIVIDUAL TAXES
INHERTTANCE TAX DTVTSTON
DEPT. 280601
HARRISBURG) PA 17128-0601
MARTHA A HEBERLIG
lOq MEETING HOUSE RD
CARLISLE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF XNHERITANCE TAX
APPRAXSEHENT. ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOXNTL¥ HELD OR TRUST ASSETS
'04 lqAY -7 ? 3 :(:)3
PA Ii, It. IS
~ ,till]i:::
DATE 05-10-200q
ESTATE OF BROWN
DATE OF DEATH 11-10-2003
COUNTY CUMBERLAND
SSN/DC 189-18-6189
ACN Oq11315q
Amoun~ Remi~ed
MARTHA A
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE
RETAIN LOWER PORTION FOR YOUR RECORDS
REV-IS48 EX AFP [01-03)
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON dOINTLY HELD OR TRUST ASSETS
DATE 05-10-200q
ESTATE OF BROWN
MARTHA A DATE OF DEATH 11-10-2003 COUNTY CUMBERLAND
FILE NO. S.S/D.C. NO. 189-18-6189 ACN Oqll315q
TAX RETURN WAS: (X) ACCEPTED AS FILED ¢ ) CHANGED
dOZNT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: WAYPOINT BANK ACCOUNT NO.
1700017255
TYPE OF ACCOUNT: ( ) SAVINGS (~ CHECKING ( ) TRUST C ) TIME CERTIFICATE
DATE ESTABLISHED 06-02-199q
Account Balance 2,287.98
Percent Taxable X 0.166
Amount Subject to Tax 381.3q
Debts and Deductions - .00
Taxable Amount 381.3q
Tax Rate X .q5
Tax Due 17.16
NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
*'REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT
DATE
RECEIPT
NUMBER
DISCOUNT (+)
INTEREST/PEN PAID (-)
=AYMENT MUST BE MADE BY 08-11 ZOOq~.
AMOUNT PAID
IF PA/D AFTER THIS DATE) SEE REVERSE FOR CALCULAT/ON OF ADDITIONAL INTEREST.
XF TOTAL DUE 1S LESS THAN $1, NO PAYMENT XS REQUIRED.
XF TOTAL DUE XS REFLECTED AS A "CRED/T*' ( CR}, YOU MAY BE DUE A REFUND.
SEE REVERSE SXDE OF TH/S FORM FOR /NSTRUCTXONS.
.00
17.16
.00
17.16
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
PURPOSE OF
NOTICE:
To fulfill the requirements of Section ZI~O of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (7Z P.S.
Section 91~0).
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADMZN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
ZNTEREST:
Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the
reverse side.
-- Make check or money order payable to: REGISTER OF NILLS, AGENT.
A refund of a tax credit, which ams not requested on the tax return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS15). Applications are available at the Office of
the Register of Nills, any of the Z5 Revenue District Offices or by calling the special Iq-hour answering service
for forms ordering: 1-800-56Z-ZOSO; services for taxpayers aith special hearing and or speaking needs:
1-800-~qT-50ZO (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment
of tax (including discount or interest) as shoan on this Notice may object within sixty (60) days Of receipt of
this Notice by:
--aritten protest to the PA Department of Revenue, Board of Appeals, Dept. ZBIOZ1, Harrisburg, PA 171lB-lOll, OR
--electing to havathe matter determined at the audit oft he account of the personal representative, OR
--appeal to the Orphans' Court
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individua! Taxes, ATTN: Post Assessment Review Unit, DEPT. ZB06Ol, Harrisburg, PA 171Z8-0601
Phone (717) 787-6S05. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-la01) for an explanation of administratively correctable errors.
If any tax due is paid aithin three (3) calendar months after the decedent's death, a five percent
discount of the tax paid is alloaed.
The 15Z 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 would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, er nine (9) months and one (1) day
frae the data of death, to the date of payment. Taxes ehich became delinquent before January 1, 19BI
bear interest at the rate of six (6g) percent per annum calculated et a daily rate of .O0016q.
A11 taxes which became delinquent on or after January 1, 198Z will bear interest at a rate which mill vary from
calendar year to calendar year with that rate announced by the PA Department of Revenue.
The applicable
interest rates for 1982 through gOOq are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 ZOZ .0005~8 1988-1991 11Z .000501 ZOO1 9Z .O00gq7
1983 16Z .000~58 199Z 9Z .O00Zq7 ZOOZ 6Z .000219
1984 llZ .000301 1993-199q 7Z .OO019Z 2003 5Z .000157
1985 132 .000556 1995-1998 9Z .O00Z~7 ZOOq ~Z .000110
1986 lOX .O00Z7q 1999 7Z .00019Z
1987 9Z .O00Zq7 ZOO0 8Z .000Z19
--Interest is calculated as foXloas:
ZNTEREST= BALANCE OF TAX UNPAZD X NUffBER OF DAYS DELTNQUENT X DAZLY XNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (1S) days
beyond the date of the assessment. If payment is made after the interest computation date shown an the
Notice, additional interest must be catcutated.
BUREAU OF INDIVIDUAL TAXES
ZNH£RTTANCE TAX DZVTSZON
DEPT. Z80601
HARR/SBURG, PA 171Z&-0601
ELLEN HATELLO
19 CALEDONIA BLDG
HERSHEY
CONNONWEALTH OF PENNSYLVANIA
DEPARTNENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAZSEHENT, ALLONANCE OR DZSALLONANCE
OF DEDUCTIONS, AND ASSESSMENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
PA 17~035-2215
REV-15q8 EX AFP C01-03)
DATE 05-10-200q
ESTATE OF HARREN IRENE E
DATE OF DEATH 01-19-200q
FILE NUHBER ~/-~.~Z- c.~c.~-7
COUNTY CUNBERLAND
SSN/DC 196-1~-2196
ACN 0~1159~3
Amoun~ Remi~ed
HAKE CHECK PAYABLE AND RENIT PAYNENT TO:
REGISTER OF WILLS
CUHBERLAHD CO COURT HOUSE
CARLISLE, PA I70I$
CUT ALONG THIS LINE
REV-1548 EX AFP C01-03)
RETAIN LOWER PORTION FOR YOUR RECORDS
NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLONANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSNENT OF TAX ON dOZNTLY HELD OR TRUST ASSETS
DATE 05-10-200~
ESTATE OF HARREN
IRENE E DATE OF DEATH 01-19-200q COUNTY CUNBERLAND
FILE NO. S.S/D.C. NO. 196-1~-2196 ACN 0~1139~$
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
dOZNT OR TRUST ASSET INFORHATZON
FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. 51~0110669
TYPE OF ACCOUNT: ( ) SAVINGS ¢~ CHECKING ¢ ) TRUST ( ) TIHE CERTIFICATE
DATE ESTABLISHED 02-01-1970
Account Balance 1,Z58.q6
Percent Taxable X 0.500
Amount Sub,}ct to Tax 629.23
Debts and DeductAons - 650.00
Taxable Amount .00
Tax Rate X .15
Tax Due .00
NOTE:
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+)
DATE NUHBER INTEREST/PEN PAID (-) AHOUNT PAID
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBHIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYHENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
TF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.
.00
.00
.00
.00
BUREAU OF /NDTV/DUAL TAXES
TNHERTTANCE TAX D/VISTOH
DEPT. Z80601
HARRTSBURg, PA 17128-0601
MARTHA A HEBERLIG
lOq MEETING HOUSE RD
CARLISLE PA 17015
COMMONWEALTH OF PENNSYLVAN'rA
DEPARTHENT OF REVENUE
ZNHERZTANCE TAX
STATEMENT OF ACCOUNT
DATE 06-01-200q
ESTATE OF BROWN
DATE OF DEATH 11-10-2005
FILE NUHBER 21 0~-055q
COUNTY CUHBERLAND
ACN 0111515q
Amoun'l: Reei~ed
REV-*II~07 EX AFP
HARTHA A
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
NOTE: To insure proper credi~ ~:o your account:, submi~ ~:he upper portion of ~his form wi~h your ~ax payment.
CUT ALONG TH'rS LINE ~-* RETA'rN LOWER PORT'rON FOR YOUR RECORDS *~
REV-1607 EX AFP (01-03)
ESTATE OF BROWN
NNN INHERITANCE TAX STATEMENT OF ACCOUNT ~
MARTHA A FILE NO. Z10q-O$5q ACN Oqll$15q DATE 06-01-200q
THIS STATEMENT 1S PROV/DED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELO#
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 05-10-200q
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYMENTS (TAX CREDITS):
17.16
PAYMENT RECEIPT DISCOUNT ¢+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
Oq-l$-gooq CD005805 .00 17.16
IF PA/D AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE XS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE KS REFLECTED AS A **CREDIT**
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.
TOTAL TAX CREDIT 17.16
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
PAYMENT:
Detach the top portion of this Notice and submit with your payment made payable to the name and address
printed on the reverse side.
-- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF NILLS, AGENT.
-- If NON-RESIDENT DECEDENT make check or money order payable to: COMMONNEALTH OF PENNSYLVANIA.
REFUND (CR): A refund of a tax credit, ahich was not requested an the Tax Return, may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications are available at
the Office of the Register of Nills, any of the 15 Revenue District Offices or frae the Department's Zq-hour
answering service for fores ordering: 1-&OO-56Z-ZgSO; services for taxpayers with special hearing and / or
speaking needs: 1-BOO-qqT-5OZg (TT only).
REPLY TO:
Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau
of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 18060I, Harrisburg, PA 17lZB-0601, phone
(717) 787-6505.
DISCOUNT: If any tax due is paid within three (3) calendar months after the decadent's death, a five percent (51) discount
of the tax paid is allowed.
PENALTY:
The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 16, 1996, the first day after the and of the tax amnesty period.
INTEREST:
Interest is charged beginning with first day af delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, Z9BZ bear interest at the rate of
six (62) percent per annum calculated at a daily rate of .00016q. 211 taxes which became delinquent on and after
January l, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1981 through 200¢ are:
Interest Daily Interest Daily Interest
Year Rate Factor Year Rate Factor Year Rate
1982 ZOZ .OOOSq8 1988-1991 llZ .000301 ZOO1 92
1985 16Z .000~38 1992 92 .0002~7 ZOOZ 6Z
198~ 112 .000~01 199~-199~ 72 .000192 2003 52
1985 132 .000356 1995-1998 92 .0002q7 ZOO~ qZ
1986 lOZ .OOOZ7q 1999 71 .000192
1987 91 .0002~7 ZOO0 8Z .000219
Daily
Factor
.0002~7
.000164
.000137
.000110
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAXD X NUNBER OF DAYS DELXNQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. Xf payment is made after the interest computation data shown on the
Notice, additional interest must be calculated.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'*'
BUREAU OF INDl~lDO""TA)(t$:r:!!"';c:
INHERITANCE TAX iJrn$!DIj_A-
PO BOX 280601-._
HARRISBURG PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEKENTL ALLONANCE OR DISALLONANCE
OF DEDUCTION5, AND ASSESSKENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-15" EX AFP 112-D4)
29
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
03-01-2005
BROWN
11-10-2003
21 04-0354
CUMBERLAND
189-18-6189
04113153
Allount Rellitted
MARTHA
A
BETTYr': M WAGGOftER'-
2100 ENOLA RD
CARLISLE PA 17013
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
Rifv:is~8-EX--AFP--(Oi-:03i------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 03-01-2005
ESTATE OF BROWN
MARTHA
A DATE OF DEATH 11-10-2003
COUNTY
CUMBERLAND
FILE NO. 21 04-0354
TAX RETURN WAS:
S.S/D.C. NO. 189-18-6189
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
04113153
FINANCIAL INSTITUTION: WAYPOINT BANK
ACCOUNT NO.
1700017255
TYPE OF ACCOUNT: () SAVINGS (X) CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 06-02-1994
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
2,287.98
0.166
381.34
.00
381.34
.15
57.20
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
04-13-2004 CD003814 .00 17.16
INTEREST IS CHARGED THROUGH 03-09-2005 TOTAL TAX CREDIT 17.16
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 40.04
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 1. 00
TOTAL DUE 41.04
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ·
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'*
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
NOTICEOF'IHHERITANCE TAX
APPRAISEMENT. ALLOMANCE OR DISALLORANCE
OF DEOUCTION~, ANO' ASSESSMENT OF TAX ON
JOINTLY NELO OR TRUST ASSETS
REY-15~8 EX AFP Cl2-D4l
,,-
DATE
ESTATE OF
DATE OF DEATH
.FILE NUMBER
C.OUNTY
SSN/DC
ACN
03-01-2005
BROWN
11-10-2003
21 04-0354
CUMBERLAND
189-18-6189
04113153
Allount Rellitted
MARTHA
A
BETTY M WAGGONER
2100 ENOLA RD
CARLISLE PA 17013
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ___ RETAIN LOWER PORTION FOR YOUR RECORDS ___
RE-V=iS4-i-Ex--AFP--roi-:031------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 03-01-2005
ESTATE OF BROWN
MARTHA
A DATE OF DEATH 11-10-2003
COUNTY
CUMBERLAND
FILE NO. 21 04-0354
TAX RETURN WAS:
S.S/D.C. NO. 189-18-6189
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
04113153
FINANCIAL INSTITUTION: WAYPOINT BANK
ACCOUNT NO.
1700017255
TYPE OF ACCOUNT:
DATE ESTABLISHED
( ) SAVINGS (>0 CHECKING ( ) TRUST ( ) TIME CERTIFICATE
06-02-1994
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
X
2,287.98
0.166
381.34
.00
381.34
.15
57.20
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
X
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
04-13-2004 CD003814 .00 17 .16
INTEREST IS CHARGED THROUGH 03-09-2005 TOTAL TAX CREDIT 17 .16
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 40.04
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 1.00
TOTAL DUE 41. 04
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRI, YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I
PURPOSE DF
NOTICE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCQUNT:
PENAL TV:
INTEREST:
To fulfill the requirellents of Sectlon 2:140 of the Inheritance and Estate Tax Act, Act Z3 of 2000. (72 P.S.
Section 9140).
Detach the top portion
reverse side.
-- Make check or 1I0ney
of this Hotice and submit with your payment to the Register of Wills printed on the
order payable to:
REGISTER OF WILLS, AGENT.
A refund of a tax credit, which was not requested on the Tax Return, .ay be requested by cOllpleting an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available
online at www.revenue.state.oa.us. any Register of Wills or Revenue District Office, or frail the Depart.ant's
24~hour answering service fOr for.s orders: 1-800-362-2050; services for taxpayers with special hearing and/or
speaking needs: 1-800-447-3020 (TT only).
Any party in interest not satisfied with the appraisment, allowance or disallowance of deductions or assessment of tax
(inclUding discount or interest) as shown on this Hotice may object within 60 days of the date of receipt of this notice
by filIng one of the fallowing:
A) Protest to the PA Departllent of Revenue, Board of Appeals. You may Object by f1ling a protest online at
www.boardofappeals.state.pa.us on or befOre the expiration of the sixty-day appeal period. In order for
an electronic protest to be valid, you IIUSt receive a confjr.ation ~ber and processed date from the
Board of Appeals website. You Nay also send a written protest to PA Department of Revenue, Board of Appeals
P.O. Box 28102:1~ Harrisburg, PA 17128-1021. Petitions gay not be faxed.
B) Election to have the matter deterllined at the 8udit of the account of the personal representative.
C) Appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA Depart.ent of Revenue,
Bureau of Individual Taxes~ ATTN: Post Assessllent Review Unit, P.O, Box 2:80601, Harrisburg, PA 17128-0601
Phone (7171 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Residant
Decedent" (REV-ISO!) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5Z)
discount of the tax paid is allowed.
The 151. tax a.nesty non~participation penalty is co.puted on the total of the tax and interest aSSQssed, and not
paid before January 18, 1996, the first day after the end of the tax a.nesty periOd. This non-participation
penalty is appealable in the same manner and in the the sage ti~e period as you would appeal the tax und interest
that has been assessed 85 indIceted on this notice.
Interest is charged beginning with first day of delinquency, Dr nine (9) months and one (11 day
from the date of death, to the date of payment. Taxes which becage delinquent before January 1, 198Z
bear interest at the rate of six (6Z) percent per annu. calculated at a daily rate of .000164.
All taxes which beca.e delinquent on or after January 1, 1982 will bear interest at a rate which will vary
calendar year to calendar year with that rate announced by the PA Depart.ent of Revenue. The applicable
interest rates for 198Z through Z005 are:
Interest Daily
Rate Factor
zor- :ooD54i
16Z .000438
11Z .000301
13Z .000356
10~ .000274
9Z .000247
frolll
Year
i98Z
1983
1984
1985
1986
1987
Year
00-1991
1992
1993-1994
1995-1998
1999
2000
Interest
Rate
-rrr-
.X
7X
9Z
7Z
8Z
Dally
Factor
:ii'D03ill
.000247
. DOD192
.000247
.000192
.000219
Daily
Factor
. Qiiffi7
.000164
.000137
.000110
.000137
Year
ZOOi
2002
2003
2004
2:005
Interest
Rate
~
6Z
5X
4X
5X
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becoges delinquent will reflect an interest calculation to fifteen (IS) days
beyond the date of tha assessment. If pay.ent is made aftar the interest cOllputation date shown on the
NOtiCIB, additional interest gust be calculated.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG~ PA 17128-0601
*'
INFORMATION NOTICE
rAND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 04 35>1
04113153
04-02-2004
REV-1543EXAFPIG9-0Gl
ZC~ST. OF MARrHA' A' ;ROWN
S.S. NO. 189-18-6189
DATE OF DEATH. 11-10-2003
COUNTY CUMBERLAND
U
TYPE OF
ACCOUNT
o SAVINGS
IX] CHECKING
o TRUST
o CERTIF.
FORMS TO:
BETTY M WA660NER
2100 ENOLA RD
CARLISLE PA 17013
REMIT PAYMENT AND
RE6ISTER OF WILLS
CUMBERLAND CD COURT
CARLISLE, PA 17013
HOUSE
WAVPDINT BANK has provided the Departllent 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 institutjon~ 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 COllmonwealth
of Psr>nsylvania. QIl.stion~ .av be answerlild hy callinq (717) 781-8327.
COMPLETE PART 1 BELOW
Account No. 1700017255
I( I( I( SEE
Date
Established
REVERSE SIDE FOR
06-02-1994
FILING AND PAYMENT INSTRUCTIONS
A.ccount Balance
Parcent Taxabla
A..ount Subject to Tax
Tax Rate
Potential Tax Due
x
2,287.98
16.667
381.34
.15
57.20
To insure proper credit to your account~ two
(2) copies of this notice must acco.pany your
pay.ant to the Register of Wills. Make check
payable to: "Register of Wi1ls~ Agent".
x
NOTE: If tax pay_ents are made within three
(3) months 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.
PART TAXPAYER RESPONSE
m f.':,.'i::..~.':.Il'ii':p.".ii~.:.'.:'I.:.:1'.':;~~I.:.I'imip.:.:...jmll.:.".'II.:.I~..,:.::::[~.:.~t.::.::I..::.IJ.;.'.:~.D.:'...:.:1:i..,.I:...:'].I:.'i:mp.':.lft..:.'I.1
..m....'.._".....,~;"".~r,'........,.,',........,.,',,.........,.,.,_..-..,...,.,., ".........,.,',..,.,..,.,..-........,.,',.,......,.,'. .......,.,."........,..."........",.........,.,.,.........,.
,.._,.....,.,.,..........,.,.._.......,.,...._......,.,."..,.....,.,.,.._.......,.,.,<..,....,.,..,,_......,.,...,_......,.,.,',.....,,._
............-......,.............,..........,..............,........................,......................................................................,.....-.....................................
..................,..................-...............................,.,...............-............-...................,.....
[CHECK ]
ONE
BLOCK
ONLY
A. 0 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
Wills and an official assess_ent will be issued by the PA Department 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. 0 The above inforMation is incorrect and/or debts and deductions were paid by you.
"au _l.Ist collplllte PART 0 and/or PART 0 below.
PART
~
TAX RETURN - COMPUTATION OF
LINE 1. Data Established 1
2. Accoun~ Balance 2
3. Percent Taxable 3
4. AMount Subject to Tax 4
S. Debts and Deductions 5
6. AMount Taxable 6
7. Tax Rata 7
8. Tax Due 8
x
TAX ON JOINT/TRUST
0"-02.- 1'1'14
2. :J. 37.1<i?
. lb. b~ 7
381. '/-
D. ao
3 ~~:~l
ACCOUNTS
If you indicate a different tax rata~ please state your
relationship to decedent:
x
PART
@]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax COMPutation)
I
$
Under penalties of periury~ I declare that the facts I
COMplete to the best of .y knowledge and balief.
have reported above are true~ correct
HOME ( '7 i7 ) ~ If- 3 - 4-" !) 8'
WORK ( )
TELEPHONE NUMBER
and
TAXPAYER SI6NATURE
DATE
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on infor.ation
sub~ittBd by the financial institution.
Z. InhsritancB tax baeo.as delinquent nine months aftar the decedent's date of death.
3. A joint account is taxable Bven though the decedent's na.s was added 85 a .atter of convenience.
4. Accounts (including those held between husband and wife) which the decedent put in joint na~BS within on8 year prior to
death are fully taxable 85 transfars.
5. Accounts established jointlY between husband and wife mora than ona 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 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 assessment
(For. REV-1548 EX] upon receipt of the return fro. the Register of Wills.
2. BLOCK B _ If the assat 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 andlor 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 them 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-1548 EX] upon receipt
of the return fro. the Register of Wills.
TAX RETURN - PART
2
- TAX COMPUTATION
LINE
1. Enter
NOTE:
the date the account originallY was established or titled in the .anner existing at date of death.
For a decedent dying after 12/12/82: 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 (M.] appears before your first na.e in the address portion of this notice, the $3,000 exclusion
alraady 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
JOINT OWNERS
Exa.ple: A joint asset registered
DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE
SURVIVING JOINT OWNERS
in the na.e of the decedent and two other persons.
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 3 (JOINT OWNERS] DIVIDED BY 2 {SURVIVORS] = .167 X 100
16.77. {TAXABLE FOR EACH SURVIVOR]
1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT
OWNERS OR TRUST BENEFICIARIES
X 100
PERCENT TAXABLE
Exa.ple: Joint account registered
the decedent.
1 DIVIDED BY 2 {SURVIVORS] s .50
in the na.e of the decedent and two other persons and established within one year of death by
4. The amount 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 S] fro. the amount subject to tax (line 4].
7. Enter the appropriate tax rate {line 7] as determined below.
X 100
507. {TAXABLE FOR EACH SURVIVOR]
death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 07..
The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children
whether or not they have been adoptlild by others, adopted childrliln and step children. "Lineal descendents" includes all children of the
natural parents and their desclilndents, 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 3X &X lSX lSX
01/01/9S to 0&/30/00 OX &X lSX l5X
07/01100 to present OX 4.5Y.- 12X lSX
MThe tax rate Imposed on the not value of transfers fro. a deceased child twenty-one years of age or yo
unger at
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 ite.s.
B. You actually paid the debts after death of the decedent and can furnish proof of payment.
C. Debts being clai.ed .ust 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.
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX Z80601
HARRISBURG PA 171Za-06o1
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
RECORD ADJUSTMENT
JOINTLY HELD OR TRUST ASSETS
*'
REY-16D4 EX AFP (03-05)
,")
:L
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
06-22-2005
BROWN
11-10-2003
21 04-0354
CUMBERLAND
189-18-6189
04113153
MOunt R...itted
MARTHA
A
BETTY ~~AGGONER
2100 ENOLARD
CARLISLE PA 17013
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS .....
................................................................................................................
REV-1604 EX AFP (03-05)
__ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS __
DATE 06-22-2005
ESTATE OF BROWN
MARTHA
A DATE OF DEATH 11-10-2003
COUNTY
CUMBERLAND
FILE NO. 21 04-0354
ADJUSTMENT BASED ON:
S.S/D.C. NO. 189-18-6189
ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
ACN
04113153
FINANCIAL INSTITUTION: WAYPOINT BANK
ACCOUNT NO.
1700017255
TYPE OF ACCOUNT: () SAVINGS (X) CHECKING () TRUST () TIME CERTIFICATE
DATE ESTABLISHED 06-02-1994
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
2,287.98
0.166
381.34
.00
381.34
.45
17 .16
NOTE: TO INSURE PROPER CREDIT TO YOUR
ACCOUNT, SUBMIT THE UPPER PORTION
OF THIS NOTICE NITH YOUR TAX
PAYMENT TO THE REGISTER OF WILLS
AT THE ADDRESS SHONN ABOVE.
MAKE CHECK OR MONEY ORDER PAYABLE
TO: "REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
04-13-2004 CD003814 .00 17 .16
TOTAL TAX CREDIT 17 .16
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ./
( IF TDTAL DUE IS LESS THAN $1, NO PAYNENT IS REQUIRED. IF TDTAL DUE IS REFLECTED AS A "CREDIT" (CR), Q..":> "'-
YDU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.)
REV-1470 EX (6-88)
'* INHERITANCE TAX
EXPLANATION
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
PO Box 280601
HARRISBURG PA 17128-0601
DECEDENrS NAME FILE NUMBER
MARTHA BROWN 2104-0354
REVIEWED BY ACN
SCOTT ELLISON 04113153
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
THE TAX RATE HAS BEEN CORRECTED TO 4.5%.
ROW
PaQe 1