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PENNSYLVANIA INHERITANCE TAX
~ INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 ~ (~(~~
PO BOX 280601 ~i ~ n ^,(
HARRISBURG PA 171zB-B6o1 -- .. ~. ~~ TA~(P,.Al~'ER RESPONSE ACN 08164764
-~ ~ '' ~' DATE 12-26-2008
REV-1543 E% AFP (OB-OB)~' "' - •~~' "'i `''
TYPE OF ACCOUNT
2D09 J~~ ! 3 ~~ I I' EST. OF ALICE H THOMAS ^ SAVINGS
SSN 200-24-7566 ® CHECKING
Ci,.~{~;,~ ~,F DATE OF DEATH 07-25-2008 ^ TRUST
OR~t-L~;~~i~`.~ ~'~aU~~ COUNTY CUMBERLAND ^ CERTIF.
~~,,~5,;~ , y'~ _. ~%-~ REMIT PAYMENT AND FORMS T0:
GEORGE W MARTZ JR REGISTER OF WILLS
15 3RD ST CUMBERLAND CO COURT HOUSE
SUNBURY PA 17801 CARLISLE, PA 17013
FIRST NATL BANK OF PA provided the Department with the information below, which has been used in calculating the
potential tax due. Records indicate that at the death of the above-named decedent, you were a point owner/beneficiary of this account.
If you feel the 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. Tease call <717. 787-8327 with suestiens.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 11064633 Date 09-12-2005 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 2, 622.86 payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax ~` 1,311.43 months of the decedent's date of death,
Tax Rate X 12 deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax Due ~` 157 • 37 nine months after the date of death.
PART TAXPAYER RESPONSE
AILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT
A. The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
C H E C K a discount or avoid interest, or 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.
ONE
B L 0 C K B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
D N L Y to be filed by the estate representative.
C. ^ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART ~ below.
PART If indicating a different tax rate, please state OFFICIAL ll5E ONLY ^ AAF
relationship to decedent: PA DEPARTMENT OF REVENUE
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD
LINE I. Date Established 1 1
2. Account Balance 2 $ 2
3. Percent Taxable 3 X 3
4. Amount Subject to Tax 4 $ 4
5. Debts and Deductions 5 ~
6. Amount Taxable 6 '~ 6
7. Tax Rate 7 X 7
8. Tax Due 8 $ $
PART DEBTS AND DEDUCTIONS CLAIMED
^3
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation) 5
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
-, pomp_ late tq a be t o my knowledgee and belief. HOME C570 )o`1~S~D a 9
%/~~l -(.'R-~-~U,~'X~-W 'K P .~ . ~`i W O R K I ) I I a1
TAXPAYER SIGNATURE TELEPHONE NUMBER DAT
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information
submitted by the financial institution.
2. Inheritance Tax becomes delinquent nine months after the decedent's date of death.
3. A point account is taxable even when the decedent's name was added as a matter of convenience.
4. Accounts (including those held between husband and wife) the decedent put in point names within one year prior to
death are fully taxable.
5. Accounts established .iointly 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 fully taxable.
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 a 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 estate's representative, place an "X" in Block B of Part 1 of the "Taxpayer Response" section. Sign one
copy and return to the register of wills of the county indicated.
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 who died after l2/12/82, accounts the decedent put in point names within one year of death are
fully taxable. However, there is an exclusion not to exceed 53,000 per transferee, regardless of the value of
the account or the number of accounts held.
If a double asterisk (~~) appears before your first name in the address portion of this notice, the S3,000 exclusion
was 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 percentage of the account that is taxable to each survivor is determined as follows:
A. The percentage taxable of point assets established more than one year prior to the decedent's death:
1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF MULTIPLIED BY 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 percent (TAXABLE TO EACH SURVIVOR)
B. The percentage 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 MULTIPLIED BY 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 percent (TAXABLE FOR EACH SURVIVOR)
4. The amount sub]ect to tax (Line 4) is determined by multiplying the account balance (Line 2) by the percent taxable (Line 3).
5. Enter the total of the debts and deductions listed in Part 3.
6. The amount taxable (Line 6) is determined by subtracting the debts and deductions (Line 5) from the amount subject to tax (Line 4).
7. Enter the appropriate tax rate (Line 7) as determined below. '
^The tax rate imposed on the net value of transfers from a deceased child 21 years of age o y g t
death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent.
The lineal class of heirs includes grandparents, parents, children and other 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 are legally responsible for payment, or the estate sub]ect to administration by a personal representative is insufficient
to pay the deductible items.
B. You actually paid the debts after the 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 8 1/2" x 11" sheet of paper. Proof of
oavment may be requested by the PA Department of Revenue.
TAXPAYER. ASSISTANCE
IF YOU NEED FURTHER INFORMATION OR ASSISTANCE, CONTACT ANY REGISTER OF WILLS,
PA DEPARTMENT OF REVENUE DISTRICT OFFICE OR THE BUREAU DF INDIVIDUAL TAXES, AT
C717) 787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS
ONLY: 1-800-447-320.
Date of Death Spouse Lineal Sibling Collateral
07/01/94 to 12/31/94 3 percent 6 percent 15 percent 15 percent
01/01/95 to 06/30/00 0 percent 6 percent 15 percent 15 percent
07/01/00 to present 0 percent 4.5 percent ~ 12 percent 15 percent
r oun er a
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
MARTZ GEORGE W JR
15 3RD ST
SUNBURY, PA 17801
--- told
ESTATE INFORMATION.. SSN: 200-24-7566
FILE NUMBER: 2109-0038
DECEDENT NAME: THOMAS ALICE H
DATE OF PAYMENT: 01 / 1 3/ 2009
POSTMARK DATE: 01 /1 2/2009
COUNTY: CUMBERLAND
DATE OF DEATH: 07/25/2008
ACN
ASSESSMENT
CONTROL
NUMBER
REV-1162 EX(11-96)
N0. CD 010761
AMOUNT
08164764 ~ S 157.37
TOTAL AMOUNT PAID:
REMARKS:
CHECK# NO NUMBER
SEAL
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
S 157.37
INITIALS: JN
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS