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CDMMDNWEALTH DF PENNSYLVANIA ~-' ~yJW ~ ~ ~QS
DEPARTMENT OF REVENUE `\iV" I N F () RMAT I ON NOT I C E
BUREAU DF INDIVIDUAL TAXES AND FILE N0. 21 !Jd _ ~~~~
DEPT. 288601
HARRISBURG, PA 171z8-B~eol TAXPAYER RESPONSE ACN 02148130
REY-1545 E% ~FP (09-007 DATE 11-22-'200'2
TYPE OF ACCOUNT
EST. OF LYLE COOLBAUGH ^ savlNGs
S.S. N0. 128-01-2664 ®CHECKING
DATE OF DEATH 10-OS-2002 ~ TRUST
COUNTY CUMBERLAND ~ CERTIF.
KAREN ~1 BRADSHAW REMIT PAYMENT AND FORMS T0:
2738 ROSEGARDEN BLVD S REGISTER OF WILLS
MECHANICSBUIRG PA 17055 CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PENNSYLVANIA STATE BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. Questions way be answered by calling (7177 787-8327.
COMPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 10403400 Date 12-28-1999
To insure proper credit to your account, two
Established (2) copies of this notice must accompany your
Account Balance 6,702. i6 Payment to the Register of Wills. Make check
Percent Taxable X payable to: ^Register of Wills, Agent^.
50.000
Amount Subject to Tax 3,351.08 NOTE: If tax payments are Wade within three
(3) months of the decedent's date of death,
Tax Rate x .045 you may deduct a 5% discount of the tax due.
Potential Tax Due 150 , 80 Any inheritance tax due will become delinquent
nine (9) months after the date of death.
PART TAXPAYER RESPONSE
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 nay 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.
BLOCK B. ~ The above asset has been or will be re orted and tax
0 N L Y P paid with the Pennsylvania Inheritance 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 2^ and/or PART 3^ below.
PART If you indicate a different tax rate, please state your
relationship too decedent:
TAX RETURfa - COMPUTATION OF TAX ON JOINT: TRUST ACCO
€€~~~~
UNT ~.~•• .~~~.•••'.~.'
LINE 1. Date Established 1 f
~~
(~(~' ( ~~~~~ ~~~•.:~:~'•:~~,
2. Account Balances
~ ,
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l,,~o~zr Iii ~
~s ~~`"`~
3. Percent Taxable
3 ~ 1
X T('' a ~ UC 1~ ~..~"``
4.
Amount Subject to Tax
4
~ ,~ •j ~ , ~~ S ~~ S 's
y- ~ "';'''
~ °°
s
5.
Debts and Deducaions
5 -:~-`
- I ~S' l 3 ~ 7 ~
~` `~ ~1
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6. Amount Taxable _
6 ~ ~ ' `
......
~'''"`
7. Tax Rate ~ ~, °s ::
8. Tax Due 8 ~
~ ~":. !'~ S`- :€=s €`~s°E:
PART
^
3 ......................:....
DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE
DESCRIPTION
AMOUNT PAID
AL (Enter on Line 5 of
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best: of ny knowledge and belief. q ~2 / 1
y% ~ L-l ~ ~,~ J HOME C ~ « ) to l ~ ~ ~ ~ ~U /`~/~
1l ~LQG -l ;;~yll2t_~/e1~_d,u~-' WORK C )
~XPAYFR CTf`IJeTUOc
i~LCrnunt 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 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 ono 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. BLDCK 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 Nills.
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 17128-0661 in the
envelope Provided.
3. BLOCK C - If the notice information is incorrect and/ar 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 dea
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 (**) aPPears before your first Wane 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 data 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:
4.
5.
6.
7.
1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) _ .167 X 100 = 16.7% (TAXABLE FOR EACH SURVIVOR)
1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY SURVIVINGBJOINT OWNERS X 100 = PERCENT TAXABLE
JOINT OWNERS
Example: A joint asset registered in the name of the decedent and two other parsons.
9. 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 DR 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 = 56% (TAXABLE FOR EACH SURVIVOR)
The amount subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 3).
Enter the total of the debts and deductions listed in Part 3.
Tha amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax Cline 4).
r..+e~ +tie =nnrcpriate tax rate (line 7) as determined below.
Date ofi 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%
..~i..e ..+ +ran 4.5%*
efers from a deceas 12%
ed child twenty-on 15%
e years of age or y
younger at
*The tax rate ampuanu un .~~_ ..a- -~---- -~ - - -
death to or for the use of a natural parent, an adoptive parent, or a stepparent o e c i s ..
The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children
whether or not they have bean adapted 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
___..__+_~ .... +tie oe nnnartment of Revenue.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280607
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX(11-96)
N0. CD 001908
BRADSHAW KAREN A
2738 ROSEGARDEN BLVD SOUTH
MECHANICSBURG, PA 17055
,old
ESTATE INFORMATION: ssrv: its-o~-2ss4
FILE NUMBER: 2102- 1 082
DECEDENT NAME: COOLBAUGH LYLE
DATE OF PAYMENT: 12/03/2002
POSTMARK DATE: 1 2/02/2002
couNTY: CUMBERLAND
DATE OF DEATH: 10/08/2002
REMARKS: KAREN BRADSHAW
CHECK#1131
SEAL
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
02148130 ~ 565.73
TOTAL AMOUNT PAID:
INITIALS: SK
RECEIVED BY: MARY C. LEWIS
REGISTER OF WILLS
565.73
REGISTER OF WILLS
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COMMONWEALTH OF PENNSYL'UANIA / ~ / " ~CJS"
DEPARTMENT OF REVENUE I N FO R R1AT I O N NOT I C E
BUREAU OF INDIVIDUAL TA;~(ES FILE N0. 21 -f/ ~ ~ /O per,
DEPT. 28D601
HARRISBURG, Pa lnzs-Disol ~ TAXPAYERNRESPONSE ACN 02148129
REV-1543 E% AFP (09-007 DATE 11-22-200'1
TYPE OF ACCOUNT
EST. OF LYLE COOLBAUGH ® SAVINGS
S.S. N0. 128-01-2664 ~ CHECKING
DATE OF DEATH 10-OS-2002 ~ TRUST
._ COUNTY CUMBERLAND ~ CERTIF.
REMIT PAYMENT AND FORMS T0:
KAREN ~1 BRADSHAW REGISTER OF WILLS
2738 ROSEGARDEN BLVD S CUMBERLAND CO COURT HOUSE
MECHANICSBUIRG PA 17055 CARLISLE, PA 17013
PENNSYLVANIA STATE BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, ycu 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 6e answered by calling C717) 787-8327.
COMPLETE PART 1 BELOW ~[ ~ ~[ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 26401489 Date 12-28-1999 .,~
J To insure proper credit to your account, twc
Established ?~ ~ (21 copies of this notice must
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax D~~~JcG~„y`
a accompany your
11 431.79 ~ ^~ ~D payment to the Register of Wills. Make check
~ ~ ~ payable to: ^Register of Wills, Agent^.
X 50.000 `L ~ .
5 715.90 f .l ~' NOTE: If tax payments are made within three
~ ~ 1' (3l months of the decedent's date of death,
LL,, . 0 4 5 .` ~~ you may deduct a 5% discount of the tax due.
•L~T~ 3(. 257 .22 b+~n ~l Any inheritance tax due will become delinquent
_ F,~ a nine C9) months after the date of death.
TAXPAYER RES
t
A. ® The above information and tax due is correct.
1. Yau 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
0 N E Wills and an official assessment will be issued by the PA Department of Revenue.
BLOCK ~ B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance T
0 N L Y to be filed by the decedent's representative. ax return
C. ~ The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART 2^ and/or PART 3^ below.
PART If you indicate a different tax rate, please state your
relationship to decedent:
TAX 4ETL'.°,N - L'~JMPUITATION 0~ 3AX 3w'1 JCIN T r TRUST ACCc7~JNTS ~'
~;~ '
LINE 1. Date Established 1 `~~`~=~='~'='
2. Account Balanaa 2 ~'
::::::
`'`'pi`
::::~::
. Percent Taxable 3
::::::::::::<::...... .
X
_~~s
4. Amount Subject to Tax 4
`~~ ~~#
5. Debts and Deductions 5 - ~`
6. Amount Taxable (, ~ ° °°
'
'
'
7. Tax Rate 7 X
s€
8. Tax Due g
~s'?`
PART
0 DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION
AMOUNT PAID
TOTAL [Enter on Line 5 of Tax Computation) $
Under penalties
com~~p//lete to the b~e~st
'=~~ of perjury, I declare that the facts I
of~ knowle~dg//e and belief.
'1~
" have reported above
HOME C ^ )
~p
~ j~ are true, c'o~/rrect angqd
~~ ~f/o fO~/Z/GrZ
l-_
l~~iL. ?iGc,
TAYPAVCO crr_ueTne~ /<~
-~-C~-Gl1 )
WORK ( ~__'T_
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 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 Prier 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 tc the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment
(Farm REV-1548 EX) upon receipt of the return froe the Register of Wills.
2. BLOCK B - If the asset specified an 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 EXl 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 data of death.
NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one (1) year of death are
taxable fully as transfers. However, there is an exclusion not to exceed 53,000 per transferee regardless of the value of
the account or the number of accounts held.
If a double asterisk (*w) 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 data 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 8Y 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 8Y 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 (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 tc tax (line 4).
7. Enter the appropriate tax rate Cline 77 as determined below.
^The tax rate imposed on the net value of transfers from a deceased child twenty one years of age ar 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 adapted 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 administraticn by a personal representative is insufficient
to pay the deductible items.
8. 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". Pracf of
cayment may be requested by the PA Department of Revenue.
Date of Death Spouse Lineal Sibling Collateral
07/01/94 to 12/31/94 3% 6% 15% 15%
01/01/95 to 06/30/00 0% 6% 15% 15%
07/01/00 to present 0% 4.5%* 12% 15%
COMMONWEALTH OF PENNSYL\/ANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
REV-1162 EX~11-96)
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 001909
BRADSHAW KAREN A
2738 ROSEGARC)EN BLVD SOUTH
MECHANICSBURG, PA 17055
-------- fold
ESTATE INFORMATION: SSN: 12s-01-2664
FILE NUMBER: 2102-1082
DECEDENT NAME: COOLBAUGH LYLE
DATE OF PAYMENT: 12/03/2002
POSTMARK DATE: 1 2/02/2002
couNTY: CUMBERLAND
DATE OF DEATH: 10/08/2002
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
02148129 ~ 5244.36
TOTAL AMOUNT PAID:
REMARKS: KAREN BRADSHAW
CHECK#1132
SEAL
INITIALS: SK
RECEIVED BY: MARY C_ I FWIS
5244.36
REGISTER OF WILLS
REGISTER OF WILLS
\ i7_,c~ y
y COMMONWEALTH OF PENNSYLVANIA
BUREAU OF INDIVIDUAL "f AXES DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX
APPRAISENENT ALLONANCE OR DISALLONANCE
OF DEDUCTION, AND ASSESSNENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS REV-1548 EX AFP coi-oar
DATE 01-28-2003
ESTATE OF COOLBAUGH LYLE
DATE OF DEATH 10-08-2002
,FILE NUMBER 21 02-1082
- COUNTY CUMBERLAND
KAREN A BRADSHAW SSN/DC 128-01-2664
ACN 02148129
2738 ROSEGARDEN BLVD S
MECHANICSBURG PA 17055 Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LIME------- RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1548 EX AFP CO1-03) °°°----°-------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 01-28-2003
ESTATE OF COOLBAUGH LYLE DATE OF DEATH 10-08-2002 COUNTY CUMBERLAND
FILE N0. 21 02-1082 S.S/D.C. N0. 128-01-2664
ACN 02148129
IA1C KtIUKN was: CX) ACCEPTED AS FILED C ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: PENNSYLVANIA STATE BANK ACCOUNT N0. 26401489
TYPE OF ACCOUNT: C ~ SAVINGS C ) CHECKING C ) TRUST C ) TIME CERTIFICATE
DATE ESTABLISHED 12-28-1999
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
11,431.79
X 0.500
5,715.90
.00
5,715.90
X .45
257.22
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 T0:
"REGISTER OF WILLS, AGENT."
PAYMENT
DATE RECEIPT
IVUMBER DISCOUNT {+)
INTEREST/PEN PAID C-)
AMOUNT PAID
12-02-2002 CD001909 12.86 244.36
TOTAL TAX CREDIT 257,22
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 TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFILECTED AS A "CREDIT" ( CR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
PURPOSE OF
NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S.
Section 9140).
PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the
reverse side.
-- Make check or money order payable to: REGISTER OF WILLS, AGENT.
REFUND CCR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" CREV-1313). Applications are available at the Office of
the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service
for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs:
1-800-447-3020 CTT only).
OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment
of tax (including discount or interest) as shown on this Notice may obiect within sixty C60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--electing to have the matter determined at the audit of the account of the personal representative. OR
--appeal to the Orphans' Court
ADMIN-
ISTRATIVE
CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing ta: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
DISCOUNT: If any tax due is paid within three <3) calendar months after the decedent's death, a five percent (5%)
discount of the tax paid is allowed.
PENALTY: The 15Y. 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: Interest is charged beginning with first day of delinquency, or nine (9) months and one C1) day
from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982
bear interest at the rate of six C6Y.) percent per annum calculated at a daily rate of .000164.
All taxes which became delinquent on or after January 1, 1962 will bear interest at a rate which will vary from
calendar near to calendar year with that rate announced by the PA Department of Revenue. The applicable
interest rates for 1982 through 2003 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 20Y. .000548 1987 9% .000247 1999 7Y. .000192
1983 16% .000438 1988-1991 11% .000301 2000 8% .000219
1984 11% .000301 1992 9Y. .000247 2001 9% .000247
1985 13% .000356 1993-1994 7Y. .000192 2002 6% .000164
1986 10% .000274 1995-1998 9% .000247 2003 5% .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NU?IBER OF DAYS DELINQUENT 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. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
1~ ~~ =y
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
KAREN .A BRADSHAW
2738 ROSEG~ARDEN BLVD S
MECHANICSBURG PA 17055
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT ALLONANCE OR DISALLONANCE
OF DEDUCTION, AND ASSESSMENT OF TAX ON
JOINTLY NELD OR TRUST ASSETS
REV-1548 EX AFV f01-OS)
DATE 02-25-2003
ESTATE OF COOLBAUGH LYLE
DATE OF DEATH 10-08-2002
FILE NUMBER 21 02-1082
COUNTY CUMBERLAND
SSNiDC 128-01-2664
ACN 02148130
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~
----------------------------------------------------------------------------------------------------------------
REV-1548 EX AFP 1:01-03)
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 02-25-2003
ESTATE OF COOLBAIIGH LYLE DATE OF DEATH 10-08-2002 COUNTY CUMBERLAND
FILE N0. 21 02-1082 S.S/D.C. N0. 128-O1-2664 ACN 02148130
TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: PENNSYLVANIA STATE BANK ACCOUNT N0. 10403400
TYPE OF ACCOUNT: ( ) SAVINGS (X) CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 12-28-1999
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
6,702.16
X 0.500
3,351.08
1,813.58
1,537.50
X .45
69.19
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 T0:
"REGISTER OF WILLS, AGENT."
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT (+)
INTEREST/PEN PAID (-) AMOUNT PAID
12-02-2002 CI1001908 3.46 65.73
TOTAL TAX CREDIT 69.19
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 TOTAL DUE IS LESS THAN S1, 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. )
PURPOSE DF
NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S.
Section 9140).
PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the
reverse side.
-- Make check ar money order payable to: REGISTER OF WILLS, AGENT.
REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an ^Application
for Refund of Pennsylvania Inheritance and Estate Tax" CREV-13137. Applications are available at the Office of
the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service
for faros ordering: 1-800-362-2050; services far taxpayers with special hearing and or speaking needs:
1-800-447-3020 (TT only).
OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment
of tax (including discount ar interest) as shown on this Notice may object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--electing to have the matter daternined at the audit of the account of the personal representative, OR
--appeal to the Orphans' Court
ADMIN-
ISTRATIVE
CORRECTIONS: Factual errors discovered an this assessment should he addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent' (REV-1501) for an explanation of administratively correctable errors.
DISCOUNT: If any tax due is paid within three C3) calendar months after the decedent's death, a five percent (5%)
discount of the tax paid is allowed.
PENALTY: The 15% 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-participaticn
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: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day
fron the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982
bear interest at the rate of six C6%) percent per annum calculated at a daily rate of .000164.
All taxes which became delinquent on or after January 1, 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 1982 through 2003 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Vear Rate Factor Year Rate Factor
1982 20% .000548 1987 9% .000247 1999 7% .000192
1983 16% .000438 1988-1991 11% .000301 2000 8% .000219
1984 11% .000301 1992 9% .000247 2001 9% .000247
1985 13% .000356 1993-1994 7% .000192 2002 6% .000164
1986 10% .000274 1995-1998 9% .000247 2003 5% .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT 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. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.