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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 1J128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 011032
SAVIDGE GEORGE
101 N 36TH STREET
CAMP HILL, PA 17011
sole
ESTATE INFORMATION: sSN: tai-72-sss5
FILE NUMBER: 2109-0282
DECEDENT NAME: SAVIDGE MARGARET M
DATE OF PAYMENT: 03/24/2009
POSTMARK DATE: 03/23/2009
COUNTY: CUMBERLAND
DATE OF DEATH: 01 / 10/ 2009
REMARKS: GEORGE SAVIDGE
CHECK#640
SEAL
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
09108148 ~ 593.90
TOTAL AMOUNT PAID:
INITIALS: WZ
HEV~1162 EX11 L96~
593.90
NDA EARNER STRASBAUGH
RECEIVED BY
REGISTER OF WILLS
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE a~~ ~//',--~~c,
BDREAU OF INDIVIDDAL TAxES ~ AND FILE NO. 21 - ' (..d q~
PG eox zegsBl TAXPAYER RESPONSE ACN 09108148
HARRIg BURG PA 17128-8601
DATE 02-12-2009
REV -]54] E% RFP (09-O R)
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GEORGE SAVIDGE
101 NORTH 36TH STREET
CAMP HLLL PA 17011
EST. OF MARGARET M SAVIDGE
SSN 141-12-6695
DATE OF DEATH 01-10-2009
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
MEMBERS 1ST FCU pravitletl the Department with the information below, which has been usetl in calculating the
potenkial tax tlue. Records intli cats that at the death pf the above-named tlecedent, You were a ioink owner/beneficiary of this accounk.
If you feel the information is incorrect, please obtain written correction fron the financial institution, attach a copy tb this fore
antl return it to the above address. This account is taxable in accortlan ca with the Inheritance Tax laws of the Conmonwe alkh of
Pennsvlvania. Please call OlT) 78]-8327 wish m,e stions.
COMPLETE PART 1 BELOW ^ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 182503-11
Account Balance
Percent Taxable
Amount Subject Yo
Tax Rate
Potential Tax Oue
PART
Data 04-09-2004
Establishetl
$ 4,392.76
X 50.000
S 2,196.38
84
To ensure proper credik to the account, kwo
copies of this notice nu st accompany
Daum ent ko the Resister of Wills. Make check
payable to "Resister of Wills, Apent".
NOTE: If tax pays cots era matle wikhin three
monkhs of the dacatlent's tlate of death,
tletlu ct a 5 percent discount on the tax tlue.
AnY Inheritance Tax due will become delinquent
nine nonths attar the tlate of death.
A. jt'~The above information and tax tlue is correct.
i/ ~ ~ Remik paYnent ko the Resister of Wills with kwa copies of this notice to obtain
r CHECK a discount or avmitl int avast, or check box "A" and return this nmti ce to the Regisker of
I ONE ~ Wills antl an official assessment will be issuetl by the PA Oeoartment of Revenue.
L BLOCK B. ~ The above asset has been or will be reported and tax paitl with the Pennsylvania Inherikan ce Tax return
ONL Y to be tiled by the estate representative.
C. ~ The above inf orna ion is incorrect antl/mr debts antl tlatlucti ons ware paitl.
C onplete PART z~ and/or PART 3^ below.
pgRT If intlieaYing a different tax rate, please state (~ p~ a r
2 relationship to decedent: "7 ty~ (~ §t ~ i~: ~ '~
e
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TAX
RETURN - COMPUTATION OF
TAX ON JOINT/TRUST ACCOUNTS ~
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LINE 1. Date Established 1 [
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2. Account Balanea 2 $ f~ (
3. Percent Taxable 3 X
4. Amount Subject to Tax 4 $ ~
5. Oabts and Deductions 5 e~.
6. Amount Taxable 6
S S
7. Tax Rate 7 X
e. Tax Oue g ~`_ (~ ¢
a.
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
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PART DEBTS AND DEDUCTIONS CLAIMED
3^
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
GENERAL INFORMATION
1. FAILURE TD RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based pn inf ormakion
submitted by the financial instil ution.
2. Inheritance Tax becomes tlelinmuent nine months after the decedent's date of death.
3. A ioint account is taxable even when Yha decedent's name vas added as a matter of convenience.
4. Accounts (i nclutling those held between husband and wife) the decedent out in ioink names within one year prior to
death are fully tazabl e.
5. Accounts established jointly bete een husband and wife more than one year prior to death are not taxable.
6. Accounts held by a decedent "in trust tor" another or others are fully taxable.
REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE
1. BLOCK A - If the information and cam potation in the notice are cprrecY and tletluctians are not being claimed, place an "X"
in Block A of Park 1 of the "Taxpayer Response" section. Sign two conies 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 assessm enk
(Form REV-1548 EX) upon receipt of the return from the register of wills.
2. BLOCK B - If the asset specif ietl on this notice has been or will be repo rked and tax paid with the Pennsv lvania Inheritance
Tax Return filed by the estake's representative, place an "X" in Block B of Part 1 of the "T ax paw er Response" section. Sign one
copy and return to the register of wills of Yha caunkv indicated.
3. BLOCK C - If the notice information is incorrect and/or detlu ctions are being claim edr check Block C and complete Parts Z and 3
according to the instructions below. Sign Yvo copies and submit them with your check for khe an punt of tax payable to the register
of wills of the county indicated. Tho PA Oeparim ant of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt
of the return from khe register of wills.
TAX RETURN - PART 2 - TAX COMPUTATION
LINE
1. Enter She date the account originally was establ ishetl or titled in khe manner existing ak date of tleakh.
NOTE: For a decedent who died after 12/12/02, accounts the decedent put in joint names within one wear 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 hel tl.
If a double asterisk U U apnea rs before your Hrst nave in the atltl ress porkion of this notice, the 53,000 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 joint 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 300 = PERCENT TAXA OLE
JOINT OWNERS SURVIVING JOINT UWN ERS
Example: A joint asset registered in the name of khe decedent and Yvo other persons:
1 DIVIDED BY 3 (JOINT DWN ERS) DIVIDED BV 2 (SURVIVORS) _ .l6] X 100 = 16.] percent (TAXABLE TD EACH SURVIVOR)
B. The percentage taxable far assets created within one year of the decedent's death or accounts owned by the decedenk but held
in krust for another individual (sl (trust beneficiaries):
1 DIVIDED BV TOTAL NUMBER OF SURVIVING JOINT MULTIPLIED BY 100 = PERCENT TAXABLE
DWN ERS OR TRUST BENEFICIARIES
Example: Joint account resist ered in the name of She decedent and two other persons and est ablishetl within one year of death by
She decedent.
3 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50 percent (TAXABLE FOR EACH SURVIVOR)
4. The amount subject to tax Cline 4) is determined by multiplying the account balance (Line D by the percent taxable (Line 3).
5. Enter khe total of the debts and deductions listed in Part 3.
6. The amount Taxable (Line 6) is tlet ermi ned by subtracting the debts and deductions (Line 5) from the amount subieck to tax (Line 4).
]. Enter the appropriate tax rata (Line ]) as determined below.
Date of Death Spouse Lineal Sibling Collateral
07/01/94 to 12/31/94 3 percenk 6 pa rc ent 15 percent IS percent
01/01/95 to 06/30/00 0 percenk 6 percent 15 pert enk 15 percent
07/01/00 to present 0 pa rc ent 4.5 percent ~ 12 percent 15 percent
•The tax rake imposed on the net value of tran sf ors from a deceased child 21 years of age or younger at
death to or for the use pf a natural parent, an adoptive parent ar a stepParenY of the child is 0 percenk.
The lineal class Of heirs includes erantloa rents, Parents, children and Other lineal tle scentlent s. "Children" includes natural children
whether or not Yhev have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of Me
natural parents and their descendents, whether or not they have been adopted by others; adopted descendents and their descendants;
and sk ep-descendants. "Sibling s'• are defined as intlivi duals who have at least one parent in comnon with the decadent, 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 tletluctians era tlet ermined as fellow s:
A. You are le golly responsible for payment, or the eskate subject to atlminist ration by a personal representative is insufficient
ko pay khe tletlucti ble iten s.
B. Vou actually paid the debts after the death of the decedent and c n furnish proof of pavnent.
C. Debts being claimed must be item iz etl fully in Part 3. If additional space is ne etletl, use B 1/2" x 11" sheet of paper. Proof of
pavm ent may ba reouest ed by the PA Oepartm ent of Revenue.