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PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU DF INDIVIDUAL TAXES AND FILE N0. 21 Cpl par61
PD BOX 280601 TAXPAYER RESPON.S~'`~:~ l~l!=~~r"';./~'CN 09107742
HARRISBURG PA 17128-0601 -~ '.- ,,
~ ;~ ~ ,DATE 02-10-2009
REV-1543 EX AFP (08-OB) ' "-`~ ~ ~ '~1 f {'; ~.~ ~~
ANGELA C JOHNSON
17 LARCH DR
SHIPPENSBURG PA 17257
EST. ~F9EM'C~Y ~ dQHWso~9
SSN 210-18-9583
DATE OF DERj~](~ 17-2008
COUNTY//''yyO~R~PN " ~y~quD
REMIT Pbtl[Ji~~{~~ T~
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
CERTIF.
ADAMS COUNTY NATIONAL BANK 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 joint 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
Pe rn s~lvania. Please call C717) 767-8327 with questi o~~s.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 4991029 Date 01-23-2001 To ensure proper credit to the account, two
Established copies of this notice must accompany
payment to the Register of Wills. Make check
Account Balance $ 2, 021.76 payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 1,010.88 months of the decedent's date of death,
Tax Rate X . 045 deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax Due ~` 45.49 nine months after the date of death.
P~T TAXPAYER RESPONSE
~ FAILURE TO RESPOND WILL RESULT IN AN DFFICIAL TAX A5SE5SMENT
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
BLOC K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tau return
0 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 U5E ONLY ~ AAF
relationship to decedent: PA DEPARTMENT OF REVENUE
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD
LINE 1. Date Established 1 1
2. Account Balance 2 $ 2
3. Percent Taxable 3 X 3
4. Amount Subject to Tax 4 +S C1
5. Debts and Deductions 5 - 5
6. Amount Taxable 6 $ 6
7. Tax Rate 7 X 7
8. Tax Due 8 $ g
~.
PART DEBTS AND DEDUCTIONS CLAIMED
3^
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation) $
Unde~ penalties of perjyry, I declare that the facts I have reported abo/ve are,t,r e corr c~n~1 _
//e~,'te.,t~ he ,b ~'t af!m `jk/no ledge and belief. HOME C7 % ) `/7/ (/-f~/'
l.Lf ~ 7 , ~j ~~~ WO R K
AXPAYF} SIGNATU TELEPHONE NUMBER AT
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 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 joint names within one year prior to
death are fully taxable.
5. 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 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
lax 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 12/12/82, accounts the decedent put in joint names within one year of death are
fully taxable. However, there is an exclusion not to exceed S3,000 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 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 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) (trust 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 subject 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.
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
^Ihe tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger-at
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 subject 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
payment may be requested by the PA Department of Revenue.
TAXPAYER. ASSISTANCE
IF YOU NEED FURTWER INFORMATION OR ASSISTANCE, CONTACT ANY REGISTER OF WILLS,
PA DEPARTMENT OF REVENUE DISTRICT OFFICE OR THE BUREAU DF INDIVIDUAL TAXES, AT
(717] 787-8327. SERVICES FOR TAXPAYERS WITW SPECIAL WEARING AND/OR SPEAKING NEEDS
ONLY: 1-80~-447-3020.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
JOHNSON ANGELA C
17 LARCH DR
SHIPPENSBURG, PA 17257
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ACN
ASSESSMENT
CONTROL
NUMBER
-- ford
ESTATE INFORMATION: ssN: 2~o-~a-x583
FILE NUMBER: 2109-0287
DECEDENT NAME: JOHNSON EMORY G
DATE OF PAYMENT: 04/06/2009
POSTMARK DATE: 04/03/2009
COUNTY: CUMBERLAND
DATE OF DEATH: 1 1 / 1 7/ 2008
AMOUNT
09107742 ~ 545.49
TOTAL AMOUNT PAID:
REMARKS:
SEAL
CHECK# 351
INITIALS: JN
RECEIVED BY:
545.49
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REV-1162 EX(11-96)
N0. CD 01 1080
REGISTER OF WILLS