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PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 08-0613
PD sox zao6ol ,,'' ~-` 1-- ,-„
H1-RRISBURG PA rnzB-ocBl =~- ~- '_:`rAXPAYER RESPONSE ACN 09122680
'"'~ ~:~ * * REVISED NOTICE * * * DATE 04-21-2009
REV-1541 BY ~11RP-(B8-aB) ~ ,~_..-~.
2009 i9AY - I AN ! I ~ Q2
CLERi~ Or
ORPHAA!'S ~Q~JRT
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CHRISTOPH S BROWN
3110 LEWISBERRY RD
YORK HAVEN PA 17370
E5T. OF DONALD M BROWN
SSN 218-28-4058
DATE OF DEATH 05-25-2008
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
TYPE OF ACCOUNT
SAVINGS
CHECKING
TRUST
® CERTIF.
FULTON BANK provided the Departaent with the inforaation below, which has bean used in calculating the
potential tax due. Records indicate that at the death of the above-naaed decedent, you ware a Joint owner/beneficiary of this account.
If you feel the infonation is incorrect, please obtain written correction frog the financial institution, attach a copy to this fora
and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Coeaonwealth of
Pennsylvania. Please call C717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 252-0 063225 Date 12-0 6-1994 To ensure proper credit to the account, two
Established copies of this notice gust accoapany
payeent to the Register of Wills. Make check
Account Balance $ 996 .50 payable to "Register of Wills, Agent".
Percent Taxable X 50 .000
NOTE: If tax payaents are cede within three
Amount Subject to Tax $ 498 .25 aonths of the decedent's date of death,
Tax Rate X .045 deduct a 5 portent discount on the tax due.
Any Inheritance Tax due will becose delinquent
Potential TaX Due $ 22 • 42 nine aonths after the date of death.
PART TAXPAYER RESPONSE
1^
A. ~ Tha above inforwation and tax due is correct.
Resit payeent to the Register of Wills with two copies of this notice to obtain
CHECK a discount or avoid interest, or check box "A" and return this notice to the Register of
C ONE ~ Wills and an official assassaent will be issued by the PA Departaent of Revenue.
B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
0 N L Y to be filed by the estate representative.
C. ~ The above inforaa ion is incorrect and/or debts and deductions were paid.
CoaDlete PART ~2 and/or PART 3~ below.
PART If indicating a different tax rate, please state
Q relationship to decedent:
TAX RE TURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Data Established 1
2. Account Balance 2 $
3. Percent Taxable 3 X
4. Amount Subject to Tax 4 $ --.€ '
5. Debts and Deductions 5 '~`
6. Amount Taxable 6 $
7. Tax Rate 7 X '
8. Tax Due 8 $ Y ±
PART
DEBTS AND DEDUCTIONS CLAIMED
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
belief.
complete to the best of my knowled
ge and HOME C~~~ ) ~'~$ ~~Sa-`
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TA PAYER SIGNATURE TELEPHONE NUMBER .
DATE
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
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 ^otter 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 sore 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 Black 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
(Fore REV-1548 EX) upon receipt of the return from the register of wills.
2. BLOCK 8 - 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 coaplete Parts 2 and 3
according to the instructions below. Sipn 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 ar titled in the manner existing at data 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 03,000 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 03,D00 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 oath survivor is determined as follows:
A. The percentage taxable of joint assets established more than one year Drier to the decedent's death:
1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF MULTIPLIED BY 100 = PERCENT TAXABLE
JOINT WdNERS SURVIVING JOINT OWNERS
Example: A joint asset registered in the name of the decadent 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 decadent 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 antl 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 CLina 4) is determined by multiplying the account balance Cline 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 Cline 4).
7. Enter the appropriate tax rate (Line 7) as determined below.
Data of Death Spouse Linea3 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
^The tax rate imposed on the net value of transfers from a deceased child 21 years of ago 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 hairs includes grandparents, parents, children and other lineal descendents. "Children" includes natural children
whether or not they have bean adopted by others, adopted children and step children. "Lineal descendents" includes all children of the
natural parents and their descendants, whether or not they have bean 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 adwinistration 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.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
BROWN STEPHEN D
3110 LEWISBERRY RD
YORK HAVEN, PA 1 7370-91 1 1
fob
ESTATE INFORMATION: SSN: 218-28-4058
FILE NUMBER: 2108-0613
DECEDENT NAME: BROWN DONALD M
DATE OF PAYMENT: 05/01 /2009
POSTMARK DATE: 04/30/2009
couNTY: CUMBERLAND
DATE OF DEATH: 05/25/2008
REV-1762 EX(11-96)
NO. CD 01 1 183
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
101 ~ 522.42
TOTAL AMOUNT PAID:
REMARKS:
$22.42
CHECK#1703
INITIALS: JN
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
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