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PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 q ~`~J-l
Po Box zao6al ~ TAXPAYER RESPONSE ACN
HARRISBURG PA lnzs-0601 09123971
rsEV-isca Ex ter-roe-oe,' ~ .'.~ ~. ~ DATE 0 4 - 1 3 - 2 0 0 9
~,n,~g FiH~ ( J ~t~ I I ~ ~1J TYPE OF ACCOUNT
EST. OF DORA E OHARA ® SAVINGS
r~, ~`` SSN 193-14-1910 ~ CHECKING
nn~~ ~~'~`"'~' ~~' DATE OF DEATH 03-30-2009
l.,'fli'iU^.,J ~ ~!'~~~ 7T ~ TRUST
~~ , , '`; J'~''n~ COUNTY CUMBERLAND ~ CERTIF.
P%1 REMIT PAYMENT AND FORMS T0:
MARY E MUNDORF REGISTER OF WILLS
5236 MEADOWBROOK DR CUMBERLAND CO COURT HOUSE
MECHANICSBURG PA 17050-6834 CARLISLE, PA 17013
PSECU 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 yeu 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
..°ertrtsvlvanlc. Please call :7.T7 7a7-Sb27 with giie 5tlons.
COMPLETE PART 1 BELOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 8502181095-S7 Date 07-21-2006
To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance $ 101,224.33 payment to the Resister of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 16.667
Amount Subject to Tax $ 16,871.06 NOTE: If tax payments are made within three
months of the decedent's date of death,
Tax Rate )( .045 deduct a 5 percent discount on the tax due.
Potential Tax Due ~ 759.20 Any Inheritance Tax due will become delinquent
nine months after the date of death.
PART TAXPAYER RESPONSE
1
A. I:~ The
IJ above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
CHECK a discount or avoid i nterest, or 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.
B L 0 C K
0 N L Y B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
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
relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date 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 $
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best of my knowledge and belief.
HOME C / ) L/- `
WORK ( ) /U /j / b
TAXP ER SIGNAT RE TELEPHONE NUMBER DAT
PART DEBTS AND DEDUCTIONS CLAIMED
a
DATE PAID PAYEE DESCarPrrnu ...,,....~ ...__
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 ioint 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. 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 a check for the amount of
tau to the register of wills of the county indicated. The PA Department of Revenue will issue an official assessment
(Form REY-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 vavable 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 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 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 point assets established more than ono 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 ioint 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)
4
5
6
7
^The tax rate imposed on the net value of transfers from a deceased child 21 years o 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 then 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:
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)
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.
The amount taxable (Line 6) is determined by subtracting the debts and deductions (Line 5) from the amount subject to tax (Line 4).
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
f a e percent
or Younger a
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
=.,~a~t .~~ do requested by the PA Department of Revenue.
BUREAU OF INDIVIDUAL TAXES
PO BOX 260601
HARRISBURG PA 17128-0601
'.' t
._
REV-1543 IX~~P'(0e~-BB7
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND FILE N0. 21 ~~ ~~ ~
TAXPAYER RESPONSE ACN 09123969
DATE 04-13-2009
ORPI'~~~1'~~ r;~~1..!RT
C~P', v ~' ~ , ~~
MARY E MUNDORF
5236 MEADOWBROOK DR
MECHANICSBURG PA 17050-6834
EST. OF DORA E OHARA
SSN 193-14-1910
DATE OF DEATH 03-30-2009
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
PSECU 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-maned 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 fora
and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of
Pennsylvania. P"lease call C717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 8502181095-S4 Date 01-24-2006 To ensure proper credit to the account, two
Established copies of this notice must accompany
Account Balance 10
931
08 payment to the Register of Wills. Make check
"
,
. payable to
Register of Wills, Agent".
Percent Taxable X 16.667
Amount Subject to Tax
$
1
821
88 NOTE: If tax Daynents are made within three
'
.
, 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 became delinquent
Potential Tax Due $ 81.98 nine months after the date of death.
P
T TAXPAYER RESPONSE
~
1
A. The above information and tax due is correct.
Remit payment 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
Wills and an official assessment will be issued by the PA Department of Revenue.
0 N E ~
BLOCK 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 inforna ion is incorrect and/or debts and deductions were paid.
Complete PART ~ and/or PART ~ below.
PART If indicating a different tax rate, please state
^Z relationship to decedent:
TAX RETURN - CDMPUTATION OF
LINE 1. Date 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
B. Tax Due 8 $
PART DEBTS AND DEDUCTIONS CLAIMED
3^
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I have reported above are~7t/rue, corlrect and
complete to the best of my knowledge and belief. HOME C7/7 ) /(//'~~u~i4~
_ WORK C ) /Uq D
TAXPq~YER SIGNATURE ` TELEPHONE NUMBER ATE
TAX ON JOINT/TRUST ACCOUNTS ~PAI
~.
TOTAL CEnter on Line 5 of Tax Computation) S
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information
subsitted 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 vrior 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 REY-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 raeistar 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.
NDTE: For a decedent who died after 12/12/62, accounts the decedent put in joint 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 C*~) 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 DF DIVIDED BY TOTAL NUMBER OF MULTIPLIED BY 100 = PERCENT TAXABLE
JOINT OWNERS SURVIVING JOINT DWNERS
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 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 BV 2 (SURVIVORS) _ .50 X lOD = 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.
The 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 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 deductions are determined as follows:
Date of Death Spcuse 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
A. You are legally responsible for payment, or the estate subject to administration by a personal representative is~insufticient
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
Dayment nay 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
NO. CD 01 1248
MUNDORF MARY E
5236 MEADOWBROOK DR
MECHANICSBURG, PA 17050-6834
fold
ESTATE INFORMATION: ssN: is3-i4-is~o
FILE NUMBER: 2109-0457
DECEDENT NAME: OHARA DORA E
DATE OF PAYMENT: 05/15/2009
POSTMARK DATE: 05/14/2009
couNTY: CUMBERLAND
DATE OF DEATH: 03/30/2009
REMARKS:
CHECK# 0517
SEAL
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
09123971 ~ 5759.20
09123969 ~ 539.92
TOTAL AMOUNT PAID:
INITIALS: JN
REV-1162 EX(11-96)
5799.12
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS