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PENNSYLVANIA INHERITANCE TAX
~ ~ INFORMATION NOTICE
AND FILE N0. 21 l'~ Oq~z
BUREAU OF INDIVIDUAL TAXES ~~'~~'~t~.~~~'R.j~"~`~~ii' RESPONSE ACN 09150245
PO BOX 280601 .; ~•,+ p ~ A~
HARRISBURG PA 17128-0601 -
~~~- ,"~'~ ~ DATE 08-06-2009
REV-1543 EX AFP COB-08) '"" t-G - _.. i, i.,. _;
? TYPE OF ACCOUNT
~~~ ~~~ ~~ ~ ~~~T'. OF STELLA SUTA ^ SAVINGS
$SN 146-28-5417 ® CHECKING
t^ ~~ ~~"~ ~.~' DATE OF DEATH 07 -16 -2009 ^ TRUST
~/~~~'~,. A.~~~~~~~ f~F~l..,~(`~COUNTY CUMBERLAND ^ CERTIF.
~~i5;`A ~ '', ;EMIT PAYMENT AND FORMS T0:
JACOB A SUTA REGISTER OF WILLS
41 SHADY RD CUMBERLAND CO COURT HOUSE
NEWBURG PA 17240-9394 CARLISLE, PA 17013
FARMERS 8~ MERCHANTS TRUST CO 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 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 form
and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of
Pennsylvania. Please call C717) 787-8327 with nupstions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 35-32275 Date 06-29-2007 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 $ 5, 686.26 payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax Dayments are made within three
Amount Subject to Tax $ 2, 843.13 months of the decedent's date of death,
Tax Rate ~( ~ 15 deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax Due $ 426.47 nine months after the date of death.
PART TAXPAYER RESPONSE
!: •'+ e•' r:'
f'• .~:%:%!9'''i ..:';~.'~.'.`: f riff:.. ::/ r ~ g: ..' f ~ '
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 ar 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
B L 0 C K B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
O N L Y t be filed by the estate representative.
C. The above informa 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 ~` ~/~p"~/~ Z~~ ~ f• ~
2. Account Balance 2 ~
3. Percent Taxable 3
,::
4. Amount Subject to Tax 4 $ ~ 43 ' ~ "~~~ ~~ ~,~''~~~~ ~'~`' §
~~. d
5. Debts and Deductions 5 - G 5~ '' ~ ~ F~.,~,£~,,.~, rf'~~fi`p '+ ''' '~~
6. Amount Taxable 6 '`"'+r'•~f'~~'' Arc
7. Tax Rate A ~ •U,~4r~r :,,r.,~ •: .'
8. T a x D u e ~ h `~~
PART DEBTS AND DEDUCTIONS CLAIMED
0
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I
complete to the best'o-f~my knowledge and belief .
~~~~~~ ~
T
RE
have reported above are true, correct and
HOME C7/7 ) ~'23 ~ liBt )'
WORK C ) /0 6
TELEPHONE NUMBER DAT
TOTAL CEnter on Line 5 of lax computations ~
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 near 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
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 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 who died afterl2/12/82, accounts the decedent put in joint names within one year of death are
fully taxable. However, there is an exclusion not to exceed 83,000 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 83,000 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 SURVIVINGBJOINT OWNERS MULTIPLIED BY 100 = PERCENT TAXABLE
JOINT OWNERS
Example: A joint asset registered in the name of the decedent and two other persons:
1 DIVIDED 8Y 3 (JOINT OWNERS) DIVIDED 8Y 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) ttrust 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 near 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 Cline 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
The tax rate imposed on the net value of transfers from a deceased child 21 nears 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
___.__~_~ ~.. ~ti,, ow nnnnrtmant of Revenue.
1 ~
Estate of Stella Suta 146-28-5417 File# 21 Acn 09150245
7/27/09 Fishers Florist
7/2?/09 Alert Pharmacy Ser
8/8/09 The Store
8/29/09 Shippensburg Fam Pract
9/9/09 Restland Mem Park
9/9/09 DE Paola Monument
Flowers $ 58.30
Medication 110.92
Diner aver Mem Ser 479.87
Doctor 24.26
Cemetery 667.52
Bronze Monument 1310.00
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 01 1840
SUTA JACOB A
41 SHADY RD
NEWBURG, PA 17240
-------- told
ESTATE INFORMATION: sSN: 146-28-5417
FILE NUMBER: 2109-0942
DECEDENT NAME: SUTA STELLA
DATE OF PAYMENT: 10/07/2009
POSTMARK DATE: 10/06/2009
COUNTY: CUMBERLAND
DATE OF DEATH: 07/ 16/2009
REMARKS:
CHECK# 217
SEAL
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
09150245 ~ 5182.65
TOTAL AMOUNT PAID:
INITIALS: JN
REV-1162 EX(11-96)
5182.65
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS