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INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES _ ,.~ .,,, ~..~., ~.~ND FILE N0. 21 09-0736
PO BOX 280601 r
HARRISBURG PA 17128-0601 't .~ T~-~~A~Y~R RESPONSE ACN 09163770
- ~` t'~;`
REV-1543 EX AFP (08-OB> ~ ' ~ ' `•w'f '-'~ -` DATE 10 - 0 7 - 2 0 0 9
~~~ _~ ~~ ~! ~ ~~ TYPE OF ACCOUNT
EST. Ofi MARIAN BRUDOWSKY ~ SAVINGS
SSN 179-14-8711 ® CHECKING
_,~ ~,~,..~, -,..DATE OF DEATH 0 7 - 24 - 2 0 0 9 ~ TRUST
C~R~~~L''•±`` '-~''~•~'~~ UNTY CUMBERLAND CERTIF.
~~..~~ ~ t -~ ''•~ t' •'~- ~ MIT PAYMENT AND FORMS T0:
KIMBERLY SCHARDT REGISTER OF WILLS
605 S MAIN ST CUMBERLAND CO COURT HOUSE
MARYSVILLE PA 17053 CARLISLE, PA 17013
Account Balance
Percent Taxable
is notice must accompany
$ 6, 029.11 payment to the Register of Wills. Make check
payable to "Register of Wills, Agent".
X 50.000
Amount Subject to Tax $ 3, 014 .56 NOTE: If tax payments are made within three
Tax Rate
X months of the decedent's date of death,
.045 deduct a 5 percent discount on the tax due
Potential Tax Due
$
135
.66 .
Anv Inheritance Tax due will become delinquent
P
RT nine months after the date of death.
A
1 TAXPAYER RESPONSE
PENNSYLVANIA INHERITANCE TAX
MEMBERS 1ST FCU 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
Pennsylvania. Please call C717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 70722-11 Date 04-27-1987
To ensure proper credit to the account, two
Established copies of th'
TAX RETURN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
PART
DATE PAID PAYEE
OF TAX ON JOINT/TRUST ACCOUNTS
1 '~ _ 27 - ~ 9 5~ 7
z_ $ ~ oz.g .. ~1
3 _ X O [~ O
4 $ ~' I ~ ~ ~'""W
5 ---~-
6 $ 3 Of N S~
~- X o c/ 5'
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
AMOUNT PAID
TOTAL CEnter on Line 5 of Tax Computation) g
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
o •} COmP~ to the est my knowledge and belief.
jl~/ n~,~.. HOME C 7 ~ 7 ) 1 J`~7- ~ S-
TAXPAYER SIGNATURE WORK C ) 3_7 _~O
TELEPHONE NUMBER DATE
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 ]pint names within one year prior to
death are fully taxable.
5. Accounts established ]ointly 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 death.
NOTE: For a decedent who died afterl2/12/82, accounts the decedent put in ]pint 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 ]pint 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 point asset registered in the name of the decedent and two other versons:
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 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 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 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 then 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:
A. You are legally responsible for payment, or the estate sub]ect 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
____~ __ .. .... ........ems+sa ti.. +-,a Pe Department of Revenue.
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 012430
SCHARDT KIMBERLY D
605 S MAIN ST
MARYSVILLE, PA 17053
- fold
ESTATE INFORMATION: SSN: 179-14-8711
FILE NUMBER: 2109-0736
DECEDENT NAME: BRUDOWSKY MARIAN L
DATE OF PAYMENT: 03/09/2010
POSTMARK DATE: 03/08/2010
COUNTY: CUMBERLAND
DATE OF DEATH: 07/ 24/ 2009
REMARKS:
ACN
ASSESSMENT
CONTROL
NUMBER
REV-1162 EX(11-96-
AMOUNT
09163770 ~ 5135.66
TOTAL AMOUNT PAID:
5135.66
CHECK# 1 176
INITIALS: JN
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS