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HomeMy WebLinkAbout04-0557COHNON~IEALTH OF PENNSYLVANIA DEPAHTNENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1511S EX AFP (09-00) ZNFORHATZON NOTICE AND TAXPAYER RESPONSE FZLE NO. 21b ACN 0ql2$0q$ DATE 06-1q-200q RICHARD L BERGER 90 EASY RD CARLISLE PA 17015 TYPE OF ACCOUNT EST OF LINDA R BERGER [] SAVTNGS S.S. NO. 210-$6-7565 [] CHECKING DATE OF DEATH 02-0~-200~ [] TRUST '04 J5 i 15 :'!" CUMBERLAND [] CERTTF. REMIT PAYMENT AND FORMS TO: REGISTER OF MILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 MEMBERS 1ST FCU has provided the Department with the information listed below ~h[ch has been used in calculating the potential tax due. The[r records indicate that at the death of the above decedent, you aarp a joint owner/beneficiary of this account. [f you feel thls information is incorrect, please obtain ~rltten correction from the financial institution, attach a copy to this fore and return it to the above address. This account is taxable in accordance ~[th the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions amy be answered by calling (717) 767-B~27. COMPLETE PART I BELON x # # SEE REVERSE SZDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 108760-00 Dat. 05-26-1989 Established Account Balance 5~2.62 Percent Taxable X 16. 667 Amount Sub~ect to Tax 90 Tax Rata X . O0 PotantAal Tax Due . O0 To insure proper credit to your account, two (Z) cop[es of this notice must accompany your payment to the Register of Rills. Make check payable to: "Register of Nills, Agent". NOTE: If tax payments are made within three (5) months of the decedent's date of death, you may deduct a 52 discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE A. I~The above information and tax due is correct. You may choose to remit payment to the Rag[star of gills with two copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of  CHECK ~ Wills and an official assessment will be issued by the PA Department of Revenue. ONE J BLOCK B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ONLY to be fiIed by the decedent's representative. ~The above information is incorrect and/or debts and deductions were paid by C. you. You must complete PART [] and/or PART []below. PART TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS l i~ii[i!!![!!!!![!::ii !! ![ ! ! [!!!! ! !!!! ! !! !! !! ![ !!!!! ![!!!!!!!!!!~! ! !~!~!~![[[!![!!!!![!!!!!!~!~ ~! !! ~! ~ LINE 1. Data Established 2. Account Balance ~. Percent Taxable q. A.ount Subject to Tax 5. Debts and Deductions 6. A.ount Taxable 7. Tax Rata 8. Tax Due PART DATE PAID DEBTS AND DEDUCTIONS CLA/MED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line $ of Tax Computation) Under panalties of/~/erjury, I declare that the facts T have reported above ara true, correct and colnplata +Ja-~tha best la~ ,, knowl~g, and belief. HOME (~/~) ~~ ~ ~ TAXPAYER SIGNATORE ' ~ TELEPHONE NUMBER DATE GENERAL INFORHATION 1. FAILURE TO RESPOND H/LL RESULT ZN AN OFFICIAL TAX ASSESSNENT with applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent ri]ne months after the dacadent's date of death. 5. A joint account is taxable even though the dacedent's name was added as a ;attar of convanienca. 4. Accounts (including those held bet#men husband and eJfe) eh]ch the decedent put in joint names within one year prior to death ara FuLly taxable as transfers. 5. Accounts established jointly between husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent ']n trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART I - TAXPAYER RESPONSE 1. BLOCK A - IF the information and computation in the notice are correct and deductions are not being cia]mad, place an in block "A" of Part I of the "Taxpayer Response" section. Sign two copies and submit thee with your check for the amount of tax to the Register of Hills of the county ]ndicated. The PA Department of Revenue w]11 issue an official assessment (Form REV-IS4& EX) upon receipt of the return from the Rea]star of Hills. Z. BLOCK B - Zf the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return f]led by the dacadent's rsprosentat]va, place an "X" ]n block "B" of Part 1 of the "Taxpayer Response" section. S]gn one copy and return to the PA Department of Revenue, Bureau of Znd]vJduaZ Taxes, Oept 280601, Harrisburg, PA 17118-0601 in the envelope provided. $. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts Z and according to the instructions below. Sign two copies and submit them with your check For the amount of tax payable to the Register of Hills of the county ]nd]coted. The PA Department of Revenue w]11 issue an offic]al assessment (Fora REV-1548 EX) upon receipt of the return From the Register of Hills. TAX RETURN - PART 2 TAX CONPUTATTON LINE 1. Enter the date the account originally was established or t]tled in the manner existing at date of death. NOTE: For a decedent dying after 1Z/II/BI: Accounts which the decedent put in joint names w]th]n one (1) year of death ara taxable fully as transfers. Hoesver, there is an exclusion not to exceed $5,000 per transferee regardless of the value of tho account or the number of accounts held. If e double asterisk (ex) appears before your first name in the address portion of this not]ce, the $5,000 exclusion already has been 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. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable far joint assets established more than one year pr]or to the decedent's death: ! DIVIDED BY TOTAL NUNBER OF DIVIDED BY TOTAL HUHBER DF X lO0 PERCENT TAXABLE JOINT OHNERS SURV/VING JOINT Or, HERS Example: A joint asset registered in the name of the decedent and two other persons. I DIVIDED BY $ (JOINT OHNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 = 16.71 (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decsdant's death or accounts oened by the decedent but held in trust For another ]ndividual(s) (trust boner]clef]es): I DIVIDED BY TOTAL NUHBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE ONNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established eithin one year of death by the decedent. I DIVIDED BY Z (SURVIVORS) = .50 X 100 = 50X (TAXABLE FOR EACH SURVIVOR) The amount sub]act to tax (line 4) is determined by multiplying the account balance (line Z) by the percent taxable (line 5. Enter the tote1 of the debts and deductions listed in Part 5. 6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 7. Enter the appropriate tax rate (line 7) as determined below. De~e of _nea_~h ) Spouse Lineal Sibling Collateral 07/01/94 ~o 12/31/94 SX 6X 15X 15X 01/01/95 ~co 06/50/00 OX 6X 157, 157. 07/01/00 ~o present OX ~.5Zx 12X lex eThe tax rate imposed on the ne younger at death to or for the use of a natural parent, an adopt]va parent, or a stepparant of the child is OZ. The lineal class of he]rs includes grandparents, parents, ch[ldran, and 1]meal descendents. "Children" includes natural ch]ldran whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" ]ncludes all ch]ldren of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "S]bl]ngs" are daf]nad as individuals who have at least one parent in common with the decadent, whether by blood or adopt]on. The "Collateral" class of hairs includes all other banaficiar]as. CLAIHED DEDUCTIONS - PART 5 - DEBTS AND DEDUCTIONS CLAIHED Allowable debts and deduct]one ara determined as follo.s: A. You legally are responsible for pay.ant, or the estate subject to adainistrat]on by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed must be item]zed fully ]n Part 5. If additional space is needed, use pla]n paper 8 1/Z" x 11". Proof of payment may be requested by the PA Department of Revenue. CONHONNEALTH DF PENNSYLVANIA DEPARTMENT OF REVENUE EPT.OF INDIVIDUAL TAXES 280601 HARRISBURG, PA 171Z8-0601 REV-1E4S EX &FP INFORMATION NOTZCE AND TAXPAYER RESPONSE IFILE NO. 21~ ~S~ ACN 0~IZ$044 DATE 06-1~-Z00~ RICHARD L 90 EASY RD CARLISLE BERGER PA 17015 TYPE OF ACCOUNT BST. OF LINDA R BERGER [~SAVINOS S.S. NO. 210-$6-7565 [] CHECKING DATE OF DEATH OZ-Oq-ZO04 [] TRUST COUNTY CUHBERLAND I I CERTIF. REMIT PAYMENT AND FORHS TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 MEMBERS 1ST FCU has provlded the Department ~ith the information listed belo~ ahich has been used in calculating the potential tax due. Their records indicate that at the death o; the above decedent, you eere a joint oener/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this ~orm and return it to the above address. This account is taxable in accordance aith the Tnheritanca Tax Laos o~ the Commonaealth of Pennsylvania. Questions may be answered by calling (717) 787-~3Z7. COHPLETE PART ! BELON ~ ~ # SEE REVERSE SIDE FOR FILING AND PAYHENT INSTRUCTIONS Account No. 1085R5-11 Date 05-26-1989 Established Account Balance 1,168.28 Percent Taxable X 16.6 6 7 Amount SubSect to Tax 19q.7Z Tax Rate X . O0 Potential Tax Due . O0 To insure proper credit to your account, too (Z) copies of this notice must accompany your payment to the Register o~ Nills. Hake check payable to: "Register of NilIs, Agent". NOTE: If tax payments are made eithin three (5) months of the decedent's date of death, you may deduct a SZ discount of the tax due. Any inheritance tax due ~ill become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE A. ~The above inforeation and tax due ]s correct. /~--~- You may choose to remit payment to the Register o~ gills ~ith too copies of this notice to obtain CHECK e discount or avoid interest, or you may check box "A" and return this notice to the Register of ONE -~ NiZls and an official assessment aill be issued by the PA Department of Revenue. SLOCK~ s. ~ The above asset has been or NJ[[ be reported and tax paid ~[th the Pennsylvania [~er[tance Tax return ONLY to be filed by the decedent's representative. C. ~ The above information [s incorrect and/or debts and deductions ~ere paid by you. You must co;plate PART ~ and/or PART ~ bela.. PART If you indloat., different tax rate, please $. Percent Taxable $ ~ ~. Amount SubSact to Tax ~. 5. Debts and Deductions ~ 6. Amount Taxable 6 7. Tax Rata 7 ~ 8. Tax Due 8 PART DATE PAID DEBTS AND DEDUCTIONS CLAIHED PAYEE DESCRIPTION AHOUNT PAID TOTAL (Enter on Line S of Tax Coaputation) Unde?/~',~naltias/~f~ par~ury,~ I declare that the facts I have reported above ara true, correct and TAXP~ER SIGNATURE ~ - ~ ~ ~ TELEPHONE NUHBER DATE GENERAL ZNFORMATZON 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT aith applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decedent's date of death. 5. A joint account is taxable even though the decedent's name mas added as a matter of convenience. 4. Accounts (including those held between husband and mife) Hhich the decedent put in joint names aithin one year prior to death are fully taxable as transfers. S. Accounts established jointly betaeen husband and aife more than one year prior to death are net taxable. 6. Accounts held by a decedent "in trust for" another or ethers are taxable fully. REPORTING INSTRUCTIONS - PART I - TAXPAYER RESPONSE 1. BLOCK A - [f the information and computation in tho notice ars correct and deductions are not being claimed, place an "X" in block "A" of Part I of the "Taxpayer Response" section. Sign tho copies and subalt them Hith your check for the amount of tax to the Register of Hills of the county indicated. The PA Department of Revenue #ill issue an official assessment (Fore REV-154& EX) upon receipt of the return from the Register of HiLls. Z. BLOCK D - If the asset specified on this notice has been or Hill be reported and tax paid aith the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in block "B" of Part I of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individua! Taxes, Dept Z80601, Harrisburg, PA 171ZB-0601 in the envelope provided. 5. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts Z and 5 according to the instructions beloa. Sign two copies and submit them with your check for the amount of tax payable to the Register of #ills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-154B EX) upon receipt of the return from the Register of Nills. TAX RETURN - PART Z - TAX COMPUTATION LINE 1. Enter the date the account originally Has established or titled in the manner existing at date of death. NOTE: For · decedent dying after 1Z/1Z/DZ: Accounts ahich the decedent put in joint names within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (ma) appears before your first name in the address portion of this notice, the $5,000 exclusion already has been 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. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior to the dacedent's death: I DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUHBER DF X 100 PERCENT TAXADLE JDINT ONNERS SURVIVINg JOINT ONNERS Example: A joint asset registered in the name of the decedent and tho other persons. 1 DIVIDED BY 3 (JOINT ONNERS) DIVIDED BY Z (SURVIVORS) = .167 X lO0 = 16.7Z (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created aithin one year of the dacedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): I DIVIDED BY TOTAL NUMBER OF SURVIvINg JOINT X 100 = PERCENT TAXABLE OHNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and tho other persons and established aithin one year of death by the decedent. 1 DIVIDED BY Z (SURVIVORS) = ,50 X lO0 = 50Z (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line 4) is determined by multiplying the account balance (line Z) by the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 5. 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 beloH. Da~e of Death Spouse ] Lineal Sibling Collaleral 07/01/9q *~o 12/31/9q 3Z 6Z 01/01/95 to 06/30/00 OX 6Z 07/01/00 ~o proson~ OX 4.Sin 127. 157. mThe tax rata imposed on th; nat younger at death to or for the use of e natural parent, an adoptive parent, or a stepparent of the child is The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children Hhather or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes al1 children of the natural parents end their descendents, Hhether or nat they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" ara defined as individuals Hho 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 AlloHable debts and deductions ara determined as folloHs: A. You legally ara 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 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, usa plain paper 8 1/Z" x 11". Proof of payment may ba requested by the PA Department of Revenue. Mr. l~el~d L. B~rg~r 90 E~sy Rd C~li~l¢, PA 17013-9597 CONNONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT, 280601 HARRISBURG, PA 17128-0601 R£V-Z;43 EX AFP (09-00) ZNFORHATZON NOTICE AND TAXPAYER RESPONSE FILE "0. 21'- 0~ ~ ~)~ -] ACH 0q123215 DATE 06-15-200q EST. OF LINDA R BERGER S.S. NO. 210-$6-7565 DATE OF DEATH 02-0~-200~ COUNTY CUMBERLAND ,~u~ 24 ', !i:. :2'i KELLY M BERGER 106 PLAINVTEN DR HBG PA 17112L- TYPE OF ACCOUNT [] CHECKING []TRUST [] CERTIF. REHTT PAYMENT AND FORHS TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NENBERS 1ST FLU has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this 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 cf Psnnsy[vania. ~astions may be o;*~sced by calling (7173 787-~Z7. COMPLETE PART I BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Accoun~ No. 108760-~0 Date 03-05-2005 Established Account Balance 12 Percen~ Taxable X 50. 000 Aeoun~ Sub~ec~ ~o Tax 6, ~06.87 Tax Ra~e X . Potential Tax Due 288. $1 To insure proper credit to your account, two CZ) copies of this notice must accompany your payment to the Register of Hills. Hake check payable to: "Register of Hills, Agent". NOTE: If tax payments are made within three (3) months of the decedent's date of death, you may deduct a 5Z discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the dote of death. PART TAXPAYER RESPONSE You may choose to remit payment to the Register of gills with two coples of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of  CHECK ~ Hills and an official assess, ant will be issued by the PA Department of Revenue. ONE BLOCK J S. [] The above asset has been or will be reported and tax paid with the Pennsylvania Tnheritance Tax return ONLY to be filed by the decedent's representative. C. [] The above information is incorrect and/or debts and deductions mere paid by you. You must complete PART [] and/or PART [] betoe. PART If you ind[ca~ce a d~fferen~ ~ax re~e~ please s~a~e your raZa~ionship ~o decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Da~a Established 1 2. Accoun~ Balance 2. $. Percen~ Taxable $ ~ q. Amoun~ SubSect ~o Tax q 5. Debts and Deductions 5 - 6. Amoun~ Taxable 6 7. Tax Ra~e 7 ~ 8. Tax Due 8 PART DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on L~ne 5 of Tax Computation) $ y Under penalties of perjury, Z declare that the fac~s Z have reported above ara true, carrot ~~~/~ knowledge and belief.~ HOME (~Jl) q,~ ',0~ ~ T~PAYER SIGNA~ TELEPHONE NUHBER and DATE GENERAL INFORMATION 1. FA/LURE TO RESPOND NZLL RESULT IN AN OFF/C/AL TAX ASSESSHENT alth applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decedent's date of death. 3. A joint account is taxable even though the deced~nt's name was added as a matter of convenience. q. Accounts (including those held between husband a~d mile) ahich the decedent put in joint names within one year prior to death are fully taxable as transfers. 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 ara taxable ~ully. 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 tea copies and submit thsa with your check for the amount cf tax to the Register cf Hills of the county indic~:~ed. The PA Department of Revenue ail! issue an official assessment (Form REV-iS48 EX) upon receipt of the return frB~ the Register of Nills. Z. BLOCK B - If the asset specified on this notice ~s been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in block 'B" of Part 1 of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, ~l,rsau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the envelops provided. 3. DLOCK C - If the notice information is incorrect ~d/or.. deductions ara being claimed, check block "C" and complete Parts Z and 3 according to the instructions below. Sign tad coke'[os and submit thee with your check far the amount of tax payable to the Register of Nills of the county indicated. The PA Department of Revenue will issue an official assessment (Fora REV-1548 EX) upon receipt of the return from the Register of Hills. TAX RETURN - PART Z - TAX COMPUTATION LINE 1. Enter the data the account originally was establisl~ed or titled in the manner existing at date of death. NOTE: For a decedent dying after 1Z/1Z/BZ: Accoun{s which the decedent put in joint names aithin one (1) year of death ara taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of the account or tho number of accounts held. i ..~ If a double asterisk (mw) appears before yo~ first name in the address portion of this notice, tho $3,000 exclusion already has been deducted from tho account ~elance as reported by the financial institutian. 2. Enter the total balance of the account including idterast accrued to the date of death. The percent of the account that is taxable for sect1 survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE JOINT OHNERS SURVIVING JOINT ONNERS Example: A joint asset registered in the name bf the decedent and two other persons. ! DIVIDED BY 5 (JOINT OHNERS} DIVIDED BY Z (S~VIVORS) = .167 X ion = 16.71 (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within dba year of the decedant's death or accounts owned by the decedent but held in trust for another individual(s) (trust bene;tciaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X lO0 = PERCENT TAXABLE ONNERS 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 Z (SURVIVORS) = .50 X 100 507. (TAXABLE FOR EACH SURVIVOR) The amount subject to tax (line q) is determined by multiplying the account balance (line Z) by the percent taxable (line 5. Enter the total of the debts and deductions listed in Part 3. 6. Tho amount taxable (line 6} is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line ~). 7. Enter the appropriate tax rate (line 7) as determined baloa. De~e of Death Spouse I L/nee1 Sibling Collateral 07/01/9q ~o 12/$1/9q 01/01/95 {o 06/30/00 O~ 6Z 15Z 15X 07/01/00 ~o proson~ OZ younger at mThe tax rate imposed on th~ at vai of transfers death to or for the use of a natural parent, an adoptive arent~ or e stapparent of the chiId is The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether or not they have been adopted by others, adapted chiIdren and step chiZdren. "Lineal descendents" includes all children of the natural parents and their descendents, ahather or not they have been adopted by others, adopted descendents and their descendants end 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 ~ - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible [tees. B. You actually paid tho debts after death of the decedent and can furnish proof of payment. C. Debts being claimed must be itemized fully in Part 3. If additionaI space is needed, usa plain paper 8 I/Z" x 11". Proof of payment nay be requested by the PA Dapartaent of Revenue. CO~ '~EALTH OF PENNSYLVANIA .,DE~.KIM~NT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 17128-0601 REV-~Ii5 EX AFP (09-00) ZNFORHATZON NOTICE AND TAXPAYER RESPONSE ACN 04124045 DATE 06-21-2004 oiJ~ 24 RICHARD L BERSER 90 EASY RD CARLISLE PA 17015 ;. EST. OF LINDA R BERGER S.S. NO. Z10-$6-7565 DATE OF DEATH 02-04-2004 COUNTY CUMBERLAND TYPE OF ACCOUNT [] SAVZNGS [] CHECKZNG [] TRUST [] CERTZF. REHIT PAYHENT AND FORHS TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 HEHBERS 1ST FCU has provided the Department wlth the information listed below which has been used Jn calculating tha potential tax due. Their records indicate that at the death o~ the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, plaasa obtain writtan correction from the financial institution, attach a copy to this fore and return it to the abova address. This account is taxable in accordance with the Inheritance Tax Laws of fha Commonwealth o~ Pannsylvan]a. Questions may be answered by calling (717) 787-8327. COMPLETE PART I DELON ~ # # SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Accoun* No. 108760-40 Da*e 05-05-2005 Established Accoun~ Balance 12,815.75 Porcan~ Taxable X 50.000 Aeoun~ Subjac~ ~o Tax 6,406.87 Tax Ra~a X .00 Po*an~ial Tax Due .00 To insure proper credit to your account, two (Z) copies of this notice must accompany your payment to tho Register of #ills. Make check payable to: '"Ragistar of Hills, Agent"· NOTE: If tax payments ara made within three (5) months of the dacadent's date of death, you may deduct a SZ discount of the tax due. Any inheritanca tax due will become delinquent nine (9) months after tha date of death. PART TAXPAYER RESPONSE CHECK ONE BLOCK ONLY PART TAX LINE A. J)(] The above information and tax dua is correct. · You may choose to ramit payment to tha Register of Mills with two copies of this notice to obtain a discount or avoid intarest, or you may check box "A" and return this notice to the Register of Rills and an official assessment will be issued by the PA Department of Revenue. B. O The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to ba filed by the dacedant's rapresantativa. C. O The above inforeation ~s incorract and/or debts and daductions ware paid by you. You must complate PART ~ and/or PART [] balow. If you indAca~e a differan~ ~ax ra~e, please s~e~e your reZe~[onsh[p ~o decedent: RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS 1. De~a Established 2. Accoun~ Balance 2. $. Parcon~ Taxable $ ~ q. Aaoun~ Sub5oc~ ~o Tax q $. Dab,s and Deductions $ - 6. Amoun~ Taxable 6 7. Tax Ra~e 7 ~ 8. Tax Due ~ PART DATE PAID DEI~TS AND DEDUCTZONS CLAZNED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line $ of Tax Computation) Under pal)allies of pa~'jury, I .d~lclare ~het ~he fac~s T have reported above ara ~rue, correc~ and TAXPA~R S[SN~U~ TELEPHONE NUH~ER DATE GENERAL INFORMATION 1. FAILURE TO RESPOND #ILL RESULT ZN AN OFFICIAL TAX ASSESSHENT mith applicable interest based on information submitted by the financial institution. Z. /nheritance tax becomes delinquent nine months after the decedent's date of death. 3. A joint account is taxable even though the decedent's name ams added as a matter of convenience. ¢. Accounts (including those held between husband and wife} which the decedent put in joint names within one year prior to death are fully taxable as transfers. S. 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 taxable fully. REPORTING INSTRUCT[OHS - PART ! - TAXPAYER RESPONSE 1. BLOCK A - Tf the information and computation in the notice arm 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 thee with your check for the amount of tax tc the Register of Mills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-15CB EX) upon receipt of the return from the Register of Hills. Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid ~ith the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in block "S" of Part 1 of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of [ndividual Taxes, Dapt lB0601, Harrisburg, PA 171ZB-0601 in the envelope provided. 5. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register of Hills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-iS¢8 EX) upon receipt of the return from the Register of Hills. TAX RETURN - PART Z - TAX COM?UTATION LTNE 1. Enter the date the account originally was established or titled in the manner existing at date of death. ROTE: For a decedent dying after 1Z/II/BI: Accounts which the decedent put in joint names within one (1) year of death are taxable fully as transferS. HaNover, there is an exclusion not to exceed $3,000 per transferee regardless of the value of the account or the number of accounts held. Tf a double asterisk (la) appears before your first name in the address portion of this notice, the $3,000 exclusion already has been deducted from the account balance as reported by the financial institution. Z. Enter the tatar balance of the account including interest accrued to the date cf death. 3. The percent of the account that is taxable for each survivor is determined as follo, s: A. The percent taxable for joint assets established more than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUNBER OF DTVTDED BY TOTAL NURBER OF X 100 = PERCENT TAXABLE JOINT O~JNERS SURVIVTNG JOINT ONNERS Example: A jolnt asset registered in the name of the decedent and t,o other persons. I DIVXDED BY 3 (JOINT ONNERS) DIVIDED BY 2 (SURVXVORS) = .167 X lO0 = 16.7Z (TAXABLE FOR EACH SURV/VOR} B. The percent taxable for assets created within one year of the decedent's death or accounts oened by the decedent but held in trust for another individual(s) (trust beneficiaries): ! DIVTDED BY TOTAL NURBER OF SURVTVTNG JOINT X 100 = PERCENT TAXABLE ONNERS OR TRUST BENEF/CTARTES Example: Joint account registered in the name of the decedent and too other persons and established ~ithin one year of death by the decedent. I DIVIDED BY Z (:SURVIVORS) = .50 X 100 = 507. (TAXABLE FOR EACH SURVIVOR) ¢. The amount subject to tax (line ¢) is determined by multiplying the account balance (line Z) by the percent taxable (line 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 S) from the amount subject to tax (line ~). 7. Enter the apF rate (line 7) as determined below. Date of Death I Spouse Lineal J Sibling Collateral 07/01/9~ ~o 12/$1/9~ SZ 6Z 15Z lex 01/01/95 ~o 06/50/00 OX 6X 15X 15X 07/01/00 ~o presen~ OX q.$Z~ 12X l~X ~- ..~ ,,,~,,a n~ transfers from e deceased child t~enty-ane years of agen~r younger Bt xThe tax rate impose death to or for the usa of a natural parent, an adoptive parent~ or a stspparent of the child is The Lineal class of hairs includes grandparants~ parents, children, and lineal descendents. "Children" includes natural children mhether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the nature1 parents and their descendents, ~hether or nat they have been adopted by others~ adopted descendents and their descendants and step-descendants. "Siblings" ara defined as individuals who have at least one parent [n common with the dacedent~ ~hether by blood or adopt[on. The "Collateral" class o~ heirs ~ncludes a11 other beneficiaries. CLA[HED DEDUCTIONS - PART 5 - DESTS AND DEDUCTIONS CLA[HED A11o~able debts and deductions ara determined as A. You legally are responsible ~or payaent~ or the estate subject to administration by a personal representative is insuff[cient to pay the deductible items. B. You ac~ally pa[d ~e debts afteP death of the decedent and can furnish proof of payment. C. Debts being cIaimed must bm itemized fully in Part 5. If additional space is needed~ use plain paper 8 l/Z" x 11". Proof of payment may be requested bY ~e 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. REV-1162 EX(11-96) CD 004079 BERGER RICHARD L 90 EASY RD CARLISLE, PA 17013 fold ESTATE INFORMATION: SSN: 210-36-7565 FILE NUMBER: 2104-0557 DECEDENT NAME: BERGER LINDA R DATE OF PAYMENT: 06/24/2004 POSTMARK DATE: 06/24/2004 COUNTY: CUMBERLAND DATE OF DEATH: 02/04/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04123215 $288.31 REMARKS: RICHARD L BERGER TOTAL AMOUNT PAID: $288.31 SEAL CHECK# 1034 INITIALS: VZ RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS CORHONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPTo 280601 HARRISBURG, PA 1712B-0601 REV-15~$ EX AFP (09-0I1) ZNFORNATZON NOTZCE AND TAXPAYER RESPONSE FILE NO. 21 (.~ 5~'~ ACN 0q122575 DATE 06-08-200q KELLY M BERGER 106 PLAINVIEW DR HBG PA 17112 TYPE OF ACCOUNT EST. OF LINDA R BERGER [--~SAVINGS S.S. NO. 210-56-7565 ~-~CHECKZNG DATE OF DEATH 02-0~-200~ F--JTRUST COUNTY CUMBERLAND J~JCERTZF. REH/T PAYHENT AND FORHS TO: REGISTER OF ~ILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 HEHBERS 1ST FCU has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this 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 aith the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by calling (717) 787-83Z7. COMPLETE PART 1 BELO# x # # SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS PART Account No. 1085~5-11 Data 05-26-1989 Established Account Balance 1,168.28 Percent Taxable X 16. 667 Amount Sub.ject to Tax 19~.72 Tax Rate X . Potential Tax Due 8.76 To insure proper credit to your account, tho (2) copies of this notice must accompany your payment to the Register of #ills. Hake check payable to: "Register of Rills, Agent". ROTE: If tax payments ara made within three ($) months of the decedant's date of death, you may deduct a 5Z discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. TAXPAYER RESPONSE CHECK ONE BLOCK ONLY PART TAX LINE A. []The above information and tax due is correct. 1. You may choose to remit payment to the Register of Hills with two copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of Rills and an official asses~ent will be issued by the PA Department of Revenue. B. []The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be fiJed by the decedant's representative. C. []The above information is incorrect and/or debts and deductions ware paid by you. You must complete PART []and/or PART Zf you indicate a different tax rate, please state your relationship to decedent: RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS 1. Data Established 2. Account Balance 2 $. Percent Taxable $ X q. Amount SubSect to Tax q. 5. Debts and Deductions S - 6. Amount Taxable 6 7. Tax Rate 7 ~ 8. Tax Due 8~ PART DATE PAID DEBTS AND DEDUCTIONS CLAIMEn PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line $ of Tax Computation~ $ Under' penalties of perjury, I declare that the facts ! have repor.~,ed~ above_..a~r.e ir, ua, ~ ~ 11 - ' TELE~ ~ GENERAL INFORHATION 1. FAILURE TO RESPOND #ILL RESULT ZN AN OFFZCZAL TAX ASSESSNENT with applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decedent's date of death. 5. A joint account is taxable even though the dacadent's name was added as a matter of convenience. ¢. Accounts (including those held between husband and wife) which the decedent put in jalnt names within one year prior to death ara fully taxable as transfers. 5. Accounts established jointly between husband and wife more than one year prior to death are net taxable. 6. Accounts held bY a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions ara not being claimed, place an in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them eith your 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-15¢8 EX) upon receipt of the return from the Register af Nills. Z. BLOCK B - If the asset specified on this notice has been or will be reperted and tax paid with the Pennsylvania Inheritance Tax Return filed by the decadent's representative, place an "X" in block "B" of Part I of the "Taxpayer Response" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept ZB0601, Harrisburg, PA 17118-0601 in the envelope provided. 5. BLOCK C - [f the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts Z and ccording to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register a ...... =-~icated The PA Department of Revenue will issue an official assessment (Fora REV-15~B EX) upon receipt of Wills of tne count= .,,u · ' ' of the return from the Register of Wills. TAX RETURN - PART Z - TAX COHPUTATION of death. LINE 1. Enter the date the account originally ems established or titled in the manner existing at date NOTE: For a decedent dying after II/ti/BI: Accounts which the decedent put in joint names within one fi) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk (em) appears before your first name in the address portion of this notice, the $3,000 exclusion already has been deducted from the account balance as reported by the financial institution. Z. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established more than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUNBER OF DIVIDED BY TOTAL NUHBER OF X 100 = PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the name of the decedent and two other persons. i DIVIDED DY 3 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .167 X lO0 = I6.71 (TAXABLE FOR EACH SURVIVOR) B.The percent taxable for assets created within one year of the decadent's death or accounts ached by the decedent but held in trust for another individual[s) [trust beneficiaries): I DIVIDED BY TOTAL NUHBER OF SURVIVING JOINT X lO0 = 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. I DIVIDED BY Z (SURVIVORS) = .SO X 100 = SOl [TAXABLE FOR EACH SURVIVOR) ¢. The amount subject to tax (line ~) is determined by multiplying the account balance (line Z) by the percent taxable (line Enter the total of the debts and deductions listed in Part 5. · (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax [line ~. The amount taxable del -mined below. , Da~e of -ne~-{h I Spouse I Lineal I Sibling Collateral 07/01/9¢ ~o 12/$1/9¢ SZ 6Z 01/01/95 to 06/30/00 OX 6X 07/01/00 ~o ~e_~t OX 4.Six . . .. ~ho Pounger at 7. Enter the app ·Tha tax rate death to or for the usa of a natural parent, an adoptive parent, or a steppal The lineal cZass of hairs includes grandparents, parents, children, and lineal descendents. "Children" includes nature! 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 $ - DEBTS AND DEDUCTIONS CLAIHED Allowable debts and deductions are determined as follows: A. You legally are responsible for payment, or the estate subject to admlnistration by a personal representative is to pay the deductible 3tams. the decedent and can furnish proof of ~a~ment. - : ...... ~ 1/Z" x 11". Proof of S. You actually paid ~. dmbts ~?ta~ d~a~,~ .... rt S If additional spec. is naa,mo, usa p,a COMMONHEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 171Z8-0601 RE¥-lSqS EX AFP :09-oD) ZNFORNATZON NOTICE AND TAXPAYER RESPONSE FILE NO. ACN 04122574 DATE 06-08-2004 TYPE OF ACCOUNT h..'::.~:;:~ EST. OF LTNDA R BERGER [] SAVINGS .... S.S. NO. 210-:56-7565 []CHECK'rNG DATE OF DEATH 02-04-Z004 [] TRUST COUNTY CUHBERLAND [] CERT-rF' KELLY M BERGER ' REHZT PAYHENT AND FORHS TO: 106 PLAINVIEW DR REGISTER OF WILLS CUMBERLAND CO COURT HOUSE HBG PA 17112 , i, CARLISLE, PA 1701:5 HEHBERS 1ST FCU has provided the Department aith the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this fora and return ]t to the above address. This account ia taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvanie~ Q[,estJons may ba answered by calling (7173 COMPLETE PART ! BELOW # # ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 108760-00 Date 05-26-1989 PART Established Account Balance 542.62 Percent Taxable X 16.667 Amount Subject to Tax 90.44 Tax Rate X .045 Potential Tax Due 4.07 To insure proper credit to your 8ccount~ tho (2) copies of this notice must accompany your Payment to the Register of Hills. Make check payable to: "Register of Niils~ Agent". MOTE: If tax payments ara aada within three (~) months of the dacadant's date of death, you may deduct a 5Z discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date o~ death. CHECK~ ONE BLOCK ONLY TAXPAYER RESPONSE A. [] Tho above information and tax due is correct. 1. You may choose to remit PaYment to the Register of Hills with two copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of Hills and an official assessment will ba issued by the PA Department of Revenue. B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. C. [] The above information is incorrect and/or debts and deductions were paid by you. You wust complete PART [] and/or PART [] below. PART zf you indicate a different tax rate, please state your [~] relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS L]:NE 1. Date Established 1.. PART 2. Account BaZance 2. $. Percent Taxable $ ~ ~. Amount Subject to Tax ~. $. Debts and Deduc*ions $., 6. Amount Taxable 6, 7. Tax Rate ~ X 8. Tax Due 8 DATE PAID DEBTS AND DEDUCTZONS CLAZMED PAYEE  DESCRIPTION AMOUNT PAID TOTAL (Enter ~n Line $ of Tax Com~ $ Under penalties of perjury, 3' declare that the facts ! have reported above ere tru- -~ - wXedge and belief. -~ -, ~-,-ec[ eno . / : , ......... TELEPHONE NUMBER GENERAL INFORMATION 1. FAILURE TO RESPOND HILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decedent's date of death. 5. A joint account is taxable even though the decadant's naaa was added as a matter of convenience. q. Accounts (including those held batqaeen husband and wife) which the decedent put in joint names within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife more than one year prior to death ara not taxable. 6. Accounts held by a decedent "in trust for" another or others arm taxable ful[Y. 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 in block "A" of Part ! of the "Taxpayer Response" sac[ion. Sign two cop[es and submit them with your check for the amount of tax to the Rag[star of Hills of the county indicated. The PA Department of Revenue w[11 issue an official assessment [Fore REV-1Sq8 EX) upon race[pt of the return free the Register of Wilts. Z. BLOCK B - If the asset specified on this not[ce has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the dacedant's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" sac[ion. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes~ Oep[ ZB06Ol, Harrisburg, PA lTlga-oGOl in the Parts Z and envelope provided. 3. BLOCK C - If the not[ce information is incorrect and/or deductions ara being claimed, check block "C" and complete according to the instructions below. Sign two cop[es and submit thee with your check for the amount of tax payable to the Register of N[lls of the county indicated. The PA Department of Revenue will issue an official assessment (Fora REV-lSq8 EX) upon receipt of the return free the Register of Wills. TAX RETURN PART Z - TAX COMPUTATION existing at date of death· are LINE 1. Enter the date the account originally was established ar titled in the manner NOTE: For a decedent dying after 1Z/II/BI: Accounts which the decedent put tn joint names within one (1) year of death taxable fully as transfers. However, there is an exclusion not to exceed S3,000 per transferee regardless of the value the account or the number of accounts held. If a double asterisk Caw) appears before your first name in the address portion of this not[ce, the $5,000 exclusion already has been deducted from the account balance as reported by the financial [nstitut[on- Z. Enter the total balance of the account including interest accrued to the date of death. 5. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established more than one year pr[or to the decadent's death: I DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE SURVIVING JOINT OWNERS JOINT ONNERS Example: A joint asset rag[stared in the name of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT ONNERS) DIVIDED BY Z [SURVIVORS) = .167 X lO0 = 16.Tg (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the dacadant's death or accounts owned by tho decedent but held in trust for another individual(s) [trust beneficiaries): 1 DIVIDED BY TOTAL NUNBER OF SURVIVING JOINT X lO0 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered tn the name of the decadent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY Z (SURVIVORS) ' .S0 X 10O = SOX (TAXABLE FOR EACH SURVIVOR) Tho amount subject to tax (line q) [s datarainad by multiplying the account balance (line Z) by the percent taxable (1[ne Enter the total of the debts and deductions listed tn Part 3. The amount taxable (line 6) is determined by subtract[no the debts and deductions (line 5) from the amount subject to tax El[ne q). 7. Enter the appropriate tax rate Il[ne 7) as determined below. 6. lid twenty-one years of age or younger at death to or for the usa of a natural parent, an adopt[va parent, or a stapparant of the child is OX. The lineal class of he[rs includes grandparents~ parents, children, and lineal descendents. "Children" includes natural children whether or nat 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 stap-descendants. "Siblings" ara defined as individuals who have at least one parent in common with the decedent, whether by blood or adoption. The -Collateral" class of he[rs includes al1 other beneficiaries. CLAIMED DEDUCTIONS - PART ~ - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions ara determined as follows: . A. You legally are 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 death of the decedent and can furnish proof of payment. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 l/Z" xll". Proof of 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. REV-1162 EX(11-96) CD 004069 BERGER RICHARD L 90 EASY RD CARLISLE, PA 17013 fold ESTATE INFORMATION: SSN.. 210-36-7565 FILE NUMBER: 2104-0557 DECEDENT NAME: BERGER LINDA R DATE OF PAYMENT: 06/21/2004 POSTMARK DATE: 06/19/2004 COUNTY: CUMBERLAND DATE OF DEATH: 02/04/2004 ACH ASSESSMENT CONTROL NUMBER AMOUNT 04122374 J $4.07 04122375 $8.76 REMARKS: TOTAL AMOUNT PAID' $12.83 SEAL CHECK# 1006 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS THE STOUFFER FAMILY 106 Plainview Drive, Harrisburg, PA 17112 GREET~ iT'Oi.5:/.---:.---:'.'-."!-'- h,,llh,,lll,,,,.Ih,lh,,Ih,,Ih.hh,lhhh,hh,hh, BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX Z80601 HARRISBURG, PA 171ZD-0601 KELLY M BERGER 106 PLAINVIEW DR HBG CONMONWEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE NOT/CE OF /NHER/TANCE TAX APPRAISEHENT, ALLO#ANCE OR DISALLONANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE ll-Z9-ZOOq ESTATE OF BERGER DATE OF DEATH OZ-Oq-ZO0~ FILE NUMBER COUNTY ACN 21 0~-0557 CUMBERLAND Z10-$6-7565 0~1ZZ57~ Amoun'l: Rem'i t:~Bd RE¥-ISq8 EX AFP (Dg-Oq) LINDA R MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE RETAIN LONER PORTION FOR YOUR RECORDS REV-1548 EX AFP C01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE ll-g9-zooq ESTATE OF BERGER LINDA R DATE OF DEATH OZ-Oq-2OOq COUNTY CUMBERLAND FILE NO. Z1 0q-0557 S.S/D.C. NO. 210-56-7565 ACN OqlZZ57q TAX RETURN WAS: tX) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. 108760-00 TYPE OF ACCOUNT: (~ SAVINGS C ) CHECKING C ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 05-Z6-1989 Account Balance 5q2.62 Percent Taxable X 0.166 Amount Subject to Tax 90.qq Debts and Deductions - .00 Taxable Amount 90.qq Tax Rate X .q5 Tax Due q.07 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: ffREGISTER OF WILLS, AGENT.'* TAX CREDITS: PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID 06-19-200q CD00q069 .00 q.07 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE q.07 .00 .00 .00 IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE 1S LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) PURPOSE OF NOTICE: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act 25 of 2000. (72 P.S. Section 91q0). PAYMENT: REFUND (CR): OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Detach the top portion of this Notice and submit aJth your payment to the Register of Nills printed on the reverse side. -- Make check or money order payable to: REGISTER OF NILLS, AGENT. A refund of a tax credit, which was not requested an the Tax Return, may bm requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1513). Applications ara available online at wee.revenue.state.pm.us, any Register of Nills or Revenue District Office, or from the Department's Iq-hour answering service for forms orders: 1-BOO-362-ZOSO; services for taxpayers with special hearing and/or speaking needs: 1-800-q~7-5020 CTT only). Any party in interest not satisfied with the appraisment, allowance or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within 60 days of the date of receipt of this notice by filing Dna of the folloming: A) Protest to the PA Oepartment of Revenue, Board of Appeals. You may object by filing a protest online at www.boardofappeals.stata.pa.us on or before the expiration of the sixty-day appeal period. In order for an electronic protest to be valid, you must receive a confirmation number and processed date from the Board of Appeals mabsita. You may also send a mrittan protest to PA Department of Revenue, Board of Appeals P.O. Box 281021, Harrisburg, PA 17128-1021. Petitions may not be foxed. B) Election to have the matter determined at the audit of the account of the personal representative. C) Appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, P.O. Box 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. Sam page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due ls paid within three ($) calendar months after the decedent's death, a five percent (52) discount of the tax paid is allowed. The 152 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes mhich became delinquent before January l, 1982 bear interest at the rate of six (6Z) percent par annum calculated at a daily rate of .00016q. All taxes which became delinquent on or after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOOq are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198Z ZOZ .O005qS 1988-1991 11Z .000~01 2001 9Z .O00Zfi7 1985 16Z .000fi58 1992 9Z .0002q7 2002 62 .00016q 198fi llZ .000501 1993-199~ 72 .00019E 2003 52 .000157 1985 132 .000356 1995-1998 92 .O00Zq7 ZOOq ~Z .000110 1986 102 .O00Z7q 1999 7Z .000192 1987 92 .0002q7 ZOO0 82 .O00Z19 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY TNTEREST FACTOR --Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU OF ZNDIVZDUAL TAXES ZNHERTTANCE TAX DTVTS'rON DEPT. 280r, 0! HARRI'SBURG, PA 17128-0601 KELLY N BERGER 106 PLAINVIEW DR HBG PA 17112 CONHONWEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE INHERITANCE TAX STATEHENT OF ACCOUNT DATE ESTATE OF DATE OF DEATH FILE NUNBER COUNTY ACN REV-160? EX AFP (01-05) 07-26-200q BERGER LINDA R 02-0q-200~ 21 0~-0557 CUNBERLAND 0~125215 Amoun~ Rem/~ed I HAKE CHECK PAYABLE AND RENIT PAYNENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credi~ ~o your account, submi~ ~he upper portion of ~his form wi~h your ~ax payment, CUT ALONG THZS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS -~ REV-1607 EX AFP (01-03) N~ ZNHERZTANCE TAX STATEHENT OF ACCOUNT ~ ESTATE OF BERGER LINDA R FILE NO. 21 0q-0557 ACN 0q125215 DATE 07-26-200~ THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHO#N BELOW IS A SUHNARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSNENT OR RECORD ADJUSTNENT: 07-26-200~ PRINCIPAL TAX DUE: Z88.$1 PAYMENTS (TAX CREDITS) PAYNENT DATE 06-2~-200~ RECEIPT NUNBER CD00q079 DISCOUNT (+) INTEREST/PEN PAID (-) .00 IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULAT/ON OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" AMOUNT TOTAL TAX CREDIT 288.31 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. BUREAU OF ZHDZVZDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG, PA 17128-0601 KELLY M BERGER 106 PLAINVIEW DR HBG PA 17112 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTTCE OF ZNHERXTANCE TAX APPRAZSEHENT. ALLO#ANCE OR DTSALLOHANCE OF DEDUCTTON.~, AND ASSESSHENT OF TAX ON JOXNTLY HELD OR TRUST ASSETS DATE 11-29-200~ ESTATE OF BERGER DATE OF DEATH 02-04-200~ FILE NUMBER 21 04-0557 COUNTY CUMBERLAND i~i~/ ~'(*'~ ~.,-~ .... SSN/DC 210-$6-7565 ~-: ~ '~; ACN 04122575 Amount Remitted REV-16ii8 EX AFP C09-O~) LINDA R MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS *~I REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 11-29-2004 ESTATE OF BERGER LINDA R DATE OF DEATH 02-04-200~ COUNTY CUHBERLAND FILE NO. 21 04-0557 S.S/D.C. NO. 210-$6-7565 ACN 0~122375 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEHBERS 1ST FCU ACCOUNT NO. 108545-11 TYPE OF ACCOUNT: ¢ ) SAVINGS (~ CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 05-26-1989 Accoun~ Balance 1,168.28 Percen~ Taxable X 0.166 Amoun~ Sub~ec~ ~o Tax 19~.72 Debts and Deduc~Aons - .00 Taxable Amoun~ 194.72 Tax Ra~e X .45 Tax Due 8.76 TAX CREDTTS: NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. HAKE CHECK OR HONEY ORDER PAYABLE TO: "REGISTER OF MILLS, AGENT." PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 06-19-2004 CDOOR069 .00 8.76 TOTAL TAX CREDIT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) 8.76 .00 .00 .00 PURPOSE OF MOTICE: PAYMENT: REFUND OBJECTIONS: ADH[N- ISTRATZVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act Z~ of ZOO0. (72 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. -- Make check or money order payable to: REGISTER OF HILLS, AGENT. A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Ra~und of Pennsylvania Inheritance and Estate Tax" (REV-iSIS). Applications are available online at ew~.revenue.stata.oa.us, any Register of Hills or Revenue District Office, or from the Oepartment's Z4-hour anseering service for forms orders: 1-BO0-$6Z-ZO50; services for taxpayers aith special hearing and/or speaking needs: 1-BOO-q47-$O20 (TT only). Any party in interest nat satisfied with the appraisment, allowance or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within 60 days of the date of receipt of this notice by filing one of the following: A) Protest to the PA Department of Revenue, Board of Appeals. You may object by filing a protest online at www.boardofappeals.state.pa.us on or before the expiration of the sixty-day appeal period. In order for an electronic protest to be valid, you must receive a confirmation number and processed date from the Board of Appeals website. You amy also send a written protest to PA Department of Revenue, Board of Appeals P.O. Box ZSIOZ1, Harrisburg, PA 17128-1021. Petitions may not be foxed. B) Election to have the matter determined at the audit of the account of the personal representative. C) Appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, P.O. Box 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (52) discount of the tax paid is allowed. The 152 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January lB, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has bean assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (93 months and one ii) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164. AIl taxes which became delinquent on or after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2004 are: Interest Daily Interest Daily Interest Dally Year Rate Factor Year Rate Factor Year Rate Factor 1982 ZOZ .000548 198'~'-8-1991 112 .000301 ZO0~ 92 .000247 1983 162 .O004~B 1992 92 .O00Zq7 ZOOZ 62 .000164 1984 112 .000301 1993-1994 7Z .000192 2003 52 .0001~7 1985 132 .000~56 1995-1998 92 .000247 Z004 42 .000110 1986 102 .000274 1999 72 .000192 1987 92 .000247 ZOO0 B2 .000219 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINIIUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (IS) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 RICHARD L BERGER 90 EASY RD CARLISLE PA 17015 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPR&XSEHENT. ALLOHANCE OR DXSALLOHANCE OF DEDUCTXONS, AND ASSESSHENT OF TAX ON JOZNTL¥ HELD OR TRUST ASSETS DATE 07-15-2004 ESTATE OF BERGER DATE OF DEATH 02-04-2004 FILE NUMBER ~--~- ~"~7 COUNTY CUMBERLAND SSN/DC 210-$6-7565 ACN 04125045 Amount Remitted LINDA R MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOHER PORTION FOR YOUR RECORDS REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 07-15-2004 ESTATE OF BERGER LINDA R DATE OF DEATH 02-04-2004 COUNTY CUMBERLAND FILE NO. S.S/D.C. NO. 210-56-7565 ACN 04125043 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. 108760-00 TYPE OF ACCOUNT: C ~ SAVINGS C ) CHECKING C ) TRUST C ) TIME CERTIFICATE DATE ESTABLISHED 05-26-1989 Account Balance 542.62 Percent Taxable X 0.166 Amount Subject to Tax 90.44 Debts and Deductions - .00 Taxable Amount 90.44 Tax Rate X .00 Tax Due .00 TAX CREDITS PAYMENT RECEIPT DISCOUNT C+) DATE NUMBER INTEREST/PEN PAID C-) NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABO~/-ADDRESS · MAKE CHECK OR MONEY O~DER PAYABLE TO: "REGISTER OF WILLS, AGENT." AMOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN, TOTAL DUE IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. * IF TOTAL DUE IS LESS THAN ~1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) .00 .00 .00 .00 PURPOSE OF NOTICE= To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: REFUND (CR)4 OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. -- Make check or money order payable to: REGISTER OF HILLS, AGENT. A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" CREV-I$1S). Applications are available at the Office of the Register of Mills, any of the 2S Revenue District Offices or by calling the special 24-hour answering service for forms ordering: 1-800-$62-2050; services for taxpayers with special hearing and or speaking needs: 1-800-4~7-$020 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax Cincluding discount or interest) as sho~n on this Notice may ob§ect within sixty (&O) days of receipt of this Notice --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appea! to the Orphans' Court Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0&01 Phone C717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three ($I calendar months after the decedent's death, a five percent CSX) discount of the tax paid is allo~ed. The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before JanuarY 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquenny, or nine C9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before JanuarY 1, 1982 bear interest at the rate of six (&X) percent per annum calculated at a daily rate of .O001&~. All taxes which became delinquent on or after JanuarY 1, 1982 will bear interest at a rate which will varY from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198'~"~ 201 '.0005~8 1988-1991 ll~ .000301 2001 91 .000247 2002 &~ .000219 1983 l&~ .000438 1992 9~ .000247 1993-1994 7~ .000192 2003 5~ .000157 1984 11~ .000301 1995-1998 9~ .000247 2004 41 .000110 1985 13~ .00035& 1986 101 .000274 1999 7~ .000192 2000 8~ .000219 1987 9X .000247 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAXD X NUI~BER OF DAYS DEL/NI;~UENT X DAXLY XNTEREST FACTOR --Any Notice issued after the tax becomes delinquent wi11 reflect an interest calculation to fifteen (15) days beyond the date of the assessment. Zf payment is made after the interest computation date shown on the Notice, additional lnterest must be calculated. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 RICHARD L BERGER 90 EASY RD CARLISLE PA 17015 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAXSEHENT. ALLONANCE OR DISALLONANCE OF DEDUCTIONS, AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-]~48 E3( AFP (01-05) DATE 07-15-2004 ESTATE OF BERGER LINDA DATE OF DEATH 02-04-2004 FILE NUMBER ,~j~O~-~q COUNTY CUHBERLAND SSN/DC 210-56-7565 ACN 04125044 Amount Rem/tted I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA I7015 R CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS REV-1548 EX AFP C01-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 07-15-2004 ESTATE OF BERGER LINDA R DATE OF DEATH 02-04-2004 COUNTY CUMBERLAND FILE NO. S.S/D.C. NO. 210-$6-7565 ACN 04125044 TAX RETURN WAS: eX) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. 108545-11 TYPE OF ACCOUNT: C ) SAVINGS C~ CHECKING C ) TRUST C ) TIME CERTIFICATE DATE ESTABLISHED 05-26-1989 Account Balance 1,168.28 Percent Taxable X O.l&6 Amount Subject to Tax 194.72 Debts and Deductions - .00 Taxable Amount 194.72 Tax Rate X .00 Tax Due .00 TAX CREDITS: NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABO~E ADDRE~:S. HAKE CHECK OR HONEY ORDER PAYABLE TO: "REGISTER C~. HILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. C IF TOTAL DUE IS LESS THAN 41, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CA), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. .00 .00 .00 .00 PURPOSE OF NOTICE= To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 25 of 2000. (72 P.S. Section 91~0). PAYHENT= Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. -- Hake check or money order payable to= REGISTER OF gILLS, AGENT. REFUND CCR)= OBJECTIONS= ADflIN- ISTRATIVE CORRECTIONS= DISCOUNT= PENALTY= INTEREST= A refund of a tax credit, which was not requested on the tax return, may be requested by completing an '~pplication for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications are available at the Office of the Register of Nills, any of the 25 Revenue District Offices or by calling the special 2~-hour answering service for forms ordering= 1-800-562-2050; services for taxpayers with special hearing and or speaking needs= 1-800-~7-5020 (TT Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice amy object within sixty (60) days of receipt of this Notice by= --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court Factual errors discovered on this assessment should be addressed in writing to= PA Department of Revenue, Bureau of Individual Taxes, ATTN= Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (5) calendar months after the decedent's death, a five percent discount of the tax paid is allo~ed. The 15~ tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (AX) percent per annum calculated at a daily rate of All taxes which became delinquent on or after January 1, 1982 wi11 bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198"~ 20~ .0005~8 198~8-1991 11~ .000501 2007 9~ .0002~7 1985 16~ .000~$8 1992 9~ .0002~7 2002 6~ .000219 1984 11~ .000501 1995-199~ 7~ .000192 2003 5~ .000137 ]985 13~ .000356 1995-1998 9~ .0002~7 200~ 4~ .000110 1986 10~ .00027~ 1999 7~ .000192 1987 9~ .0002~7 2000 8~ .000219 --Interest is calculated as follows= INTEREST = BALANCE OF TAX UNPAZD X NUNBER OF DAYS DEL/N{~UBNT X DA/LY /NTEEBST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated.