HomeMy WebLinkAbout03-0385REV-~;~O0 EX +
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
COUNTY CODE YEAR NUMBER
DEut-UI:NT'S NAME (LAST, FIRST, AND MIDDLE INITIAl SOCIAL SECURITY NUMBER
z Martin, LouiseH. 1 7 I - 1 2- 6 4 7 4
~-~ DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) THIS RETURN BUST BE FILED IN DUPLICATE ~ THE
a.I REGISTER OF WILLS
0 03/12/2003 11/15/1914
III (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
o 3 - oo
<e~ ] [~] 1. Original Retum
o~ ~ ~: I---I 4. Limited Estate
'-' ~m I L~I 6. Decedent Died Testate
< [] 9. Utlgatlon Proceeds Received
z NAME
uJ
z Marielle F. Hazen
0
· , FIRM NAME (If Applicable)
.."' Law Office of Marielle F. Hazen
0 TELEPHONE NUMBER
717 540-4332
Z
[] 2. Supplemental Retum
O4a. Future Interest Compromise (date of deah al~ 12-12-82)
--"]7. Decedent Maintained a Living Trust (~ co~y of Trust)
--ll 0. Spousal PoverLy Credit (dam of dea~ be~een 12-31-91 and 1-1-95)
E~3. Remainder Return (damofdea~priort~ 12-13-82)
r~5. Federal Estate Tax Retum Required
__ 8. Total Number of Safe Deposit Boxes
E~] 11. Election to tax under Sec. 9113(A) (Attach Sch O)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE ANI CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
COMPLETE MAILING ADDRESS
2000 Linglestown Road
Suite 303
Harrisbur,q
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Parlnemhip or Sole-Propdetemhip (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
64~555.86
'::~::::::~ 17110
USE ONLY
C~':~
6. Jointly Owned Property (Schedule F) (6)
r-~ Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mo~age Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11 )
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
mede (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(8)
(11)
8,426.81
106.94
64~555.86
8,533.75
(12)
(13)
(14)
56,022.11
56,022.11
SEE INS1KUCTiONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxabie at collateral rate
19. Tax Due
20.
X ~ (15)
56,022.11 x .045 (16)
X .12 (17)
X .15 (18)
(19)
2,520.99
2,520.99
Decedent's Complete Address:
STREET ADDRESS
2300 Bent Creek Blvd.
CITY
Mechanicsburg
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
2,394.94
126.05
ISTATE PA
JzIP
17050
2,520.99
Total Credits ( A + B + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Une 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page I Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (SB)
Make Check Payable to: REGISTER OF WILLS, AGENT
2,520.99
0.00
0.00
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ........................................................................... [] []
b. retain the dght to designate who shall use the property transferred or its income; ........................................ [] []
c. retain a reversionary interest; or ...................................................................................................... [] []
d. receive the promise for life of either payments, benefits or care? ............................................................. [] []
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?. .............................................................................................. [] []
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a benefidary designation? ....................................................................................................... [] []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I decla'e that I have examined this retum, including accompany ng schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
Declaralioo of preparer other than the personal re~ve is based on all information of which preparer has any knowledge.
SIGN~~~~,~TURN DATE
A13~RE~S 7 Hilltop Circle
Mechanicsbur,q
S~ATIVE
PA 17055
DATE
ADDRESS
2000 Linglestown Road, Suite 303
Harrisbur,g
PA 17110
For dates of death on or after July 1, 1994 and before January t, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. {}9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. {}9116 (a) (1.1) (ii)].
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one 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% [72 P.S. {}9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. {}9116(a)(1)].
The tax rate irnoosed on the net value of transfers to or for the use of the decedent's siblinos is 12% 172 P.S. 69116~a)(1.3)]. A siblino is defined, under Section 9102. as an
SCHEDULE F
JOINTLY-OWNED PROPERTY
RE~15~9 EX + (1-97} · ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESYATE OF FILE NUMBER
Martin. Louise H.
If an asset was made joint within one year of the decede~t's date of death, it must be reposed on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
^. J. Robert Martin son
B Jeanne M. Robson
7 Hilltop Circle
Mechanicsburg, PA 17055
116 Mountain Road
Lewisberry, PA 17339
daughter
JOINTLY-OWNED PROPERTY:
Lb) I ~R DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT deed for joinfly-beld real estate. VALUE OF ASSET INTEREST DECE_nENT'S INTERES
1. A. 1987 Fidelity Investment Account #2BC-959049 40,593.48 50. 20,296.7~1
2 A 1993 PSECU Savings Account 46,363.12 50. 23,181.56
3 A 1993 PSECU Checking Account 4,213.29 50. 2,106.65
4 B 1992 Fidelity Investment Account #2BC-959030 18,600.65 50. 9,300.33
191.977 sh @ $96.89 per share
5 A 1987 Fidelity Investment Account ~2BC-959022 19,341.16 50. 9,670.58
266.701 sh @ $72.52 per share
TOTAL (Also enter on line 6, Recapitulation) $
64.555.86
~%'-1511~X + (1-97) '~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Martin. Louise H.
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
1.
2
3
DESCRIPTION
FUNERAL EXPENSES:
Monument lettering
Funeral Home
Funeral Dinner and luncheon
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address
c~. State
Year(s) Commission Paid:
Attemey Fees Law Office of Marielle F. Hazen
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Zip
Street Address
cw
Relationship of Claimant to Decedent
Probate Fees
Accountant's Fees
Tax Retum Preparer's Fees
State Zip,
Travel Expenses
TOTAL (Also enter on line 9, Recapitulation)
AMOUNT
68.00
7,535.00
304.31
500.00
19.50
8,426.81
~=V-1512 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
Martin. Louise H.
FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. West Shore EMS
2
PSECU Visa Loan
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
AMOUNT
83.15
23.79
106.94
COMM~NNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDXVIDUAL TAXES
DEPT. Z80601
HARRISBURG, PA 171ZB-0601
RE¥-I~iS EX AFP C09-00:
J R MARTIN
7 HILLTOP CIRCLE
HECHANICSBURG PA 17055-5599
ZNFORHATZON NOTZCE
AND
TAXPAYER RESPONSE
FILE NO. 21
ACN 05115789
DATE 0q-17-2005
TYPE OF ACCOUNT
EST. OF LOUISE H MARTIN [] SAVZNGS
S.S, NO. 171-12-6q7~ [] CHECKTNG
DATE OF DEATH 0:5-12-200:5 [] TRUST
COUNTY CUMBERLAND [] CERTZF.
REHXT PAYHENT AND FORHS TO:
REGISTER OF HILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
PSECU has provided the Department Nith 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 oaner/beneficiary of
this account. Xf you feel this information is incorrect, please obtain eritten 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 Laos of the Commonwealth
of PannsyIvania. Questions may be answered by calling (717} 787-85ZT.
COMPLETE PART 1 BELON# # # SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Accoun~ No. 0171126~7~ Da~a 10-Z~-1996
Established
Accoun~ Balance q6, $65.12
Percen~ Taxable X 5 0.0 0 0
Amount: Subjec~ ~o Tax 2:~, 181.56
Tax Ra{a X .0~5
Pohang:ia1 Tax Due 1 · 0R3.17
To insure proper credit to your account, tho
(Z) copies of this notice must accompany your
payment to the Register of NiXls. Hake check
payable to: "Register of Mills, Agent°.
NOTE: If tax payments are made within three
($) months of the decadant's date of death,
you may deduct a 5Z discount of the tax due.
Any inheritance tax due will become deIinquent
nine (9) months after the date of death.
PART TAXPAYER RESPONSE
A. [] The above information and tax due is correct.
2. You may choose to remit payment to the Registar of Nills eith tee capias of this notice to obtain
CHECK a discount or avoid interest, or you may check box "A" and return this notice to the Register of
ONE ~ Mills and an official assessment mill be issued by the PA Department of Revenue.
BLOCKJ B. [] The above asset has been or ail1 be reported and tax paid with the Pennsylvania inheritance Tax return
ONLY to be fixed by the decedent's representative.
C. [] The above information is incorrect and/or debts and deductions aero paid by you.
You must complete PART [] and/or PART [] beloa.
PART Tf you indicate a diffaran~ ~ax ra~a· pXaase s~a~e your
[] relationship ~o decedent:
TAX RETURN - COHPUTATZON OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Da~a Es*abXishad I
2. Accoun~ Balance ~
$. Percan~ Taxable $ X
q. Amoun~ Subjec~ ~o Tax q
S. Dab~s and Deductions 5 -
6. Amoun~ Taxable 6
7. Tax Ra~a 7 X
8. Tax Due 8
PART
DATE PAID
DEBTS AND DEDUCTTONS CLAIMED
PAYEE
DESCRIPTION AHOUNT PAID
TOTAL (Enter on Line $ of Tax Computation) $
Under penalties of perjury· Z declare ~ha~ ~he fac~s z have reported above arm ~rue· correc~ and
complete ~o ~he bes~ of my knowledge end belief. HOME ( )
NORK C )
TAXPAYER SIGNATURE TELEPHONE NUMBER DATE
GENERAL INFORMATION
1. FAILURE TO RESPOND #ILL RESULT ZN AN OFFZCIAL TAX ASSESSMENT aith applicable interest based on information
submitted by the financial institution.
Z. Inheritance tax becomes delinquent nine months after the decedant's date of death.
5. A joint account is taxable even though the dacedant's name was added as a matter of convenience.
4. Accounts (including those held between husband and wife) ehich the decedent put in joint names aithin 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 fully.
REPORTING INSTRUCTIONS - PART 1 TAXPAYER RESPONSE
1. BLOCK A - If the information and computation in the notice ara correct and deductions are not being claimed, place an "X"
in block "A" of Part I of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of
tax to the Register of Mills of the county indicated. The PA Department of Revenue will issue an official assessment
(Fore REV-154B EX) upon receipt of the return from the Register of Mills.
Z. 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 dacadant's representative, place an "X" in block "S" of Part I of the "Taxpayer Response" section. Sign Dna
copy and return to the PA nepartaent of Revenue, Bureau of Individual Taxes, nept ZOO601, Harrisburg, PA ITIZB-0601 in the
envelope provided.
5. BLOCK C - If the notice information is incorrect and/or deductions ara being c[aiaed, check block "C" and complete Parts Z and 5
according to the instructions below. Sign two copies and submit thaa 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 (Fora REV-1548 EX) upon receipt
of the return from the Register of Mills.
TAX RETURN - PART 2 - TAX COMPUTATION
LINE
1. Enter the data the account originally was established or titled in the manner existing et date of death.
NOTE: For a decedent dying aftmr 1Z/II/BI: Accounts which the decedent put in joint names within Dna (1) year of death era
taxable fully as transfers. However, there is an exclusion not to exceed $5,000 per transferee regardless of the value of
the account or the number of accounts held.
If a double asterisk (ox) appears before your first name in the address portion of this notice, the $5,000 exclusion
already has been deducted frae the account balance as reported by the flnancial 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 decadant's death:
1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE
JOINT OHNERS SURVIVINO JOINT ONNERS
ExaapIa: A joint asset registered in the name of the decedent and two other persons.
1 DIVINED BY 5 (JOINT ONRERS) DIVIDED BY Z (SURVIVORS} = .167 X 100 = 16.7X (TAXABLE FOR EACH SURVIVOR)
B.The percent 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 SURVIVINO JOINT X 100 = PERCENT TAXABLE
ONNERS OR TRUST BENEFICIARIES
Example: Joint account registered in the nome of the decadent and too other persons and established aithin one year of death by
the decedent.
1 DIVINED BY Z (SURVIVORS) = .50 X 100 = 50Z (TAXABLE FOR EACH SURVIVOR)
4. The amount subject to tax (line ~,) is determined by multiplying the account balance (line Z) by the percent taxable (line 5).
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) free the amount subject to tax (line 4).
7. Enter the appropriate tax rate (line 7) as determined below.
Date of Death Spouse Lineal Sibling Collateral
07/01/9q to 12/$1/9q
01/01/95 to 06/50/00 OX 6X
07/01/00 to present OX
mThe tax rata imposed on th; net value of :fats from a younger at
death to or for the use of a natural parent, an adoptive parent, ar a stepparent of the child is 0Z.
The lineal class af heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children
whether ar not they have been adopted by others, adopted children and step children. "Lineal descendents" includes aLL children of the
nature! parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants
and step-descendants. "Sib!ings" are defined as individua!s who have at toast one parent in common aith the decedent, ahether by blood
or adoption. The "Collateral" class of heirs includes all other beneficiaries.
CLAIMED DEDUCTIONS - PART ~5 - DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and deductions are determined as follows:
A. You legally are responsible for payeant, or the estate subject to adeinistration by a personal representative is insufficient
to pay the deductible items.
B. You actua!ly paid the debts after death of the decedent and can furnish proof of payaent.
C. Debts being claimed must ba itemized fully in Part 5. If additional space is needed, use plain paper 8 1/2" x 11". Proof of
payment may be requested by the PA Department of Revenue.
'CdMM§NNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. Z80601
HARRISBURG, PA 171Z&-0601
REV-I~dS EX AFP
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21
ACN 03115789
DATE 0q-17-2005
J R MARTIN
7 HILLTOP CIRCLE
MECHANICSBURG PA 17055-5599
TYPE OF ACCOUNT
EST. OF LOUISE H MARTIN [] SAVINGS
S.S. NO. 171-12-6q7q [] CHECKING
DATE OF DEATH 05-12-2005 [] TRUST
COUNTY CUMBERLAND [] CERTTF.
REMIT PAYMENT AND FORMS TO:
REGISTER OF MILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
PSECU 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 ware 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 with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. Questions may be answered by calling (717) 787-85Z7.
COMPLETE PART I BELOW x # ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. O171126q7q Date 10-2q-1996
Established
Account Balance q6,363.1 2
Percent Taxable X 50. 000
Amount Subject to Tax 2~5,181.56
Tax Rata X . Oq5
Po'l:antial Tax Due I, Oq$. 17
To insure proper credit to your account, tNo
(Z) copies of this notice must accompany your
payment to the Register of Hills. Make check
payable to: "Register of Hills, Agent".
NOTE: If tax payments ara made within three
(3) months of the dacedent'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.
PART TAXPAYER RESPONSE
CHECK
ONE
BLOCK
ONLY
PART
TAX
L/NE
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
Hills and an official assessment 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 filed by the decedent's representative.
C. []The above information is incorrect and/or debts and deductions ware paid by you. You must complete PART [] and/or PART [] below.
If yOU indicate a different tax rata, please state your
relationship to decadent:
RETURN - COMPUTATION OF TAX ON dOINT/TRUST ACCOUNTS
1. Date Established I
2. Account Balance 2
$. Percent Taxable $ ~
4. Amount Subject to Tax 4
$. Debts and Deductions $ -
6. Amount Taxable 6
7. Tax Rata 7 X
8. Tax Due 8
PART
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION AMOUNT PAID
TOTAL (Enter on Line $ of Tax Computation)
Under penalties of perjury, I declare that the facts I have reported above ara true, correct and
complete to the bast of my knowledge and belief. HOME ( )
WORK ( )
TAXPAYER SIGNATURE TELEPHONE NUHBER DATE
GENERAL ZNFORNAT[ON
1. FAILURE TO RESPOND NZLL RESULT ZN AN OFFICIAL TAX ASSESSNENT e[th applicable interest based on information
submitted by the financial institution,
Z. [nheritanca tax becomes delinquent nine months after the decedent's data of death.
5. A joint account is taxable even though the decedent's name Nas added as a matter af convenience.
fi. Accounts (including those held between husband and wife) ehich the decadent put in joint names within one year pr[or to
death are fully taxable as transfers.
5. Accounts established jointly between husband and alfa more than one year prior to death are not taxable.
6. Accounts held by a decedent "in trust far" another or others are taxabLe fuLly.
REPORTING INSTRUCTIONS - PART ! - TAXPAYER RESPONSE
1. BLOCK A - If the information and computation in the not[ce are correct and deductions are not being claimed, place an "X"
in block "A" of Part I of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of
tax to the Register of Nills of the county indicated. The PA Department of Revenue will issue an official assessment
(Form REV-IS48 EX) upon receipt of the return from the Register of Wills.
Z. BLOCK S - 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 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 Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in tho
envelops provided.
3. BLOCK C - If the notice inforlaat[on is incorrect and/or deductions are being claimed, check block "C" and complete Parts 2 and 5
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 mill issue an official assessment (Fora REV-iS48 EX) upon receipt
of the return from the Rag[star of Hills.
TAX RETURN - PART Z - TAX COHPUTATTON
LINE
1. Enter the date the account originally was established or titled in the manner existing at date of death.
NOTE: For a decedent dying after 12/1z/az: Accounts which the decedent put in joint names within one (1) year of death are
taxable fully as transfers. However, there [s an exclusion not to exceed $3,000 per transferee regardless of the value of
the account or the number of accounts held.
If a doubIe asterisk (ix) appears before your first name in the address portion of this notice, the $3,000 sxcIusion
already has been deducted from the account balance as reported by the financial [nstltution.
Z. Enter the toter balance of the account including interest accrued to the data of death.
5. The percent of the account that is taxable for each survivor [s determined as follows:
A. The percent taxable for joint assets established more than one year prior to tho decodsnt's death:
I DIVIDED BY TOTAL NUNBER OF DIVIDED BY TOTAL NUHDER OF X 100 = PERCENT TAXABLE
JOINT OWNERS SURVIVING JOINT OWNERS
Example.' A joint asset registered in the name of the decedent and tee other persons.
i DIVIDED DY 3 (JOINT OWNERS) DIVIDED DY 2 (SURVIVORS) = .167 X 100 = 16.7X (TAXABLE FOR EACH SURVIVOR)
B.The percent taxable for assets created e[thin one year of the decedent's death or accounts caned by the decedent but held
in trust for another individual(s) (trust beneficiaries):
1 DIVIDED BY TOTAL NUNBER OF SURVIVING JOINT X 100 PERCENT TAXABLE
OWNERS OR TRUST BENEFICIARIES
Example: Joint account registered in the nome of the decadent and two other persons and established within one year of death by
the decedent.
1 DIVIDED BY Z (SURVIVORS) = .50 X 100 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 l).
7. Enter the appropriate tax rate (line 7) as etmrmined below.
Da~e of Death Spouse L/nee1 Sibl/ng Collateral
07/01/9q ~o 12/$1/9q
01/01/95 ~o 06/30/00 OX 6X
07/01/00 ~o presen~ OX
aThe tax rate imposed on th; net vail a younger at
death to or for the use of a natural parent, an adopt[va parent, or a stepparsnt of the child is OX.
The Lineal class of heirs includes grandparents, parents, children, and l[naa! descendents. "Children" includes natural chiLdren
ehmther ar not they have bean 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 mith the decedent, whether by bleed
or adoption. The "Collateral" class of heirs includes all other beneficiaries.
CLAZNED DEDUCTIONS - PART $ - DEBTS AND DEDUCTIONS CLAZNED
AllocabLe debts and deductions are determined as foLLoes:
A. You legally ara responsibZm 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 5. If additianal space is needed, use plain paper B l/Z" x 11". Proof of
payment may be requested by the PA Department af Revenue.
~--
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-O601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 002530
HAZEN MARIELLE F ESQUIRE
845 SIR THOMAS COURT
HARRISBURG, PA 17109
fold
ESTATE INFORMATION: SSN: 171-12-6474
FILE NUMBER: 2103-0385
DECEDENT NAME: MARTIN LOUISE H
DATE OF PAYMENT: 05/06/2003
POSTMARK DATE: 05/05/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 03/12/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 92,394.94
TOTAL AMOUNT PAID:
92,394.94
REMARKS: BONNIE MARTIN
C/O MARIELLE HAZEN ESQUIRE
SEAL
CHECK# 2262
INITIALS' VZ
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
'03 MAY -6 fill :36
TO:
Law Office of Marielle F. Hazen
2000 Linglestown Road
Suite 303
Harrisburg, PA 17110
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
'03 Ii~Y -6 ,~ill :36
TO:
Law Office of Marielle F. Hazen
2000 Linglestown Road
Suite 303
Harrisburg, PA 17110
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280&0!
HARRISBURG, PA 17128-0&0!
COMHONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
NARIELLE F HAZEN
STE 505
2000 LINGLESTOb/N RD
HBG
'O3
PA 17110
~DATE 06-25-2003
i :ESTATE OF MARTIN
DATE OF DEATH 03-12-2003
21 03-0385
CUMBERLAND
101
Amount Remitted
LOUISE H
FILE NUMBER
ACM
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGTSTER OF b/ILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA I7013
CUT ALONG THIS LXNE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP C01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOb/ANCE OR DISALLOb/ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF MARTIN LOUISE H FILE NO. 21 03-0385 ACN 101 DATE 06-23-2003
TAX RETURN WAS: C X3 ACCEPTED AS FILED C 3 CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A3 (13
2. Stocks and Bonds (Schedule B3 C23
5. Closely Held Stock/Partnership Interest (Schedule C3 (53
4. Mortgages/Notes Receivable (Schedule D3
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E3
6. Jointly Owned Property (Schedule F3 (63
7. Transfers (Schedule G3 C73
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses CSchedule H3 C93
10. Debts/Mortgage Liabilities/Liens CSchedule I3 C103
il. Total Deductions
12. Net Value of Tax Return
.00 NOTE: To insure proper
.00 credit to your account,
.00 submit the upper port/on
.00 of.this form with your
.00 tax payment.
64,555.86
8,426.81
106.9q
(113
(123 56,022.11
15.
14.
NOTE:
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (IS)
16. Amount of Line 14 taxable at Lineal/Class A rate C163
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate
19. Princi)al Tax Due
TAX CREDITS
PAYHENT RECEIPT DISCOUNT C+3
DATE NUHBER INTEREST/PEN PAID (-~
05-05-2003 CD002530 126.05
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
reflect figures, that include the total of ALL returns assessed to date.
· 00 x 00 =
56,022·11 x Oq5 =
· 00 x 12 =
· 00 x 15 =
AMOUNT PAID
2,394.94
Charttable/Governmenta/ Bequests; Non-elected 9115 Trusts (Schedule J3 C153
Net Value of Estate SubSect to Tax Clq3 56,022.11
If an assessment UBS issued previously, lines 14, 15 and/or 16, 17, 18 and 19 ~11
.00
.00
2,520.99
.00
.00
2,520.99
TOTAL TAX CREDIT I
I
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
2,520.99
.00
.00
.00
( IF TOTAL DUE IS LESS THAN ~1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CAS, YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.3
.00
RESERVATION:
PURPOSE OF
NOTICE=
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADHIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents d~ing on or before December 12, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Ciass B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful CIass B CcolIateral) rate on any such future interest.
To fulfill the requirements of Section 2I~0 of the Inheritance and Estate Tax Act, Act 23 of 2000. (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.
--Rake check or money order payable to: REGISTER OF NILLS, 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" (REV-IS15). Applications are available at the Office
of the Register of Wills, any of the 25 Revenue District Offices, or by calling the special 24-hour
answering service for forms ordering: 1-800-562-2050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-5020 (TT only).
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 must 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,
--election to have the matter determined at audit of the account of the personaI representative, OR
--appeal to the Orphans' Court.
OR
Factual errors discovered on this assessment should be addressed tn writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280&01, Harrisburg, PA 17128-0601
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 (5) calendar months after the decedent's death, a five percent CSX) discount of
the tax paid is allowed.
The 15X 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 (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1982 w/ii 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 2005 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 20X .000548 1987 9X .000247 1999 7% .000192
]985 16% .000458 1988-1991 11% .000501 2000 8% .000219
1984 ]1% .000501 ]992 9% .000247 2001 9% .000247
1985 15% .000556 1995-1994 7% .000192 2002 6% .000164
1986 10% .000274 1995-]998 9% .000247 2003 5% .000157
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID
X NUNBER OF DAYS DELXNI;~UENT X DAXLY INTEREST 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 sho~n on the
Notice, additional interest must be calculated.