HomeMy WebLinkAbout03-0742COMMONWEALTH 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 NUMBER
YEAR
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
Clever, Jean Sarah 194-36-0440
LU DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR)
Q THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
LU
g ,' 07/18/2003 11/24/1914 REGISTER OF WILLS
i(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLB INITIAL)
o
o
Clever, LeRoy N.
[] 1. Original Return []
[] 4. Limited Estate []
[] 6. Decedent Died Testate (Attach copy []
of Will]
[] 9. Litigation Proceeds Received []
12-31-91 and 1-1-95)
qAME
Earl Richard Etzweiler
:IRM NAME (If applicable)
Etzweiler and Associates
FELEPHONE NUMBER
i'3 -5 0
9. ~ea?~state (Schedule A)
SOCIAL SECURITY NUMBER
] 3. Remainder Return (date of death prior to 12-13-82)
2. Supplemental Return
4a. Future Interest Compromise (date of death
after 12-12-82) [-.J
7. Decedent Maintained a Living Trust (Attach
copy of Trust) --
10. Spousal Poverty Credit (date of death between []
COMPLETE MAILING ADDRESS
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
11 .Election to tax under Sec. 9113(A) (Attach Sch O)
(1)
105 Nord~ Front Street
Harrisburg, PA 17101
None
None
None
None
None
14,176.24
None
1,716.97
2,432.07
OFFICIAL USE ONLY
Stocks and Bonds (Schedule B)
2. (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
[] 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, Mortgage 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
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(8)
14,176.24
4,149.04
10,027.20
10,027.20
(11)
(12)
(13)
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate, 8,202.20
or transfers under Sec. 9116(a)(1.2)
x .00 (15)
0.00
82.13
82.13
16. Amount of Line 14 taxable at lineal rate
1,825.00 x .045 (16)
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
x .12 (17)
x .15 (18)
(19)
20. J~
i::::::ii 5 :: :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: i ~i~ii!~i~;~: . ..........................................................................................................................................................................................................
.......................................................................................................... - ............... i! i illlliii}}iiiiiii ii :: iiiii
Copyright 2000 form software only The kackner Group, Inc. Form REV-I$00 EX (Rev. 6-00)
Decedent's Complete Address:
lSTREET ADDRESS
~ Mechanicsburg
STATE PA ZIP 17055
355 Sporting Hill Road
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
78.02
4.11
(1)
82.13
Total Credits (A + B + C) (2)
82.13
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E) (3) 0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 0.00
Make Check Payable to: REGISTER OF WILLS, AGENT
....................................................................... ,:.~: .............. ~m.,....:.,,~...~.,:....',/_.,..,~;:~.~:;~;~;,,.~?.:..c.,~~q~g~~.~
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 right 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 beneficiary 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 declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RE.~SIBLE FOR~'~F1L-~G RETURN ADDRESS
GNATU~F PERSON RESP~~E~URN ~ ADDRESS
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
102 Stoner Drive
Mechanicsburg, PA 17055
ADDRESS
DATE
DATE
Earl Richard Etzweiler DATE
..,., F~ .'~o /; - ~ ~ 105NorthFrontStreet
~4 -//.. ~:~. narrisbur..:g:~,PA 17101
For dates of death on or after July 1, 1994 and before January 1, 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 imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116 (a) (1.3)]. A sibling is defined,
under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
Clever, Jean Sarah FILE NUMBER
21--
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A C Robert Jacobs
B LeRoy N. Clever
102 Stoner Drive
Mechmficsburg, PA 17055
355 Sporting Hill Road
Mechanicsburg, PA 17055
Son
Husband
JOINTLY OWNED PROPERTY:
LETTER DATE
ITEM FOR JOINT/ MADE
NUMBER TENANT dOINT
I A 01/11/1993
07/01/1981
05/24/2002
All deb1
checkinl
joint w:
DESCRIPTION OF PROPERTY
Include name of financial institution and bank account number o
similar identifying number. Attach deed for jointly-held real estah
PNC CD Account No. 21001059069. Jont with son, C.
Robert Jacobs.
PNC Checking Account No. 5140239454. Joint with
spouse.
PNC Checking Account No. 5140454138. Joint with
son, C. Robert Jacobs.
DATE OF DEATH
VALUE OF ASSET
5,855.42
16,404.40
s of the estate were paid out of PNC
account no. 5140454138, which was
th decedent's son, C. Robert Jacobs.
6,092.66
%OF
DECD'S
INTEREST
5~%,
50%
50%
DATE OF DEATH
VALUE OF
DECEDENT'SINTEREST
2,927.71
8,202.20
3,046.33
TOTAL (Also enter on line 6, Recapitulation) 14,176.24
PN CBANK
August 22, 2003
C Robert Jacobs
102 Stoner Dr.
Mechanicsburg, PA
17055
/scp
RE:
Estate of Jean S Clever (Deceased)
SSN: 194-36-0440
DOD: 07-18-2003
Dear Mr. Jacobs:
In response to your request for Date of Death balances for the customer noted
above, our records show the following:
Certificate of Deposit
Account#21001059069 Established 01 - 11 - 1993
JEAN S CLEVER
C ROBERT JACOBS JR (Son)
DOD balance: $5,854.20 + $1.22 accrued interest
Checking Account
Account#5140239454 Established 07-01 - 1981
LEROY N CLEVER (Spouse)
JEAN J CLEVER
DOD balance: $16,403.51 + $0.89 accrued interest
Account#5140454138 Established 05-24-2000
JEAN S CLEVER (Son)
C ROBERT JACOBS
DOD balance: $6,092.34 + $0.32 accrued interest
Page 1 of 2
Safe deposit box
The decedent maintained safe deposit box #83. It was in three names.
It is located at:
LEROY N CLEVER
JEAN J CLEVER
DECIE DORTY
WINDSOR PARK
5288 SIMPSON FERRY RD.
MECHANICSBURG PA 17055
717-697-3001
Please note that this office only provides date of death balances for deposit
accounts (IRAs, CDs, Checking and Savings accounts). We do not process any
financial transactions or provide statements. If you need assistance with any of
these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local
PNC Bank branch office.
__L~cer,ely'
Erica L Schlegel
PNC Decedent Reporting
Firstside Center
500 First Ave, 4th F1 CIF
Pittsburgh PA 15219-3128
1-800-762-1775
Member FDIC
Page 2 of 2
COMMONWEALllJ OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Clever, Jean Sarah FILE NUMBER
21--
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
FUNERAL EXPENSES:
Malpezzi Funeral Home - balance due fimeral service
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Social Security Number(s) EIN Number of Personal Representative(s):
Street Address
City State Zip
Year(s) Commission paid
Attorney's Fees Etzweiler and Associates - legal tee
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State
Relationship of Claimant to Decedent
Probate Fees Register of Wills - file no letters Return
Zip
Accountant's Fees
Tax Return Preparer's Fees
Other Administrative Costs
Etzweiler and Associates - notary fee, postage and photocopies
TOTAL (Also enter on line 9, Recapitulation)
1,181.97
500.00
10.00
25.00
1,716.97
Market Plaza Way · Mechanicsburg, P/I 17055
Phone: 697.4696
FUNERAL HOME
Michael J. Malpezzi
Owner
July 30, 2003
LeRoy N. Clever
355 Sporting Hill Road
Apt. 31
Mechanicsburg, PA 1.7050
The Funeral Service for Jean Sarah Clever
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
1. PROFESSIONAL SERVICES
Services of Funeral Director/Staff
FUNERAL HOME SERVICE CHARGES
SELECTED MERCHANDISE:
Stainless Steel Casket
Sentinel
Acknowledgement cards
Register, Memorial Cards, Ackn.
100 Memorial Folders
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE TltAT YOU HAVE SELECTED
AT THE TIME FUNERAL ARRANGEMENTS WERE MADE, WE ADVANCED CERTAIN PAYMENTS TO OTHERS AS AN
ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES.
CASH ADVANCES
Opemng Grave
Cemetery Equipment
Newspaper Notices - Local
Newspaper Notices - York
Clergy/Mass Offering
Certified Copies of the Death Certificate
Flowers
Lancaster Intelligencer
TOTAL CASH ADVANCES AND SPECIAL CHARGES
$3260.00
$3260.00
$2855.00
$58.00
$23.00
$7165.00
$400.00
~ $!00.00
$455.10
$225.25
~$100.00
$10.00
$159.00~1~
$65.00
$1514.35
SUB-TOTAL
INITIAL PAYMENT / DISCOUNT / CREDITS
TOTAL AMOUNT DUE
$8679.35
$8679.35
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Clever, Jean Sarah
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
FILE NUMBER
21--
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
Easter Seals - check cleared after death
LeRoy Clever - reimbursement for payment of July nursing home bill fc~r decedent.
Country Meadows - balance due nursing home care
LeRoy Clever - reimbursement for out-ot:pocket expenses paid tbr the benefit of decedent
West Shore EMS - balance due ambulance transport
CCS, Inc. - balance due emergency medical services
TOTAL (Also enter on Line 10, Recapitulation)
AMOUNT
10.00
500.00
500.00
450.00
513.95
458.12
2,432.07
DETACH HERE AND RETURN TOP PORTION WITH YOUR PAYMENT
PO Box 60550
Harrisburg, PA 17106
(800) 521-7559
Consolidated Collection Service, Inc.
PAST DUE NOTICE
458.12 458.12 07/25/03 458.12 671349
ACCORDING TO OUR RECORDS YOUR PAYMENT HAS NOT BEEN
RECEIVED AND IS NOW PAST DUE. IF YOU ARE UNABLE TO PAY THE
AMOUNT DUE IMMEDIATELY, PLEASE CONTACT OUR OFFICE SO WE
CAN MAKE SUITABLE ARRANGEMENTS.
WE ACCEPT MASTER CARD AND VISA FOR YOUR CONVENIENCE,
SEE THE BACK OF THIS PAGE FOR INSTRUCTIONS.
IF YOUR PAYMENT IS IN THE MAIL, WE SEND OUR SINCERE THANKS.
THIS IS AN ATTEMPT TO COLLECT A DEBT. ANY INFORMATION
OBTAINED WILL BE USED FOR THAT PURPOSE.
REV-1543 EX+ (D-O.9)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
(_'.lever, Jean Sarah
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21--
NUMBER
II.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
No Assets Available tbr Distribution to Heirs
RELATIONSHIP TO
DECEDENT
Do Not List Trustee(_~
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
AMOUNT OR SHARE
OF ESTATE
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 0O2993
ETZWEILER EARL RICHARD ESQUIRE
105 NORTH FRONT STREET
HARRISBURG, PA 17101
........ fold
ESTATE INFORMATION: SSN: 194-36-0440
FILE NUMBER: 2103-0742
DECEDENT NAME: CLEVER JEAN SARAH
DATE OF PAYMENT: 09/09/2003
POSTMARK DATE: 09/08/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 07/18/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $78.02
REMARKS.
TOTAL AMOUNT PAID'
EARL R ETZWEILER ESQUIRE
$78.02
SEAL
CHECK# 4337
INITIALS: VZ
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
!-~.$$ .MAIL
ID ASSI
! I
)unty Courthouse
Jills
{igb Streets
17013
BUREAU OF ZNDZVTDUAL TAXES
ZNHERTTANCE TAX DTVZS/ON
DEPT. 280601
HARRTSBURG, PA 17118-0601
CONHONNEALTH OF PENNSYLVANZA
DEPARTNENT OF REVENUE
NOTICE OF ZNNERZTANCE TAX
APPRAZSEHENT, ALLO#ANCE OR DZSALLOHANCE
OF DEDUCTIONS AND ASSESSNENT OF TAX
EARL RICHARD ETZWEILER
ETZWEILER & ASSOCIATES
105 N FRONT ST ~
HBG PA 1710!?,
DATE
ESTATE OF
DATE OF DEATH
FILE NUNBER
~OUNTY
ACN
REV-1647 EX AFP
10-21-2003
CLEVER JEAN
07-18-2003
21 03-0742
CUHBERLAND
101
Aaount Reait~ed
NAKE CHECK PAYABLE AND RENIT PAYNENT
REGISTER OF NILLS
CUNBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTICE OF TNHERZTANCE TAX APPRA]:SEHENT, ALLO#ANCE OR
DZSALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF CLEVER JEAN S FILE NO. 21 03-0742 ACN 101 DATE 10-21-2003
TAX RETURN #AS: (X) ACCEPTED AS FTLED ( ) CHANGED
RESERVATION CONCERNING FUTURE ]:N¥~.~EST - SEE REVERSF
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Reel Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
$. Closely Held Stock/Partnership /nterest (Schedule C) ($)
~. Nortgeges/Notes Receivable (Schedule D) (~)
$. Cash/Bank Deposits/Nisc. Personal Proper~y (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
APPROVED DEDUCTIONS AND EXEHPTIONS:
9. Funeral Expanses/Ada. Costs/Hisc. Expanses (Schedule H) (9)
10. Debts/Nortgege Liabilities/Liens (Schedule Z) (10)
11. Total Deductions
.00 NOTE: To insure proper
.00 credit to your account,
.00 subait the upper portion
.00 of this fora with your
.00 ~ex Payaent.
14,,176.24
.00
(8)
1,716.97
12.
15.
1~.
NOTE:
ASSESSHENT OF TAX:
15. Amount of Line 14 a~ Spousal rate
16. Aaoun~ of Line 14 taxable a~ Lineal/Class A rate
17. Amount of Line 14 et SibZing rate
18. Aaount of Line lq taxable at Colla)cerml/Class B rate
19. Principal Tax Due
TAX CREDTTS:
P&YHENT / RECEIP1
DATE NUHBER
09-08-2003 CD002993
2,432.07
(11)
14,176.24
Net Value of Tax Return (12)
Charitable/Governaen~al Bequests; Non-elected 911:3 Trusts (Schedule J) (13)
Net VaZue of Estate Subjec~ to Tax
Zf an assessment ~as lssued previously, 11nes
reflect figures that include the total of ALL returns assessed to date.
4.149.04
10,027.20
.00
10,027.20
.00
82.13
(15). 8,202.20 x O0 =
(16) 1,825.00 x 045=
(17) .00 x 12 =
(18) .00 x 15 =
(19)=
ZF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
DZ~CuUNT (+)
INTEREST/PEN PAID (-)
AHOUNT PAID
.00
.00
82.13
4.11
78.02
TOTAL TAX CREDIT
BALANCE OF TAX DUEJ
INTEREST AND PEN.
TOTAL DUE
82.13
.00
.00
.00
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT 1S RE~UZRED.
ZF TOTAL DUE ZS REFLECTED AS A 'CREDZT' (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF TH[S FORH FOR ZNSTRUCTZONS.)
RESERVATION:
Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collataral) beneficiaries of the decedent after the expiration of any estate for
1ifa or for years, the Commoneealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class S (collateral) rate on any such future interest.
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR)=
OBJECTIONS:
ADHIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act 25 of lOgO. (7Z P.S.
Section 91q0).
Detach the top portion of this Notice and submit aith your payment to the Register of Mills 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 on the Tax Return, may be requested by completing an "Application
for Refund of PannsyXvania Inheritance and Estate Tax" (REV-ISIS). Applications are availabXe at the Office
of the Register of Hills, any of the Z5 Revenue District Offices, or by ceiling the special Iq-hour
ansaering service for fores ordering: X-800-56Z-ZOSO; services for taxpayers eith special hearing and / or
speaking needs: X-800-4q7-50ZO (TT onXy).
Any party in interest not satisfied eith the appraisement, aXloeance, or disallowance of deductions, or assessment
of tax (including discount or interest) as sheen on this Notice must object within sixty (60) days of receipt of
this Notice by:
--arittan protest to the PA Department of Revenue, Board of Appeals, Dept. Z810Z1, Harrisburg, PA 171ZS-XOZX, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans* Court.
Factual errors discovered on this assessment should be addressed in ariting to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601
Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-lSD1) 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 ESI) discount of
the tax paid is allowed.
ThalST. 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 tiaa 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 tha data of payment. Taxes which became delinquent before January l, 198Z bear interest at the rate of
six (67.) percent per annum cmlculatad at a daily rate of .000164. All taxes which became delinquent on and 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 198Z through 2005 8re:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Yeast Rate Factor Year Rate Factor
198Z 2OZ .000548 1987 92 .000247 1999 7Z . Ooolez
1985 167. .000438 1988-1991 IZZ .000301 ZOO0 8X .000219
1984 112 .000501 199Z 9Z .000247 2001 92 .000247
1985 152 .000556 1995-1994 72 .000192 ZOOZ 62 .000164
1986 lOZ .000274 1995-1998 9Z .000Z47 ZOO3 5Z .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINI;IUENT X DAZEY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the data of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.