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Home My WebLink About02-09-12 (2) 1505610140 REV-1500 ~` ~°'-'°' PA Department of Revenue OFFICULL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN will not obat d Harrisburg, PA 17128-0601 RESIDENT DECEDENT ? T , ~ ~ ` ~ 7 ENTER DECEDENT INFORMATION BELOW _ Social Security Number Date of Death MMDDYYYY Date of Birth MAADDYYYY 2 0 1 1 8 3 3 2 8 0 4 2 3 2 0 1 1 Decedent's Last Name Suffix Decedent's First Name MI RUSSELL EARL R (B Applkable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI RUSSELL N E L L I E E Spouse's Social Security Number THIS RETURN MUST Bf FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ® 1.Original Retum ^ 2. Supplemental Retum ^ 3. Remainder Retum (date of death pnor to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Retum Required ^ 6. Decedent Died Testate ^ death after 12-12-82) 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Wilq (Attach Copy of Trust) ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date of death ^ 11. Election to tax under Sec. 9113(A) between 121-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATSHOULD BE DI~CTED T0: Name Daytime Teleph ber J OEL R. ZUL L I NGER ' '`~ 71 7 ~ 6~2 , , REGISTE US Y i s~x ; First line of address 1 4 NORTH MAI N STREET ~~ ~ . ~'i Second line of address .~- - x. S U I T E 2 0 0 City or Post Office State ZIP Code DATE FILED C H A M B E R S B U R G P A 1 7 2 0 1 CorrospondenYs e-mail address: under penattles ~ perjury, I dedare that I have examined this return, inducting accompanying schedules and statemeMa, and to the beat of my knowledge and belief, it is true. oorn3ct and complete. Dedaratbn of preparor other than the personal reprtive is based on all infomiatlon of which preparer has arty knowledge. SIGNATURE OF PF.R^~N RESPONSIBLE FOR FILING RETURN DATE i ~~ Aw w w 9 OF PRl:PAR6I~OTJd6R THAN 14'NORTH AAAIN SHIPPENSBURG PA 17257 SUIT 200 CHAMBERSBURG PA 17201 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610140 1505610140 1505610240 REV-1500 EX Decedents Social Security Number Deosaenrs Name: EARL R. RUSSELL 2 0 1 1 8 3 3 2 8 RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1. • 2. Stocks and Bonds (Schedule B) ...................................... 2. • 3. Glossy Held Corporation, Partnership orSole-Proprietorship (Schedule C) ..... 3. • 4. Mortgages and Notes Receivable (Schedule D) .......................... 4. • 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. • 6. JoiMy Owned Property (Schedule ~ ^ Separate Billing Requested ....... 6. 2 6 1 2 9. 5 1 7. Inter-Vnros Transfers & Miscellaneous N~Probate Property (Schedule G) S Bi eparate lling Requested ....... 7. 8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 2 6 1 2 9 , 5 1 9. Funeral Expenses and Administrative Costs (Schedule H) .................. 9. 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ...... ....... 10. • 11. Total DeductJons (total Lines 9 and 10) ........................ ....... 11. 12. Net Value of Estate (Line 8 minus Line 11) ..................... ....... 12. 2 6 1 2 9 . 5 1 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............... ....... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ............... ....... 14. 2 6 1 2 9. 5 1 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2)x.ooo 2 3 8 0 0.5 4 15. O. 0 0 16. Amount of Line 14 taxable at lineal rate X .045 2 3 2 8. 9 7 1 s. 1 0 4. 8 0 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17. 0. 0 0 18. Amount of Line 14 taxable at collateral Hate X .15 0. 0 0 ~ g, Q~ Q Q 19. TAX DUE ............................................... ....... 19. 1 0 4. 8 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610240 1505610240 REV-1500 EX Pape 3 Decedent's Complete Address: Flle Number 00 DECEDENTS NAME EARL R. RUSSELL STREET ADDRESS 9 Michael Court c~TM STATE ZIP Shi nsbu PA 17257 Tax Payments and Credits: ~ • Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (1) 104.80 Total Credits (A + g) (2) 0.00 (3) (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 104.80 Make check payable to: REGISTER OF WILLS, AGENT _ _,, , ,,,,, ,,,,,,,,, u,~,~,,,,uu 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 transfemed : ...................................................................... ^ 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. H death ocalrred after December 12,1982, did decedent transfer property within one year of death witfrout receiving adequate oonsideration? ....................................................................................... ^ 3. Did decedent own an 'in trust for' or payable-upon~eattl 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 benefiaary designafion? .................................................................................................. ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN For dates of death on or after July 1,1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [T2 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan.1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [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 benefiaary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [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 benefiaaries is 4.5 percent, 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 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV 1509 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY EARL R. RUSSELL _ will not Drobated ff an asset was made jointly owned within one year of the decedeM'a date of death, it must be reported on Schedule G. SURVMNG JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. Nellie E. Russell 9 Michael Court spouse Shippensburg, PA 17257 s. Jennifer N. Diehl 67 S. Strawberry Drive daughter Fayetteville, PA 17222 c. JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTIMION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET X. OF DECEDENT'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 1. A. 4/1991 Acct. #6140290414, Citizens Bank 10,431.03 50. 5,215.52 2. A 4/1998 Acct. #6140727162, Citizens Bank 13,973.56 50. 6,986.78 3. A 1/2003 Acct. #6240964757, Citizens Bank 7,669.69 50. 3,834.85 4. A 9/1995 Acct. #6100577759, Citizens Bank 15,526.77 50. 7,763.39 5. B 4/1998 Acct. #6140727162, Citizens Bank 13,973.56 16.667 2,328.97 TOTAL (Also enteron Line 6, Recapitulation) I S 26 129 51 If more spaoa is needed, use additlonal sheets of paper of the same sine. REV-1513 EX+ (01-10) ESTATE Pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT FILE EARL R. RUSSELL will not rotated RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Tnistee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [Indude ouu~~IggM I distributions and transfers under Sec.91f6(a (1.2).] 1. Nellie E. Russell Spousal 23,800.54 9 Michael Court Shippensburg, PA 17257 2. Jannifer N.Diehl Lineal 6,986.78 67 S. Strawberry Drive Fayetteville, PA 17222 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: L TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. s Ir more space Is neeaed, use aWitional sheets of paper ~ the same size. ~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES FILE N0. 21 PO BDx zeasgl enn Lvania AND HIIRRISBURC PA 171zs-o6o1 p ~ ACN 12100657 DEPARTMENT OF REVENUE TAXPAYER RESPONSE DATE 0 1- 0 4- 2 0 1 2 REY-1541 E% AFP (RS-11) TYPE OF ACCOUNT EST. OF EARL R RUSSELL ® SAVINGS SSN 201-18-3328 ~ CHECKING DATE OF DEATH 04-23-2011 ^ TRUST COUNTY CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FORMS T0: NELLIE RUSSELL REGISTER OF WILLS 9 MICHAEL CT 1 COURTHOUSE SQUARE SHIPPENSBURG PA 17257-8129 CARLISLE PA 17013 CITIZENS BANK OF PENNSYLVANIA provided the department with the information below, which was used in calculating the inheritance tax due. Records indicate that at the death of the above-named decedent, yeu were a Point owner/beneficiary of this account. If you are the SpoUSe Of the deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must notify the department of your relatlonship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2. If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. Please call 717-787-8327 with questions. COMPLETE PART 1 ~{,,pW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 6140290414 Date 04-19-1991 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance ~ 10,431.03 paym°nt to the Register of Wills. Nake check payable to "Register of Wills, Agent". Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART CHECK ONE BLOCK ONLY X 50.000 $ 5,215.52 X .15 $ 782.33 TAXPAYER RESPON~ NOTE: If tax payments are made within three months of the decedent's dat• of death, deduct a 5 percent discount on the tax due. Argr inheritance tax duo will become delinquent nine months after the date of death. A. ~ The above information and tax due is correct. C. ~ The above informs ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3^ below. Remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or return this notice to the Register of Wills-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 filed by the estate representative. PART If indicating a different tax rate, please state relationship to decedent: TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Data Established I 2. Account Balance 2 ~ 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 ~ 7. Tax Rate 7 X 8. Tax Due 8 ~ PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I reported above' are true, correct and eomplof• to the best of my knowledge and belief. HOME C ) WORK C ) TAXPAYE SIGNATURE TELEPHONE NUMBER DATE ~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES FILE N0. 21 Po sox zao6ol Pennsylvania AND ACN 12100660 HARRISBURG PA 17128-0601 DEPARTMENT OFREV£NUE TAXPAYE R R E S P O N S E DATE 01-04-20.12 REY-1543 EX I1FP (05-11) NELLIE RUSSELL 9 NICHAEL CT SHIPPENSBURG PA 17257-8129 EST. OF EARL R RUSSELL SSN 201-18-3328 DATE OF DEATH 04-23-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST ® CERTIF. CITIZENS BANK OF PENNSYLVANIA provided the department with the information below, which was used in calculating the inheritance tax due. Records indicate that at the death of the above-named decedent, you were a point owner/beneficiary of this account. If you are the spouse Of the deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but You must notify the department of your relationship to the deceased Dy checking Box C in PART 1 below and writing "spouse" in PART 2. If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. Please call 717-787-8327 with questions. CO?fpC~`1`E FART 1 BELOW ~"SEf REOERSf"SIDE FOR FIEIN6 ARD` PAY7 INSTRUC~i'IONS account No. 6140727162 Date 04-27-1998 Established Account Balance $ 13, 973.56 Percent Taxable X 16.667 Amount Subject to Tax $ 2,328.97 Tax Rate X .15 Potential Tax Due ~ 349.35 P~T TAXPAYER RESPONSE 1 To ensure proper credit to the account, two copies of this notice taust accompany payment to the Register of Wills. Make check payable to "Register of Wills, Agent". NOTES If tax payments are made within three months of the decedent's data of death, deduct a 5 percent discount on the tax due. Any inhoritance tax due will become delinquent nine months after the data of death. A. ~ The above intonation and tax-due is correct. Remit payment to the Register of Wills with two copies of this notica_to obtain CHECK a discount or avoid interest, or return this notice to the Resistor of Wills and ONE ~ an official assessment will be issued by the PA Department of Revenue. BLOCK 0 N L Y B. ~ Tha above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return filed by the estate representative. C. ~ The above infona ion is incorr ct and/or debts and deductions Complete PART 2~ d/ ~ were paid. an or PART below. PART If indicating a different tax rate, please state relationship to decedent: TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS LINE I. Date Established 1 2. Account Balance 2 ~ 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 - 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 ~ PART DEBTS AND DEDUCTIONS CLAIMED a DATE PAID PAYEE DESCRIPTION sMniiur oArn Under penaitys of par3ury, I declare that the facts I reported above ar•e true, correct and completY to the best of my knowledge and belief. HOME C ) WORK E ) TAXPA ER SIGNATURE TELEPHONE NUMBER DATE BUREAU OF INDIVIDUAL TAXES PO BOX 280601 Pennsylvania HARRISBURG PA 17128 0601 DEPARTMENT OF REVENUE REV-1543 EX AFP (t5 -11) PENNSYLVANIA INHERITANCE T INFORMATION NOTICE AND TAXPAYER RESPONSE C FILE N0. 21 ACN 12100659 DATE 01-04-2012 EST. OF EARL R RUSSELL SSN 201-18-3328 DATE OF DEATH 04-23-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: NELLIE RUSSELL REGISTER OF WILLS 9 MICHAEL CT 1 COURTHOUSE SQUARE SHIPPENSBURG- PA 17257-8129 CARLISLE PA 17013 TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. CITIZENS BANK OF PENNSYLVANIA provided the department with the information below, which was used in calculating. the inheritance tax due. Records indicate that at the. death of the above named decedent, you were a ,loint owner/beneficiary of this account. If y0U are the SpOUSe Of the deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must notify the deppartment of your relatlonship to the deceased by checking Box C in PART 1 below and writing "spouse" 1n PART 2. If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. Please call 717-787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND`PAYAENT INSTRUCTIONS Account No. 6140233194 Date 12-20-1996 To ensure prover credit to the account, two Established copies of this notice ^ust sccorpargF Account Balance $ 21 , 549.53 payrent to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 50. 000 Amount Subject to Tax ~` 10 774 77 NOTE: If tax payrents are rode within three , . ronths of the decedent's date of death, Tax Rate ~( , 1 Cj deduct a 5 percent discount on the tax due. Potential Tax Due $ 1 616 22 Any inheritance tax dus will becore delinquent , . nine ronths after the date of death. C. ~ The above inform ion is incorrect and/or debts and detluctions were paid. Corplete PART 2~ and/or PART ~ below. PART If indicating a different tax rate, please state relationship to decedent: TAX RETURN - CALCULATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts-and-Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Dua OF TAX ON JOINT/TRUST ACCOUNTS 1 Z ~ 3 X 4 ~ - 5 - 6 7 X 8 ~ PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID 1 TOTAL CEnter on Line 5 of Tax Computation] ; Under ponalties of perjury, I declare that the facts I reported adove are true, correct and complete to the-best of my knowledge and belief. HOME C ) WORK' c ) TAXPAYER SIGNATURE TEL PHONE NUMBER DATE A. ~ The above inforration and tax due is correct. Rerit payrent to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or return this notice to the Register of Wills and 0 N E an official assessrent will be issued by the PA Departrent of Revenue. BLOC K ~ B. ~ The above assot has been or will be reported and tax paid with the Pennsylvania inheritance tax return 0 N L Y filed by the estate representative. BUREAU OF INDIYIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 Pennsylvania DEPARTMENT OF REVENUE REY-1563 EX 11FP (35 -13) PENNSYLVANIA INHERITANCE T INFORMATION NOTICE AND TAXPAYER RESPONSE FILE N0. 21 ACN 12100658 DATE 01-04-2.012 NELLIE RUSSELL 9 MICHAEL CT SHIPPENSBURG PA 17257-8129 EST. OF EARL R RUSSELL SSN 201-18-3328 DATE OF DEATH 04-23-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT ® .SAVINGS CHECKING TRUST CERTIF. CITIZENS BANK OF PENNSYLVANIA provided the department with the information below, which was used in calculating the inheritance tax due. Records indicate that at the death of the above-named decedent, you were a ,ioint owner/beneficiary of this account. If .you are the Spouse of the deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must notify the department of your relationship to the deceased by checking Box C 1n PART 1 below and wrlting "spouse" in PART 2. If yyou believe the information is incorrect, please obtain written correction from the financial institution, attach a copy t6 this form and return it to the above address. Please call 717-787-8327 with questions. COMP'LETf 'PAtF~l BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 6240964757 Date 01-06-2003 To ensure prover credit to the account, two Established copies of this notice must accompany Account Balance ~ 7, 669.69 pavwent to the Repistar of Wills. Naka chock payable to "Register of Wills, Agent". Percent Taxable X 50.000 Amount Subject to Tax Tax Rate Potential Tax Due $ 3,834.85 X .15 $ 575.23 NOTE) If tax payments are made within throe months of the decedent's dat• of death, deduct a 5 percent discount on tho tax due. Am inheritance tax due will become delinquent nine months after the date of death. C. ~ The above intone ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART ~ below. PART If indicating a different tax rate, please state relationship to decedent: TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 2 ~ 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 ~ 7. Tax Rate 7 X 8. Tax Due g $ PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE P AID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) i ~~ Underpanalt~iss of perjury, I declare that the facts I reported above are true, correct and complete to the bast of my knowledge and belief. HOME C ) WORK- C ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE A. 1 I The above information and tax due is correct. LJ Remit payment to the Rapistar of Wills with two copies of this notiw to obtain CHECK a discount or avoid interact, or return this notice to the Register of Wills and ONE an official assessment will be issued by the PA Department of Revenue. BLOCK ~ B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return 0 N L Y filed by the estate representative. ~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES FILE N0. 21 PO BOX 290601 Pennsylvania AND ACN 12100656 HARRISBURG PA 17128-0601 DEPARTMENT OF REVENUE TAXPAYE R RE S P 0 N S E REV-1543 E% AFP (,5-11) DATE 01- 04 - 2012 NELLIE RUSSELL 9 MICHAEL CT SHIPPENSBURG PA 17257-8129 EST. OF EARL R RUSSELL SSN 201-18-3328 DATE OF DEATH 04-23-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. CITIZENS BANK OF PENNSYLVANIA provided the department with the information below, which was used in calculating the inheritance tax due. Records indicate that at the death of the above named decedent, you were a Joint owner/beneficiary of this account. If you are the SpoUSe of the deceased and any amount other than zero is reflected Delow on the Potential Tax Due line, note no tax may be due, but you must notify the deppartment of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2. If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. Please call 717-787-8327 with questions. COMPLETE PAR`T`"1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS account No. 6100577759 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due Date 09-29-1995 Established $ 31,053.57 X 50.000 $ 15,526.79 X .15 $ 2,329.02 To ensure proper credit to the account,-two copies of this notice must accompany payment to the Register of Wills. Mak• check payable to "Register of Wills, Agent^. NOTE: If tax payments are made within three months of the decedent's date of death, deduct a 5 percent discount on the tax due. Ary inheritance tax due will become delinquent nine months after the date of d•„tn_ C. ~ The above infona ion is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3~ below. PART If indicating a different tax rate, please state a relationship to deceden t: TAX RETURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established I 2. Account Balance 2 ~ 3. Percant.Taxable - 3 X _ _ 4. Amount Subject to Tax 4 _.. 5. Debts and beduetions 5 - 6. Amount Taxable 6 7. Tax Rat• 7 X 8. Tex Due g $ PART DEBTS AND DEDUCTIONS CLAIMED '' ^3 DATE PAID PAYEE DESCRIPTION AMOUNT Pern A. ~ The above information and tax due is correct. Remft payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or return this notice to the Register of Wills end 0 N E an official assessment will be issued by the PA Department of Revenue. BLOCK ~ 8. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return 0 N L Y filed by the estate representative. Under'penelties of Perjury, I declare that the facfsi I reported above are true, correct and comple't• to the best``of ~,y knowledge and belief. HOME C ) _.: WORK C ) TAXPAYER SIGNATURE TELEPHONE NUMBER DA~_ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES FILE N0. 21 PO BOX 280601 Pennsylvania AcN NARRISBUR6 PA 17128-0601 AND 12100661 DEPARTMENT OF REVENUE TAXPAYER RESPONSE DATE REY-1563 Ez ~FP (RS-,~~ 01- 04 - 2012 JANNIFER DIEHL 9 MICHAEL CT SHIPPENSBURG PA 17257-8129 EST. OF EARL R RUSSELL SSN 201-18-3328 DATE OF DEATH 04-23-2011 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST ® CERTIF. CITIZENS BANK OF PENNSYLVANIA provided the department with the information below, which was used in calculating the inheritance tax due. Records indicate that at the death of the above-named decedent, you were a ,joint owner/beneficiary of this account. If you are the spouse Of the deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" 1n PART 2. If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. Please call 717-787-8327 with Questions. COMPLETE'. PJ1ftT~T BELOW * SEE REVERSE SIDE- FOR FILING AND' PAYMEIIT INSTRUCTIifNS t No. 6140727162 Data 04-27-1998 Established Account Balance ~ 13, 973.56 Percent Taxable X 16.667 Amount Subject to Tax ~ 2,328.97 Tax Rate X .15 Potential Tax Due ~ 349.35 PART CHECK ONE BLOCK ONLY To ensure proper credit to the account, two copies of this notice ^ust accompany payment to the Register of Wills. Make check payable to ^Register of Wi11s, Agent". NOTE: If tax payments are made within three months of the decedent's date of death, deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent nine months after the dat• of death. A. ~ The above infonation and tax due is correct. C. ~ The above inforwa ion is incorrect and/or debts and deductions were paid. Complete PART ~2 and/or PART 3^ below. Remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or return this notice to the Register of Wills 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 filed by the estate representative. PART if indicating a different tax rate, Please state relationship to decedent: TAX RETURN - CALCULATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rata 8. Tax Dua PART 3^ DATE PAID PAYEE MED DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation] i Under penalties ofi periury, I declare that the facts I reported above are true, correct and complete to the bestt of my knowledge and belief. HOME C ) WORK C ) TAXPAYER SIGNATURE TELEPHONE NUMBER DATE OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 - 6 7 X 8 +~ DEBTS AND DEDUCTIONS