HomeMy WebLinkAbout03-0914COMNON#EALTH OF PENNSYLVANZA
DEPARTMENT OF REVENUE
BUREAU OF ZNDZVZDUAL TAXES
DEPT. 280601
HARRZSBURg, PA 171Z&-DG01
REV-I~,~5 EX AFP C09-00)
GORDON
PO BOX :53
CUMBERLAND
OKERSTROM ~,'~/J,~
HI 5q829'
f
ZNFORMATZON NOTZCE
AND
TAXPAYER RESPONSE
FZLE NO. Z!-03-~I~
ACH 031375:51
DATE 10-21-2003
TYPE OF ACCOUNT
;.ST. OF CELIA R VERTTN [] SAVZNSS
S.S. NO. :585-1~'-983q [] CHECKZNS
DATE OF DEATH 06-27-2003 [] TRUST
COUNTY CUMBERLAND [] CERTTF.
RENTT PAYNENT AND FORHS TO:
REGISTER OF HILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 1701:5
FZRST UNZON NATZONAL BANK has provided the Department aith the information listed baloa which has been used in
calculating the potential tax duo. Their records [nd[cate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. Zf you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this form and return [t to tho above address. This account [s taxable [n accordance a[th tho inheritance Tax Laws of tho Commonwealth
of Pennsylvania. Questions may be anseered by calling (717) 787-6~Z7.
COMPLETE PART 1 BELOH ~ ~ ~ SEE REVERSE SZDE FOR FZLZNG AND PAYMENT ZNSTRUCTZONS
Account No. 101000825q698 Date 01-10-2000
Established
Account Balance 1,297.90
Percent Taxable X 16.6 6 7
Amount Sub,oct to Tax ~16.3~
Tax Rate X .15
Potential Tax Due :SZ. (~5
PART TAXPAYER RESPONSE
To lnsura proper credit to your account, tee
(2) copies of this notice must accompany your
payment to tho Register of Hills. Hake check
payable to: "Register of #111s, Agent".
NOTE: Zf tax payments are mede a[th[n three
($) months of tho dacedent's date of death,
you amy deduct a 5Z discount of the tax due.
Any inheritance tax due all1 become delinquent
nine (9) months after the date of death.
A. [] The above information and tax due is correct.
I. You may choose to remit payment to the Rag[star of N[11s with tam cop[as of this not[ce to obtain
CHECK -~ a discount or avoid interest, or you may check box "A" and return this notice to the Register of
ONE #il~s and an official assessment will be issued by the PA Department of Revenue.
BLOCK J D. [] The abavo asset has been or alii be reported and tax paid with the Pennsylvania Tnharitancs Tax return
ONLY to be filed by the dscedent's representative.
C. [] Tho above information is incorrect and/or debts and deductions cora paid by you.
You must complete PART [] and/or PART [] below.
PART zf you indicate a different tax rate, please s~ate your
relationship to decedent:
TAX RETURN - COMPUTATZON OF TAX ON JOZNT/TRUST ACCOUNTS
LTN~
I. Da~a Established I
2. Account Balance 2
3. Percent Taxable 3 ~
~. Amoun~ Sub~act to Tax ~
S. Debts and Deductions 5
6. Amount Taxable 6
7. Tax Rate 7
8. Tax Due 8
PART
DATE PAID
DEBTS AND DEDUCTZONS CLAZMEn
PAYEE
DESCRIPTION AMOUNT PAID
I
TOTAL (Enter on Line S of Tax Computation)
Under penalties of perjury, Z declare that tho facts Z have reported above are true, corroc~ and
~c°~'~d boli.f. HOME ( ~/~-' ) ~',~- .7c~/-//~
/ / /
HORK ( ) /~
· TAXPAYER STGH-A~URE TELEPHONE NUMBER
GENERAL INFORMATION
1. FA/LURE TO RESPOND NZLL RESULT IN AN OFFICIAL TAX ASSESSHENT with applicable interest based on information
submitted by the financial institution.
Z. Inheritance tax becomes delinquent nine months after the dacadent's date of death.
5. A joint account is taxable even though the decedant's name was added as a matter of convenience.
6. 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.
5. Accounts established jointly between husband and wife acre than Dna 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 I - TAXPAYER RESPONSE
1. BLOCK A - If tho information and computation in the notice arm correct and deductions are not being cXaiaad, place an
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 Hills of the county indicated. The PA Department of Revenue will issue an official assessment
[Fore REV-1SeB 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 with the Pennsylvania [nheritancs
Tax Return filed by the decedent's representative; place an "X" in black "B" of Part ! of tho "Taxpayer Response" section. Sign one
copy and return to the PA Department of Revenue, Dureau of Individual Taxes, Oept 280601, Harrisburg; PA 17128-0601 in the
envelope provided.
5. BLOCK C - If the notice information is incorrect and/or deductions ara being claimed, check block "C" and complete Parts Z and 5
according to the instructions below. Sign two copies and submit thee 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-1568 EX) upon receipt
of the return from the Register of Hills.
TAX RETURN - PART Z - TAX COMPUTATION
LINE
1. Enter the date the account originally was established or titled in the manner existing at date of death.
NOTE: For a decedent dying after 1Z/II/D2: Accounts which the decedent put in joint names within 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 the number of accounts held.
If a double asterisk (ex) 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.
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 folloms:
A. The percent taxable for joint assets established more than one year prior to the decedant's death:
I DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE
JOINT OWNERS SURVIVING JOINT ONNERS
Example: A joint asset registered in the name of the decedent and two other persons.
I DIVIDED BY 5 [JOINT ONNERS) 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 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 two other persons and established within ons year of death by
the decedent.
1 DIVIDED BY Z [SURVIVORS) = .50 X 100 = SOX [TAXABLE FOR EACH SURVIVOR)
The amount subject to tax (line 6) is determined by multiplying the account balance (line Z) by the percent taxable (line 5).
S. Enter the total of thm debts and deductions listed in Part 5.
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 appropriate tax rate (line 7) as determined below.
Da4e of Dea4h I Spouse I Lineal Sibling Colle4erel
07/01/9q 4o 12/31/9q 3Z 6Z
01/01/95 4o 06/30/00 OX 6Z
07/01/00 4o presen4 OX
aThe tax rate imposed on the net value cf 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 OZ.
The lineal class of hairs includes grandparents, parents, children, and lineal descendents. "Children" includes natural 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, ahether or not 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 tn common with the decedent, whether by blood
or adoption. The "Collateral" class of heirs ~nc.ludes a11 other beneficiaries.
CLAIMED DEDUCTIONS - PART 5 - DEBTS AND DEDUCT[ONS CLAIMED
Allo~abla debts and deductions are determined as follo~s:
A. You lagally are re~onsJble for payment, or the estate subject to administration by a personal representative [s insufficient
to pay the deductible items.
B. You ac~al~y pa~d the debts a~ter death o~ the decedent and can ~rnJsh proo~ o~ payment.
C. Debts being cla~med must be ~temJzed Tully Jn Part 3. ~ add~tJona~ space Js needed; use plain paper 8 ~/2~ x ~. Proo~ o~
payment may be requested by ~e PA Department of Revenue.
COMMONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF ZNDIVZDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17118-D601
REV-I$,~S EX AFP (09-00)
ZNFORNATZON NOTICE
AND
TAXPAYER RESPONSE
FZLE NO. 21- 03-~ I~
ACN 03137532
DATE 10-21-2003
CONCETTA A OKERSTRON{'~~-Y"~"'~.)
PO BOX 33
CUNBERLAND WI ~,~54829
TYPE OF ACCOUNT
EST. OF CELIA R VERTIN []SAVINGS
S.S. NO. 385-12-9834 ~-~CHECKZNG
DATE OF DEATH 06-17-2005 [~TRUST
COUNTY CUNBERLAND ~]CERTIF.
REHIT PAYHENT AND FORHS TO:
REGISTER OF WILLS
CUNBERLAND CO COURT HOUSE
CARLISLE, PA 17013
FTRST UNION NATIONAL BANK has provided the Department with the information listed balaw ehich has baen used in
calculating the potential tax due. Their records indicata that at the death of the above decedant, you were a joint owner/beneficiary of
this account. Zf you leal 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 Pannsylvania. Questions may be answered by calling (717) 787-B327.
CONPLETE PART 1 BELOW ~ # # SEE REVERSE SIDE FOR FILING AND PAYNENT INSTRUCTIONS
Accoun~ No. 1010008254698
Da~e 01 - 1 O- 2000 To insure proper credit to your account, two
Established (z) copies of this notice must accompany your
Account Balance 1,297.90 payment to the Register of Rills. Hake check
payable to: "Register of Nills. Agent".
Percen~ Taxable X 1 6.6 67
Amoun~ Sub3ec~ ~o Tax 216.32 NOTE: If tax payments ara earle within three
(3) months of the dacadant's date of death.
Tax Rate X . [5 you may deduct a SZ discount of the tax due.
Any inheritance tax due will become delinquent
Po~en~ial Tax Due 32.45 nine (9) months after the date of death.
PART TAXPAYER RESPONSE
ii~i::~i~:~:z:~;~,~,~!,f,!!~,~,~!~,;,--~.~k~ ..................... ,~.,?~??,H=,~,~.=.=.:.:.~,:=~,.;,:~...,=,.,;.;,~:,~ ........ ~ ............... ,,.,,. ..... .;. ..........................................
A. ~ Tha above information and tax due is correct.
l. You may choose to remit payment to the Register cf Hills with too copies of this notice to obtain
CHECK -~ a discount or avoid interest, or you may check box "A" and return this notice to tha Register of
ONE Hills and an official assessment w/Il be issued by fha PA Dapartment of Revenue.
BLOCK J B. [] The above asset has been or will be reported and tax paid aith the Pennsylvania Inheritance Tax return
ONLY to be filed by the decadent's reprasentative.
C. ~Tha above information is incorrect and/or debts and deductions mare paid by you.
You must complete PART [] and/or PART [] baloa.
PART Zf you /ndica~e a d/fferen~ ~ax ra~e, please s~a~e your
relationship ~o decaden~:
TAX RETURN - CONPUTATZON OF TAX ON JOINT/TRUST ACCOUNTS
L/NE
1. Da~a Established
2. Accoun~ Balance
3. Percen~ Taxable
~. Aaoun~ SubSec~ ~o Tax
$. Debts and Deductions
6. A,oun~ Taxable
7. Tax Ra~e
8. Tax Due
PART
DATE PAID
3 X
6
8 ?,
DEBTS AND DEDUCTIONS CLAIP;n
PAYEE
DESCRIPTION
AHOUNT PAID
TOTAL (Enter on Line $ of Tax
Under pane/ties of perSury, T decZare tha~ ~he fec~s I have reported above ere ~rue, correc~ and
comp^late to the best of my kno. ledge and belief. HONE (~/~) ~'-
,~ ~ WORK (
TAXPAYER S[GNATURE TELEPHONE NUMBER
GENERAL INFORHATION
1. FAILURE TO RESPOND HILL RESULT IN AN OFFICIAL TAX ASSESSHENT with applicable interest based an 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 Nas added as a matter of convenience.
~. Accounts (including those held bat~aan husband and Nile) 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 ara not taxable.
6. Accounts held by a decedent "in trust for" another or others are taxable
REPORTING INSTRUCTIONS - PART I - TAXPAYER RESPONSE
1. BLOCK A - If the information and computation in the notice ars 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 Hills of the county indicated. The PA Department of Revenue will issue an official assessment
(Form REV-[S~B 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 with the Pennsylvania Inheritance
Tax Return filed by the dacedant's representative, place an "X' in block "B" of Part [ of the "Taxpayer Response" section. Sign one
copy and return to tho PA Department of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17IZB-0601 in the
envelope provided.
$. BLOCK C - If tho notice information is incorrect and/or deductions ara being claimed, check block "C" and complete Parts Z and 5
according to the instructions below. Sign two copies and submit them with your check for tho amount of tax payable to the Register
of Hills of tho 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 of Hills.
TAX RETURN - PART Z - TAX COHPUTATION
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 1Z/Il/BI: Accounts which 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 $5,000 per transferee regardless of the value of
the account or tho number of accounts ha[d.
If a double asterisk (Nm) 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 financia[ institution.
Enter the total balance of the account including interest accrued to tho 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 Dna year prior to the decadent's death:
1 DIVIDED BY TOTAL NUNBER OF DIVIDED BY TOTAL NUNBER OF X 100 = PERCENT TAXABLE
JOINT ONNERS SURVIVING JOINT OHNERS
Example: A joint asset registered in the name of the decedent and two other persons.
[ DIVIDED BY 3 (JOINT ONNERS) DIVIDED BY P (SURVIVORS) = .[67 X lO0 = 16.TI (TAXABLE FOR EACH SURVIVOR)
B.Tho percent taxable for assets created within one year of tho decedent's death or accounts owned by tho decedent but held
in trust for another individual(s) (trust beneficiaries):
I DIVIDED BY TOTAL NUNBER 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 within one year of death by
the decedent.
I DIVIDED BY Z (SURVIVORS) = .50 X 100 SOZ (TAXABLE FOR EACH SURVIVOR)
The amount subject to tax (line ~) is determined by multiplying the account balance (line Z) by the percent taxable (tine 3).
S. Enter the total of the debts and deductions listed in Part 3.
6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line l).
7. Enter the appropriate tax rate (line 7) as determined below.
Date of Death Spouse ] Lineal Sibling Collateral
07/01/94 to 12/$1/9q SZ 61 ISZ lSl
01/01/95 to 06/50/00 OX 6Z lSZ 15X
07/01/00 to present OX
eThe tax rate imposed on the nat value of transfers from a deceased child leanly-one years age er younger at
death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is OZ.
The lineal class of heirs 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 ell children of the
natural parents end their descendents, whether or not 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 in common with the decedent, whether by blood
or adoption. The "Collateral" class of heirs inc[udes a[l other beneficiaries.
CLATNED DEDUCTIONS - PART $ - DEBTS AND DEDUCTIONS CLA[HED
Allowable debts and deductions are determined as
A. You legally are respansible for payment, or the estate subject to administration by a persona[ 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, use plain paper 8 l/Z" x 11". Proof of
payment may be requested by the 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.
CD
REV-1162 EX(11-96)
003194
OKERSTROM GORDON &
OKERTROM CONCETTA A
P O BOX 33
CUMBERLAND, WI 54829
........ fold
ESTATE INFORMATION: SSN: 385-12-9834
FILE NUMBER: 2103-091 4
DECEDENT NAME: VERTIN CELIA R
DATE OF PAYMENT: 11/03/2003
POSTMARK DATE: 1 0/30/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 06/27/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
03137531 $9.73
03137532 $9.73
TOTAL AMOUNT PAID:
$19.46
REMARKS: GORDON & CONCETTA OKERSTROM
SEAL
CHECK# 5087
INITIALS: JA
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
GORDON OKERSTROM
PO BOX 33
CUMBERLAND WI 54829
COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAXSEHENT~ ALLOHANCE OR DXSALLOHANCE
OF' DEDUCTIONS, AND ASSESSNENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
DATE 06-21-2004
ESTATE OF VERTIN CELIA
DATE OF DEATH 06-27-2003
FILE NUMBER 21 03-0914
COUNTY CUMBERLAND
SSN/DC 385 - 12 - 9834
ACN 03137531
Amount Remitted I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE k RETAIN LOWER 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 06-21-2004
ESTATE OF VERTIN CELIA R DATE OF DEATH 06-27-2003 COUNTY CUMBERLAND
FILE NO. 21 03-0914 S.S/D.C. NO. 385-12-9834 ACN 03137531
TAX RETURN WAS: eX} ACCEPTED AS FILED ( } CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: FIRST UNION NATIONAL BANK ACCOUNT NO. 1010008254698
TYPE OF ACCOUNT: C ) SAVINGS C ~ CHECKING C ) TRUST C ) TIME CERTIFICATE
DATE ESTABLISHED 01-10-2000
Account Balance 1,297.90
Percent Taxable X 0.166
Amount Subject to Tax 216.52
Debts and Deductions - ,00
Taxable Amount 216.32
Tax Rate X .45
Tax Due 9.73
TAX CREDITS:
NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH~iY~UR TAX PAYMENT TO THE
REGISTER OFf'WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
c
OR MONEY ORDER PAYABLE TO:
"REGISTER O~..WILLS, AGENT"
PAYMENT
DATE
10-50-2003
RECEIPT
NUMBER
CD003194
DISCOUNT C+)
INTEREST/PEN PAID C-)
.00
AMOUNT PAID
9.75
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
9.75
.00
.00
.00
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 CR}, YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ~
PURPOSE OF
NOTICE:
To fulfill the requirements of Section 2140 of the Inheritance and Estate T= Act, Act 25 of 2000. (72 P.S.
Section 9140).
PAYMENT=
Detach the top portion of this Notice and submit ,ith your payment to the Register of Wills printed on the
reverse side.
-- Make check or money order payable to: REGISTER OF WILLS, AGENT.
REFUND (CR)=
OBJECTIONS=
ADMIN-
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 "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications are available at the Office of
the Register of Wills, any of the 23 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=
1-800-447-3020 (TT only).
Any party in interest not satisfied w~th the appraisement, allowance, or disallowance of deductions or assessment
of tax (including discount or interest) as shown on this Notice may ob§mci within sixty C&O) 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. 280&01, Harrisburg, PA 17128-0&01
Phone C717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" CREV-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 n~ne (9) months and one (1) day
from the date of death, to the date of payment. Taxes which became delinquent before January I, 1982
bear interest at the rate of six C&X) percent per annum calculated at a daily rate of .000]64.
All taxes which became delinquent on or after January l, 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'~ 20% .000548 1988-1991 11% .000301 2001 9% .0002~7
1983 16~ .000438 1992 9X .000247 2002 &X .000219
1984 11X .000301 1993-1994 7~ .000192 2005 5~ .000157
I985 13~ .00035& 1995-1998 9X ,000247 2006 4X .000110
1986 10~ .000274 1999 7~ .000192
1987 9X .000247 2000 8~ .000219
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUIJBER OF DAYS DELINQUENT X DAILY 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 shown on the
Notice, additional interest must be calculated.
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 2806nl
HARRISBURG, PA 17128-0601
CONCETTA A OKERSTROM
PO BOX 35
CUMBERLAND WI 54829
COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE
NOTTCE OF XNHEB/TANCE TAX
APPRATSEHENT. ALLORANCE OR DXSALLONANCE
OF DEDUCTTONS, AND ASSESSHENT OF TAX ON
JOXNTLY HELD OR TRUST ASSETS
DATE 07- 1.`%-2004
ESTATE OF VERTIN
DATE OF DEATH 06-27-200.'5
FILE NUMBER 21 0`%-0914
COUNTY CUMBERLAND
SSN/DC -%85 - 12 -
ACN 0-%1-%75-%2
Amount Remitted I
REV-1568 EX AFP C01-05)
CELIA
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 1701-%
CUT ALONG THIS LINE
RETAIN LOWER PORTION FOR YOUR RECORDS
REV-1548 EX AFP COl-OS)
NOTICE OF XNHERXTANCE TAX APPRAXSEMENT, ALLOWANCE OR DXSALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 07-1-%-2004
ESTATE OF VERTIN
CELIA R DATE OF DEATH 06-27-200-%
COUNTY CUHBERLAND
FILE NO. 21 03-0914 S.S/D.C. NO. -%85-12-9854 ACN 0-%1575-%2
TAX RETURN WAS: eX} ACCEPTED AS FILED ¢ ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: FIRST UNION NATIONAL BANK ACCOUNT NO. 1010008254698
TYPE OF ACCOUNT: ( ) SAVINGS ¢~ CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 01-10-2000
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
1,297.90
o.166
216.52
.00
216.`%2
.45
9.75
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:
"REGISTER OF~WILLS, AGENT."
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID
10-$0-200`% CD005194 .00 9.75 '-
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. )
9.7`%
.00
.00
.00
PURPOSE OF
NOTICE=
PAYMENT:
REFUND CCR):
OBJECTIONS=
ADNIN-
ISTRATIVE
CORRECTIONS=
DISCOUNT=
PENALTY
INTEREST=
To fulfill the requirements of Section 2140 of the [nheritance and Estate Tax Act, Act 25 of 2000. C72 P.S.
Section 9140).
Detach the top portion of this Not/ce and submit with your payment to the Rag/s/er of N/lls pr/n/ed on the
reverse side.
-- Make check or money order payable to= REGISTER OF NILLS, AGENT.
A refund of a tax cred/t, which was not requested on the tax return/ may be requested by complet/ng an "Appl/cat/on
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications are available at the Off/ce of
the Register of N/11s, any of the 25 Revenue Distr/ct Off/cms or by call/ng the spec/al 24-hour answer/rig serv/ce
for forms order/ng= 1-800-$62-2050; serv/ces for taxpayers with spec/al hear/rig and or speak/ng needs=
1-800-~47-$020 CTT
Any party tn /nterest not sat/sf/ed w/th the appra/sement, allowance, or disallowance of deduct/ohs or assessment
of tax C/ncluding d/scount or /nterest) as shown on this Notice may object within s/xty (&O) days of receipt of
th/s Not/ce by=
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR
--elect/ng to have the matter de/era/ned at the aud/t of the account of the personal representat/ve, OR
--appeal to the Orphans' Court
Factual errors discovered on th/s assessment should be addressed in writing to= PA Department of Revenue,
Bureau of Indiv/dual Taxes, ATTN= Post Assessment Rev/mw Un/t, DEPT. 280601, Harrisburg, PA 17128-0601
Phone C717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Res/dent
Decedent" GREY-1501) for an explanation of administratively correctable errors.
If any tax due /s pa/d within three C$) calendar months after the decedent's death, a five percent (SX)
d/scount of the tax paid is allowed.
The 15% tax amnesty non-part/cipat/on penalty is computed on the total of the tax and interest assessed, and not
paid before Januar~ 18, 199&~ the f/rs/ da~ after the end of the tax amnesty per/od. This non-part/c/pat/on
penalty is appealable /n the same manner and /n the the same time period as you would appeal the tax and interest
that has been assessed as /nd/ca/ed on this notice.
Interest is charged beginning w/th f/rs/ day of del/nquency, or n/ne C9) months and one C1) 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 slx (6%) percent per annum calculated at a daily rate of .000164.
All taxes wh/ch became delinquent on or after January 1, 1982 will bear /nterest at a rate which will vary from
calendar year to calendar year w/th that rate announced by the PA Department of Revenue. The applicable
interest rates for 1982 through 2004 are:
Interest Daily Interest DaLly Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 20% .000548 198-'~'8-1991 11% .000501 200~ 9% .000247
1985 16% .000~38 1992 9X .000247 2002 G% .000219
1984 11% .00030! 1993-1994 7% .000192 200S 5~ .000137
1985 13% .O0035& 1995-1998 9% .000247 2004 4% .000110
1986 10% .000274 1999 7~ .000192
1987 9% .0002~7 2000 8~ .000219
--Interest is calculated as follows=
TN/T. REST = BALANCE OF TAX UNPATD X NUNBER OF DAYS DELTNQU~NT X DATLY TNTEREST FACTOR
--Any Not/ce issued after the tax becomes delinquent w/11 reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the /nterest computation date sho~n on the
Notice, additional /nterest must be calculated.