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HomeMy WebLinkAbout04-27-12REGISTER OF WILLS ~ (- I a- I ~~ CLERK OF ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF YORK COUNTY YORK COUNTY JUDICIAL CENTER BRADLEY C. JACOBS Register of Wills Clerk of Orphans' Court JOHN C. HERROLD Solicitor Apri126, 2012 Glenda Farner Strasbaugh Cumberland County Courthouse One Courthouse Square, Room 102 Carlisle, PA 17013 RE: Estate of Marlene R. Poplaski Date of Death: 12/21/11 Your File No. 2112-0011 Dear Glenda: ARA KIMBERLY McPHERSON Chief Deputy Register of Wills BECKY K. FOUST Chief Deputy Clerk of Orphans' Court Division Estate of Joan S. Calvert Date of Death: 02/02/12 Your File No. 2112-0167 Pursuant to the correspondence from the Department of Revenue dated April 17, 2012 (courtesy copy enclosed), please find enclosed herewith the original paperwork that we have in our files for the above-referenced estates. Sincerely, A~~- Bradley C. J bs Register of Wills ~.. , ~ N Enclosures ~ m ~ ~' ~ ~ N ~-,,.~.r. --, D -; ~',~ rn cn ~ p -- r.. n 45 NORTH GEORGE STREET YORK, PA. 17401-1240 REGISTER OF WILLS (717) 771-9607 • CLERK OF ORPHANS' COURT (717) 771-9288 FAX: (717) 771-4678 www.york-county.org ;~ ~ pennsylvania DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES April 17, 2012 MR. BRADLEY C. JACOBS REGISTER OF WILLS YORK COUNTY JUDICIAL CENTER 45 N GEORGE ST YORK, PA 17401 Telephone 717 787-8327 Re: Estate of MARLENE R. POPLASKI File Number: 2112-0011 County: CUMBERLAND Dea ister of Wills: Th ject decedent le resided in CU LA as of the d death. Acc gly, you are auth ed to cancel fil mbe 12-0499. All matters nceming this estat uld be maintain der COMB ND my File Number 211 011. All original In a ance Tax docu or the sub dent should be d to the CUMBERLAND County Register of Wills; however, you may wish to retain a copy, including photocopies of all receipts for the collection of Inheritance Taxes in the subject estate which have been issued by your office. Please contact me at the telephone number above if you have any questions Fulmer, Supervisor ance Tax Division ~ ~_ ,~, ~ - ( v ,' :7J ~ N ~,i i r. 7 CJ>~ ` C7 c'7 Sa ' --n r~ U "'f'1 ~ '._3. ~. 7 ~-- ~) ~ ~ "' (T1 -~-1 ~ Lry (-'7 ... .. DePa _ ..,.._.... _. ..~._ .. .. .,_.._. _.... _,_. ~._....,. ____._.. ._._ _. _. ... _ _... .. __ rtment of Revenue I PO Box 2806011 Harrisburg, PA 17128 1 717.787.8327 1 www.revenue.state.pa.us CommornwWh of Pennaylv~ia Deparanarrt of Rwarwa REV-1182 EX(11~86) Buroau o1 Individual Taxes tPl~aomsa,ry,~Pasiil2a-0sos PENNSYLVANIA INHERITANCE AND ESTATE TAX YK023132 OFFICWL RECEIPT RECEIVED FROM: STEVE F. POPLASKI 12 MORARI DR DILLSBURG, PA 17019 SSN: 161-30187 FILE NUMBER: DECEDENT NAME: DATE OF PAYMENT: POSTMARK DATE: COUNTY: DATE OF DEATH: 6712-0488 POPLASKI, MARLENE, R 03/16/2012 12:48:49 PM 03115/2012 YORK December 21, 2011 ACN AMOUNT 12100445 $1,100.56 12100446 $861.30 TOTAL AMOUNT PAID: $1,961.86 REMARKS: Check Check 6712-0499 MARLENE R.POPLASKIESTATE Check#134 Amount: $1,100.56 Check # 134 Amount: $861.30 RECEIVED BY: JO 03116/201212:48:48 PM ~t ~E°~.rc~c~ Regis of Wills Seal BRADLEY C. JACOBS Register of Wills & Clerlc of Orphans' Court My Commission Expires First Monday, January, 2016 This copy: Register of Wills BUREAU OF INDIVIDUAL TAXES PU BOX 280601 HARRISBURG PA 17128-0601 ~ I~ENNI~YLVAN~A INHERITANCE TAX INFORMATION NOTICE FILE N0. 671a`O~Qq pennSylvania AND AcN 12100445 DEPARTMENT OF REVENUE TAXPAYER RESPONSE DATE 01-03-2012 REY-1543 EX XFP [RS-III STEYE F POPLASKI 12 MORARI DR DILLSBURG PA 17019-1555 EST. OF MARLENE R POPLASKI SSN 161-30-4187 DATE OF DEATH 12-21-2011 COIINTY YORK REMIT PAYMENT AND FORMS T0: REGISTER DF WILLS 45 NORTH GEORGE STREET YORK PA 17401-1240 TYPE OF ACCOUNT SAVINGS CHECKING ® TRUST CERTIF. MEMBERS 1ST FCU 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 ,l oint owner/beneficiary of thfs account. If y0U are the SpOUBe 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 de artment 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 1s incorrect, Dlease obtain written correction from the financial institution, attach a copy to this form and return ft to the above address. Please call 717-787-8327 with questions. COMPLETE PART 1 BELOW x SEE REVERSE SIDE FOR FILING ANB PAYMENT INSTRUCTIONS Account No. 47846-43 Date 04-OB-2011 To ensure proper credit to the account, two Established copies of this notice oust accoapany Account Balance ~ 25 7 4 3 . 9 $ payaent to the Register of Wills. Nake check ~ pavabla to "Register of Wills, Agent". Percent Taxable X 100.00 NOTE: If tax pavaents era aade within three Amount Subject to Tex ~ 25,743.9$ aonths of the decedent's date of death, Tax Rdte X . 0 4 5 ~~ deduct a 5 De reent discount on the tax due. Arc,+ inheritance tax due will becoae delinquent Potential Tax Due ~ 1 . 1 5 `~ Q © ~ nine aonths after th• date of death. PART TAXP YER RESPONSE A. ~ Th• above inforaation end tax due is correct. JLJ~ Raait paYaant 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 C ONE ~ an official assessaent will b• issued by the PA Depertaent of Revenue. BLOCK B. ~ The above asset has been or will be reported and tax paitl with the Pennsylvania inheritance tax return ON L Y filed by the estate representative. C. ~ The above inforaa ion is incorr ct andJor debts and deductions were Daid. CoaDlet• PART ~2 and/or PART 3~ below. PART If indicating a different tax rate, Dlease state O relationship to decetlent: TAX RE TURN - CALCULATION OF TAX ON JOINTlTRUST 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 8 PART DEBTS AND DEDUCTIONS CLAIMED t (-' ~ cn DATE P AID PAYEE DESCRIPTION AMOUNT PAID Under p alties of perjury, I declare that the facts I reportetl above are-t7rue, cornreet and6/~ compl o o f m kn ledge and belief . HOME C 7~ ! ) ~~d ' ~~ 7 WORK ( ) -/!~/,~ TAXPAYER SI6NATUR TELEPHONE NUMBER DATE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT Nlth applicable interest based on infoMation subwittetl by the financial institution. 2. Inheritance tax becowes delinquent nine wonths after the decedent's date of death. i. A joint account is taxable even when the decedent's nave was added as a wetter of convenience. 4. Accounts (including those held between husband and wife) the decedent Dut in joint naves within one year prior to death are fully taxable. 5. Accounts established jointly between husband and wife pore than one year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are fully taxable. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the inforwetion and calculation in the notice are correct and deductions are not being elaiwed, place an "X" in Block A of Part 1 of the "Taxpayer Response" section. Sign two copies and subwit thew with a check for the awountof tax to the register of wills of the county indicated. The PA Dapartwent of Revenue will issue an official assesswent (Forty REV-1548 IX) upon receipt of the return frow the register of wills. 2. BLOCK B - If the asset specified on this notice has been or will be reported and tax Daid with the Pennsylvania inheritance tax return filed by the estate's representative, place an "X" in Block B of Part 1 of the "Taxpayer Response" section. Sign two copies and return to the register of wills of the county indicated. 3. BLOCK C - If the notice inforwetion is incorrect and/or deductions are being claiwed. check Block C and cowplete Parts 2 and 3 according to the instructions below. Sign two copies and subwit thaw with your check for the awount of tax payable to the register of wills of the County indicated. The PA Dapartwent of Revenue will issue an official assesswent CForw REV-1548 EX) upon receipt of the return frow the register of wills. TAX RETURN - PART 2 - TAX CALCULATION LINE 1. Enter the date the account originally was established or titled in the wanner existing at date of death. NOTE: For a decedent who died after l2/12/82, accounts the decedent put in joint naves aithin one year of death are fully taxable. However, there is an exclusion not to exceed 13.000 per transferee, reps rdless of the value of the account or the nuwber of accounts held. If a double asterisk Cvr) appears before Your first nave in the address portion of this notice, the 13,000 excl~pn was deducted frog the account balance as reported by the financial institution, /~~ 2. Enter tha total balance of the account including interest accrued to the date of death. y A 3. The percentage of the account that is taxable to each survivor is deterwined as follows: b~~ ~CD A. The percentage taxable of joint assets established sore than one year prior to the decedent's death: ~'1 e 1 DIVIDED 8Y TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF MULTIPLIED BY 100 = PERCENT TAXABLE ~ 9 ?O,~ JOINT OWNERS SURVIYING J07NT OWNERS Exawple: A jointasset ~e9istered in the nave of the decedent and two other persons: ~ - 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) _ .167 X 100 = 16.7 percent (TAXABLE 70 EACN SURVIVOR) B. The percentage taxablefor assets created within one year of the decedent's death or accounts owned bi' the decedent but held in trust for another individual(s) Ct rust benef ieia ries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT MULTIPLIED BY 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Exawple: Joint account reeistered in the nave of the decedent and two other versons and established within one year of death by the decedent. 1 DIVIDED BY 2 CSURV IV ORS) _ .50 X 100 = 50 percent (TAXABLE FOR EACH SURVIVOR) 4. The awount subject to tax (Line 4) is deterwined by wultiplyin9 the account balance Cline 2) by the portent taxable (Line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The awount taxable (Lino 6) is deterwined by subtracting the debts and deductions (Line 5) frow the awount subiect to tax (Line 4). 7. Enter the appropriate tax rata (Line 7) as deterwined below. Data of Death Spouse Lineal SSb11ng Collateral D7/O1/94 to 12/31/94 3.percent 6 percent 15 percent 15 percent 01/01/95 to 06/30/00 0 percent 6 percent 15 percent 15 percent 07/01/00 to present 0 Percent 4.5 percent ~ 12 percent 15 percent sThe tax rat' fwDOSad on the net value o transfers frog a deceased child 1 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 B percent. The lineal class of heirs includes grandparents, Parents, children and other Lineal descendents. "Children" includes natural children whether or not then have been adopted by others, adopted children and stop children. "Lineal descendents" includes all children of the natural parents end their descendents, whether or not they have been adopted by others; adopted descendents and their descendants; and step-descendents. "Siblings" era defined as individuals who have at least one parent in cowwon with the decedent, whether by Mood or adoption. The Collateral class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED All owa6le debts and deductions are deterwined as follows: A. You are legally responsible for paywent, or the estate subiect to adwinistration by a personal representative is insufficient to pav the deductible itews. 8. You actually paid the debts after the death of the decedent and tan furnish Proof of paywent. C. Debts being elaiwed wust be itewized fully in Part 3. If additional space is needed, use 8 1/2" x 11" sheet of paper. Proof of paywent ^ay be requested by the PA Dapartwent of Revenue. ~ PENNSYLVANIA INHERITANCE TAX BUREAU OF INDIVIDUAL TAXES INFORMATION NOTICE FILE N0. 67~a1 -04'49 PO BOX 260601 pennsylvania HARRISBURG PA 17126-0601 AND ACN 12100446 DEPARTMENT OF REVENUE TAXPAYER RESPONSE DATE 01-03-2012 REY-154d EX 4FP [IS-Ill STEVE F POPLASKI 12 MORARI DR DILLSBURG PA 17019-1555 MEMBERS 1ST FCU provided the department with the information below, which was used in calculating the inheritance Lax 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 15 reflected below on the Potential Tax Due line, note no tax may be due, but you must notify the deUDartment oP your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2. if you believe fhe 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. CONPLETE PART 1 BELOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 47846-52 Date 06-24-2011 7a ensure proper credit to the account, two Established copies of this notice oust accompany Account Balance ~ 20,147.42 payment to the Register of Wills. Make cheek payable to "Register of Wills, Agent". EST. OF MARLENE R POPLASKI SSN 161-30-4187 DATE OF DEATH 12-21-2011 COUNTY YORK REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 45 NORTH GEORGE STREET YORK PA 17401-1240 TYPE OF ACCOUNT SAVINGS CHECKING © TRUST CERTIF. Percent Taxable X 100.00 Amount Subject to Tax g 20,147.42 NOTE, If tax payments are made within three C months of the decedent's data of death, Tax Rate ~( , 0[f `?! deduct a 5 percent tliscqunt on the tax due. Potential Tax Due ~ 9 0 1 Any inheritance tax due will becoaa delinquent nine months after the data of death P~r TAXPA ER RESPONSE 1 A, ~Tha above info nation and tax due is correct. Ram1t 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 NE 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 ONLY filed by the estate representative. C. ~ The above informs 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 B ~` PART DEBTS AND DEDUCTIONS CLAIMED 3 DATE PAID PAYEE DESCRIPTION AMOUNT PAID 70TAL (Enter on Line 5 of Tax Computation) ~ Under pe lties of p riury, I d•cla re that the facts I reported above are tru{~e, correctp and temple o e s ow ge nd belief. HOME C 7/7)7,-~~7~ WORK ( ) ___~! XPAYER SIGNATURE TELEPHONE NUMBER DATE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on inforaation subwittetl by the financial institution. 2. Inheritance tax becowes delintluent nine wonths after the decedent's date of death. 3. A joint account is taxable even when the decedent's nave was atlded as a setter of cpnvenience. 4. Accounts (including those held between husband and wife) the decedent put in joint nacres within one year prior tp death are fully taxable. 5. Accounts established jointly between husband antl wife sore than one Year Drior to death are not taxable. 6. Accounts held try a decedent "in trust for" another or others are ful lv taxable. REPORTING INSTRUCTIONS - PART I - TAXPAYER RESPONSE 1. BLOCK A - If the inforaation and calculation in the notice are correct and deductions are not being claiwed, place an '•X° in Block A of Part 1 of the "Taxpayer Response" section. Sign two copies and subwit then with a check for The awount of tax to the register of wills of the county indicated. The PA Department of Revenue will issue an official assesswant (Fo rn REV-1548 EX3 upon receipt of the return frog the register of wills. 2. 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 estate's representative, place an "X" in Block B of Part 1 of the "Taxpayer Response" section, Sign two copies and return to the register of wills of the county indicated. 3. BLOCK C - If the notice inf orration is incorrect and/or deductions are being claiwed, chock Block C and cowplete Parts 2 and 3 accortling to the instructions below. Sien two copies and subwit thae with Your check for the awount of tax payable to the register of wills of the county indicated. The PA Devartwent of Revenue will issue an official assesswent (Fort REV-1548 IX) upon receipt of the return frow the register of wills. TAX RETURN - PART 2 - TAX CALCULATION LINE 1. Enter the date the account originally was established or titled in the wanner existing at date of death. NOTE: For a decadent who died after 12/12/82, accounts the decedent puL in joint maces within one year of death are fully taxable, However, there is an exclusion not to exceed 6,000 per transferee, regardless of the value of the account or the nuwber of accounts held. If a double asterisk Ixs) appears before Your first nave in the atldrass portion of this notice, the f3,000 exclusion was deducted frow the account balance as reported 6v the financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. SC~~ 3. The percentage of the account that is taxable to each survivor js detanined as follows: y ~~D A. The percentage taxable pf joint assets established core Shan one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF MULTIPLIED BY 100 = PERCEN~~7C~6~„E 20j~ JOINT OWNERS SURVIVING JOINT OWNERS ~-~"~~~~'(( ~``~J Exawvle: A joint asset registered in the naae of the decetlent and two other Dersons: 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) _ .167 X 100 16.7 percent (TAXABLE TO EACH SURVIVOR) B. the percentage 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 SURV IYIN6 JOINT MULTIPLIED BY 100 = PERCENT TA7fA81E OWNERS OR TRUST BENEFICIARIES Exawple: Joint account registeretl in the nave of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50 percent (TAXABLE FOR EACH SURV IYOR) 4. The awount subject to tax (Line 4) is deterwined by wultiplying the account balance (Line 2J by iha percent taxable ILine 3). 5. Enter the total of the debts and deductions listed in Pert 3. 6. The awount taxable IL ine 6) is deterwined by subtracting the debts and deductions [Line 5) frow the awount subject to tax (Line 4). 7. Enter the appropriate tax rate tL ine 7) as deterwined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3 percent 6 percent 15 percent 15 percent 01/01/95 to 06/30/00 0 percent 6 percent 15 percent 15 percent 07/01/00 to present 0 percent 4.5 percent ~ 12 percent 15 percent Kane tax rata vposed on the net value or transrers trove a deceased cnuo a years or 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. The lineal class of hairs includes prantlparent s, parents, children and other lineal descendents. "Chiltlren" includes natural children whether or not that Aeve been adopted by others, adopted children and step children. "Lineal descendants" 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-descendents. "Siblings" are defined as individuals who have at least one parent fn cowwon with the decetlent, whether by blood or atloption. The Collateral class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED All owabl• debts and deductions are deterwined as follows: A. You are legally responsible for paywent, or the estate subject to adrinistration by a personal representative is insufficient to pay the deductible itews. 8. You actually Daid the debts after the tleath of the decetlent antl can furnish proof of paywent. C. Debts being claiwed roust be itewized fully in Part 3. If additional space is nestled, use 8 1/2" x 11" sheet of paver. Proof of paywent way be requested by the PA Devartwent of Revenue. CommarweWUi d Pennsylvania Department d Revenue REV-1162 EX(11-06) Burew d Indivitlual Taxes Nanieburp, P80nii1zs-0eoa PENNSYLVANU4 INHERITANCE AND ESTATE TAX YK023133 OFFICIAL RECEIPT RECEIVED FROM: THERESA L. LONCAR 836 SILVER LAKE ROAD LEWISBERRY, PA 17339-9746 SSN: 161-30-4187 FILE NUMBER: 6712-0499 DECEDENT NAME: POPLASKI, MARLENE, R DATE OF PAYMENT: 03/16!2012 12:58:23 PM POSTMARK DATE: 03/15/2012 COUNTY: YORK DATE OF DEATH: December 21, 2011 ACN AMOUNT 12100443 $1,100.56 12100444 $861.30 TOTAL AMOUNT PAID: $1,961.86 REMARKS: 6712-0499 PERSONAL CHECK Check Check#4196 Amount: $1,100.56 Check Check # 4196 Amount: $861.30 RECEIVED BY: KS 03/16/201212:58:23 PM .Seal ~7~JP+~J~t{ Regis r of Wills BRADLEY C. JACOBS Register o[ Willa & Clerk of Orphrns' Court My Commission Expires First Monday, January, 2016 This copy: Taxpayer BUREAU OF INDIVIDUAL TAXES PO BOX 280601 IIARRISBUR6 PA 17128-0601 Pennsylvania DEPAflTMENT OF REVENUE REY-15x3 EY AFR <BS-I1) PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE AND TAXPAYER RESPONSE THERESA L LONCAR 836 SILVER LAKE RD LEWISBERRY PA 17339-9746 FILE ND. 67~a - ~L~4~ ACN 12100443 DATE 01-03-2012 EST. OF MARLENE R POPLASKI SSN 161-30-4187 DATE OF DEATH 12-21-2011 COUNTY YORK REMIT PAYMENT AND FORMS TO:. )REG1sTER OF WILLS 45 NORTH GEORGE STREET YORK PA 17401-1240 V TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST FCU 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 ,i otnt owner/beneficiary of this account. It you are the Spouse oT 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 tg the deceased by checking Box C 1n PART 1 below and writing "spouse" in PART 2. If you believe the information is incorrect, please obtain written correction from the finan c5 al instl tuti on, attach a copy to thfs form and return it to the above address. Please call 711-787-8327 with questions. COMPLETE PART 1 BELOW * §EE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 47846'42 Data 04-08-2011 7o ensure prover credit to the account, two Established copies of this notice oust accompany Account Balance 25,743.98 Dayment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 100.00 Amount Subject to Tax ~ 25,743.98 NOTE, If tax payments era made within three monthsof the decedent's date of tlaath. TaX Rate X . 0 4 5 ~ ~ deduct a 5 percent discount on the tax duo. Aron inheritance tax due will become delinouent Potential Tax Due $ 1 , 158.48 nine months after the dst• of death. P~T TAXPAYER RESPONSE 1 A, IYI The above information and tax duo is eorraet. I~ Raait payaant to the Regi,star of Wills with two eoDies of this notice to obtain CHECK a discount or avoid 3ntarest, or return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. ONE BLOCK B. ~ Tha above asset has been or will b• reDOrted and tax Daid with the Pennsylvania inheritance tax return 0 N L Y filed by the estate representative. C. ~ Tha above informs ion is incorrect and/or debts and tleductions were paid. Complete PA RT ~2 and/or PART 3~ below. PART If indicating a difforent tax rata, please state relationship to decedent: TAX RETURN - CALCULATION OF TAX ON JOINTITRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 2 ~ 3. Percent Taxable 3 X 4. Amount Sub~ect to Tax 4 ~ 5. Debts and Deductions 5 - 6. Amount Taxable 6 $ 7. Tax Rata 7 X 8. Taz Due 8 PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID TAX?PAYER SIGNATURE lELti'MUNE NUMBER `~ -r(mp Under Densities of periury, I declare that the facts I reported above are true, c rrect and compl a to the best my k ledge and belief. ~~ (,~ HOME C7~~ )~ ~Ob L ~~ / /n ew L ~f~.- .~C . ~A'h~I'i,/l~ WORK C ) j) ~ ~ l.~-~' ~ ,~!-/C GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on inforwation subwitted by the financial institution. 2. Inheritance tax becowes delinquent nine wonths after the decedent's date of death. 3. A ioint account is taxable even when the decedent's nawe was added as a wetter of convenience. 4. Accounts (including those held between husband and wife) the decedent out in joint nawes within one year orior to death are fully taxable. 5. Accounts established jointly between husband and wife wore than one year orior to death are not taxable. 5. Accounts held by a decedent "in trust for" another or others are fully taxable. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the inforwation and calculation in the notice are correct and deductions are not being claiwad, place an ^X^ in Block p of Part 1 of the "Tezpaver Response" section. Sign two copies and subwit thew with a chock for theawount of tax to the register of wills of the County indicated. The PA Departwent of Revenue Mill issue an official assesswant (Forty REV-1548 IX) upon receipt of the return frow the re Sister of wills. 2. BLOCK B - If the asset specified on this notice has bean or will be reported and tax paid with the Pennsvivania inheritance tax return filetl by the estate's representative, place an "X" in Block B of Part 1 of the "Taxpayer Response" section. Sign two copies and return to the register of wills of the county indicated. 3. BLOCK C - If the notice inforwation is incorrect and/or detluctions are being claiwad, cheek Block C and cowDlete Parts 2 and 3 according to the instructions below. Sian two copies and subnit thew with your check for the awount of tax payable to the register of wills of the county indicated. The PA Devartwent of Revenue Mill issue an official asse sswent CForw REV-1548 IX) upon racaiot of the return frow the resister of wills. TAX RETURN - PART 2 - TAX CALCULATION LINE 1. Enter the date the account originally was established or titled in the wanner existing at date of death. NOTE: For a decedent who died of ter l2/12/82, accounts the decadent put in joint nawes within one year of death are fully taxable. However, there is an exclusion not to exceed a3,000 per transferee, regardless of the value of the account or the nuwber of accounts held. If a double asterisk (~s) appears before Your first nawe in the address portion of this notice, the i3,00~~w was deducted frow the account balance as reported by the financial institution. /~ `O 2. Enter the total balance of the account including interest accrued to the date of death. ~'IQ/AI 3. The percentage of the account chat is taxable to each survivor is de tenined as follows: " I~g g0~ A. The percentage taxable of joint assets established wore than one year prior to the decedent's death: C 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF MULTIPLIED BY 100 PERCENT TAXABLE JDINT OWNERS SURVIVING JOINT OWNERS Exawple: A joint asset registered in the nawe of the tlecedent and two other parsons: 1 DIVIDED BY 3 (JDINT OWNERS) DIVIDED BY 2 (SURVIVORS] _ .167 X 100 = 15.7 percent (TAXABLE TD FJ1CH SURVIVOR) B. The Dercentage 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 DIY IDED BY TOTAL NUMBER OF BURV IVING JOINT MULTIPLIED BY 100 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Exawple: Joint account registered in the nawe of the tlecedent and two other persons and established within one near of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50 percent (TAXABLE FOR EACH SURVIVOR) 4. The awount subject to tax (Line 4) is detarwined by wultiplyine the account balance (Line Z) by the percent taxable (Line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The awount taxable (Line 6) is deterwined by subtracting the debts and deductions (Line 5) frow the awount subject to tax (Line 4>. 7. Enter the appropriate tax rate Cline 7) as deterwined below. Data of Death Spouse Lineal Sibling Collateral 07/01/44 to 12/31/94 3 percent 6 percent 15 percent 15 percent 01/01/95 to 06/30/00 0 percent 6 percent 15 percent 15 percent 07/01/00 to present 0 percent 4.5 percent * 12 percent 15 percent .ihe tax rate iwpoaed on the net va ue of transfers Prow a deceased child 1 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. The lineal class of hairs includes grandparents, parents, chiltlren and other lineal descendents. "Children" includes natural children whether or not they have been adopted by others, adopted children and step children. "Lineal tle scendent s" includes all children of the natural parents and their descendants, whether or not they have been adoptetl by others; adopted descendents and their descendants; antl step-descendants. "Siblings" are defined as intlividuals who have at least one parent in cowwon with the decedent, whether by blood or adoption. The Collateral class of heirs includes all other 6enef iciaries. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are daterwined as follows: A. You are legally responsible for paywent, or the estate subj act to adwinistration by a personal representative is insufficient to pav the deductible Stews. B. You actually paid the debts after the death of the decedent and can furnish proof of paywent. C. Debts being claiwad wust be itawized fully in Part 3. If additional spec' is needed, use B 1/2" x 11" sheet of paper. Proof of paywent ^aY be requested. by the PA Depe rtwent of Revenue. BUREAU OF INDIVIDUAL TAXES , PO BOX 280601 Pennsylvania WIRRISBURG PA 17128-0601 DEPARTMENT DF REVENUE NEV-1563 EY •FP (15-11) PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE N0. 67Ja-~L~Q~J AND ACN 12100444` TAXPAYER RESPONSE DATE D1-03-2012 THERESA L LONCAR 836 SILVER LAKE RD LEWISBERRY PA 17339-9746 EST. OF MARLENE R POPLASKI SSN 161-30-4187 DATE OF DEATH 12-21-2011 COUNTY YORK REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 45 NORTH GEORGE STREET YDRK PA 17401-1240 TYPE OF ACCOUNT SAVINGS CHECKING ® TRUST CERTIF. MEMBERS 1ST FCU provided the deDa rtment with the information below. which was used in cal culatinq the inheritance tax due. Retards indicate that at the death of the above-named decedent, you were a Jof nt owner/beneficiary of this account. If y0U are the SpoUBe 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" in PART 2, If yyou believe the infarmati on is incorrect, Dlease obtain written correction from the financial institution, attach a copy to this form and return it to the above atld ress. Please call 717-187-8327 with questions. COMPLETE PART 1 BELOW ;f SEE REVERSE SIDE FOR FILING AND PAYNENT INSTRUCTIONS Account No. 47846-46 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Dua Date 06-2G-2011 Established $ 20,147.42 X IoD.Do $ 2D,147.42 X .045 $ 906.63 To ensure proper credit to the account, two copies of this notice ^ust accowparry Daywent to the Register of Wills. Make check payable to "Register of Wills, Agent". NOTE: If tax paywents are wade within three wonths of the detadent's date of death. 7~ deduct a 5 portent discount on the tax due. 1, V Airy inheritance tax due will beeowe dalinauent r nine wonths after the date of death. C A. The above intonation and tax due is correct. ~ Resit paywent to the Re915ter of Wills with two copies of this notice to obtain a discount or avoitl interest, or return this notice to the Resister of Wills and CHECK an official assesswent will be issued by the PA Depa rtwent Of Revenue. C ONE BLOCK B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return ON L Y filed by the estate representative. C. ~ The above inforwa eon is incorrect and/or debts and deductions were Daid. Cowplete PART ~2 and/or PART 3~ below. PART If indicatin8 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 s 5. Debts and Deductions 5 b. Amount Taxable 6 $ 7. Tax Rate 7 X 8. Tax Due 8 S PART DEBTS AND DEDUCTIONS CLAIMED lei t/1 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I reported above era+~trueQ, c(gyr~r(e~ct parn~d~ co to to the b t of y knowledse and belief. HOME C~~ l ) /3O `~~ L ~~rdet~~ iVL'~ WORK ( ) 'J'~'i/t'~dt lei ~i-~llZ GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with apvlicable interest based qn inforwation subwitted by the financial institution. 2. Inheritance tax becomes delinquent nine months after the decedent's date of death. 3. A joint account is taxable even when the decedent's name was added as a wetter of convenience. 4. Accounts (including those held between husband and wife) the decedent put in joint naves within one Year prior to death are fully taxable. 5. Accounts established jointly between husband and wife wore than one year prior to death are not taxable. 6. Accounts held by a decedent "in truss for'" another or others are fully taxable. REPORTING INSTRUCTIONS - PART I - TAXPAYER RESPONSE 1. BLOCK A - If the inf orwation and calculation in the notice are correct and deductions era not being claimed, plae• an "X" in Block A of Part 1 of the "Taxpayer Response" section. Sign two copies and subwit that with a cheek for the awount of tax to the register of wills of the county indicated. The PA Department of Revenue will issue an official assesswent CForn REV-1548 IX) upon receipt of the return frow the register of wills. 2. 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 estate's representative, place an "X" in Block B of Part 1 of the "Taxpayer Response" section. Sign two copies and return to the register of wills of the county indicated. 3. BLOCK C - If the notice inforwation is incorrect and/or deductions are being claiwed, check Block C and complete Parts 2 and 3 according to the instructions below. Sign two copies and subwit thee with Your cheek for the awount of tax Datable to the register of wills of the county indicated. The PA Department of Revenue will issue an official assesswent (Forty REV-1548 EX) upon receipt of the return frow the register of wills. TAX RETURN - PART 2 - TAX CALCULATION LINE 1. Enter the date the account originally was established or titletl in the wanner existing at date of death. NOTE: For a decedent who died after l2/12/82, accounts the decedent put in joint naves within one year of death are fully taxable. However. there is an exclusion not to exceed t3.000 per transferee, regardless of the value of the account or the number of accounts held. If a double asterisk (rt) appears before your First nave in the address Portion of this notice~~~xclusion was deducted frow the account balance as reported by the financial institution. ~D 2. Enter the total balance of the account including interest accrued to the date of death. ~Ap 3. The percentage of the account that is taxable to each survivor is determined as follows: NN/! I~p q0~~ A. The percentage taxable of joint assets established wore than one year prior to the decedent's death: J 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF MULTIPLIED BY 100 = PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in the nave of the decadent and two other persons= 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) _ .167 X 100 = 16.7 percent (TAXABLE TD EACH SURVIVOR) B. The Dercentage taxable for assets created within one Year of the decedent's death or accounts owned by the decedent but heltl in trust for another individual(s) (trust beneficiaries): 1 DIVIDED 8Y TOTAL NUMBER OF SURVIVING JOINT MULTIPLIED BY 100 = PERCENT TAXABLE DWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the nave of the decedent and two other persons and established within one near of death by the decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50 percent (TAXABLE FOR EACH SURVIVOR) 4. Tho awount subject to tax (Line 4) is datarwined by ^ultiplving the account balance Cline 2) by the percent taxable (Line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The awount taxable CL ine 6) is determined by subtracting the debts and deductions (Line 5) frow the awount subject to tax (Line 4). 7. Enter She appropriate tax rate (Line 7) as deterwined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3 percent 6 percent 15 percent 15 percent O1/0.1/95.to 06/30/00 0 Percent 6 percent 15 percent 15 percent 07/01/00 to Present 0 percent 4.5 percent ~ 12 percent 15 percent •The tax rate iwposed on the net value of transfers frow a deceased child 21 years of ape or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 vercent. The lineal class of hairs includes grandparents, parents. children and other lineal descendents. "Children" includes natural children whether or not they have been adopted by othersr adopted children and step children. "Lineal descendents" includes ell children of the natural parents and Chair deseentlents, whether or not they have been adopted by others; adopted descendents and their tlescendants; and step descendants. "Siblings" era def inad as individuals who have at least one parent in comwon with the decedent, whether by blood or adoption. The Collateral class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You are legally responsible for paywent, or the estate subject to atlwinistration by a personal representative is insufficient to pay the tleductible items. B. You actually void the debts after the death of the decedent and can furnish proof of pavwent. C. Debts being claimed ^ust be itewized fully in Part 3. If additional space is needed, use B 1/2" x 11" shoat of paper. Proof of paywent way be requested 6y the PA Department of Revenue. cormwnweaMh d Pannaylvania Dapaitrnsrn d Rewr~ia REV-1182 EX(11-06) Buaau d IndlvWual Taxes ria°'t~ 12e-0eo3 PENNSYLVANIA INHERITANCE AND ESTATE TAX YK023122 OFFICIAL RECEIPT RECEIVED FROM: VALERIE A. KANE 4005 SULLIVAN STREET MECHANICSBURG, PA 17050-2174 SSN: 161-30-4187 FILE NUMBER: 6712-0499 DECEDENT NAME: POPLASKI, MARLENE, R DATE OF PAYMENT: 03/15/2012 02:09:38 PM POSTMARK DATE: 03/14/2012 COUNTY: YORK DATE OF DEATH: December 21, 2011 REMARKS: 6712-0499 PERSONAL CHECK Check Checc # 3311 Check Check # 3311 Seal ACN AMOUNT 12100447 $1 100.56 12100448 $861.30 TOTAL AMOUNT PAID: $1,961.86 Amount: $1,100.58 Amount: $881.30 RECEIVED BY: KS 03/15/2012 02:09:38 PM ~~ Regis r of mils BRADLEY C. JACOBS Register of Wills & Clerk of Orphans' Court My Commission Expires First Monday, Janusry, 2016 This copy: Register of Wills z_ BUREAU OF INDIVIDUAL TAXES Po Box zaowl HARRISBURG PA 17128-0601 Pennsylvania DEPARTMENT OF REVENUE REY-15f3 EY AFP (15-11) PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE No. 67~a~C7~{Q9 AND ACN 12100447 TAXPAYER RESPONSE DATE O1-o3-2012 VALARIE A KANE 4005 SULLIVAN ST MECHANICSBURG PA 17050-2174 EST. OF MARLENE R POPLASKI SSN 161-30-4187 DATE OF DEATH 12-21-2011 COUNTY YORK REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 45 NORTH GEORGE STREET YORK PA 17401-1240 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST FCU 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 SpnUSe Of the deceased and any amount other than zero is reTlected 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 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 717-71-8327 with questions- COMPLETE PART 1 BELOW * SEE-itEVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 47846-44 Date 04-08-2011 7o ensure vroper eredii to the account, two Established copies of this notice must accompany Account Balance 25,743.98 Payment to the Register of Wills. Make check payable to "Register of Wills. Agent". Percent Taxable )( 100.00 _--_--------~'-" : If tax payments aro aade within throe Amount Subject to Tax s 25, 743.98 months of the decedent's date of death. TaX Rate X , 04j deduct a 5 percent discount on the tax tlue. Any inheritance tax due will become del invuant Potential TaX Due ~ 1 , 158 • 48 nine aonths attar the date of death. PART TAXPAYER RESPONSE a A. The above information and tax due is correct. Remit Payment to the Register of Wills with two copies of this notice to obtain CHECK a discount ar avoid interest, or return this notice to the Realster of Wills and an official assessaent will be issued by the PA Department of Revenue. ONE BLOCK B. ~ The above asset has been or will be reported and tax paitl with the Pennsylvania inheritance tax return ON L Y filed by the estate representative. C. ~ The above inf orae ion is incorr ct and/or debts and deductions were Daid. Complete PART ~2 and/or PART 3~ below. PART If indicating a different tax rate, please state relationship to decedent: TAX RE TURN - CALCULATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established I 2. Account Balance 2 $ 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 +S 5. Debts and Deductions 5 - 6. Amount Taxable b ~ 7. Tax Rate 7 X 8. Tax Due 8 PAar DEBTS AND DEDUCTIONS CLAIMED ~ N i`- Q- cn DATE P AID PAYEE DESCRIPTION AMOUNT PAID . ~/.rn~ WORK ~ ~~~~ a~_n- ~ ~~a ~a+a-ia Under penalties of perjury, I declare that the facts I reported above are true, correct and ~ complete to the q~ylst of my knowledge and belief. unwr r'7 ) '7 ~ 7 ~ ~ L,L7i /Z S GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on inforwation subwitted by the financial institution. 2. Inheritance tax becowes delinquent nine months after the decedent's date of death. 3. A Joint account is taxable even when the decedent's nave was added es a natter of convenience. 4. Accounts (including those held between husband and wife) the decedent put in joint names within one year prior to f~ death are fully taxable. ,\ \ 5. Accounts established jointly between husband and wife sore than one year prior to death are not taxable. V '- 6. Accounts held by a decedent "!n trust for" another or others are fully taxable. crJ REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE ~ 1. BLOCK A - If the inforwation and calculation in the notice are correct and deductions are not being claiwed, place an eX~ in Block A of Part 1 of the "Taxpayer Response" section. Sign two copies and submit then with a cheek far the awount of tax to the register of wills of the county indicated. The PA Departwent of Revenue Mill issue an official assessment (Fo rn REY-1548 EX) upon receipt of the return iron the register of wills. 2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the PennsY lvania inheritance tax return filetl by the estate's representative, place an "X" in Block B of Part 1 of the "Taxpayer Response" section. Sign two copies and return to the register of wills of the county indicated. 3. BLOCK C - If the notice inf orwation is incorrect and/or deductions are being claiwed, check Block C and complete Parts 2 and 3 according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the register of wills of the county indicated. The PA Depart.ent of Revenue will issue an official assessment IFoM REV-1548 EX) upon receipt of the return from the register of wills. TAX RETURN - PART 2 - TAX CALCULATION D LINE ~~ 1. Enter the date the account originally was established or titled in the manner existing at date of death NOTE: For a decedent who died after l2/12/82, accounts the decedent put in joint names within one year fully taxable. Nowaver. there is an exclusion not to exceed 63,0@0 par transferee, regardless o e value 6f LQ~2 the account or the number of accounts held. AIp~ ~ U If a double asterisk Cws) appears before your first nacre in the address portion of this notice, the ~'.DO@ exclusion was tledueted from the account balance as reported by the financial institution. 2. Enter the total balance of th• account including interest accruetl to the date of death. 3. The Dereentage of the account that is taxable to each survivor is deterwined as follows: A. The percentage taxable of joint assets established sore than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TDTAL NUMBER OF MULTIPLIED BY 100 = PERCENT TAXABLE JOINT OWNERB SURVIVING JDINT OWNERS Example: A joint asset ragisteretl in the name of the decadent and two other parsons: 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) _ .167 X 100 = 1d.7 percent (TAXABLETO EACN SURV IV DR) B. The percentage taxable for assets created within one year of the decedent's tleath or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT MULTIPLIED 8Y 108 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY 2 CSURV IVORS) _ .50 X 100 = 50 vercent (TAXABLE FOR EACH SURYIVOR) 4. The amount subject to tax (Line 4) is tletermined by multiplying the account balance Cline 2) by the portent taxable (Line 3). 5. Enter the total of the debts and deductions listed in Part 3. d. Tha awount taxable Cline d) is date rwined by subtracting the debts and deductions fLine 5) frw the amount subject to tax (Line 4). 7. Enter the appropriate tax rata IL ins 7) as de terwined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3 percent 6 percent 15 percent 15 percent 01/01/95 to 06/30/00 0 percent 6 percent 15 percent 15 percent 07/01/00 to present 0 percent 4.5 percent + 12 percent 15 percent v7he tax rata iwpased on the net value of transfers from a tleceased child Z1 Years of ape or younger at death to or for th! Use of a natural parent, an adoptive Parent or a stepparent of the child is 0 percent. The lineal class of heirs includes grandparents, parents. children and Other lineal tlescendents. "Children" includes natural children whether or not they have boon adapted by others, adopted children antl step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not then have bean adopted by others; atlopted descendents end their descendants; and slap-descendants. "Siblings" are defined as individuals who have at least one parent in cowwon with the decedent, whether by blood or atloption. The Collateral class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are date rn fined as follows: A. Vou are legally responsible for PBYwent, or the estate subject to administration by a personal representative is insufficient to oav the deductible hews. B. You actually paid the debts after the death of the decedent and can furnish proof of payment. C. Debts being claired rust be itewized fully in Part 3. If additional space is needed, use 8 1/2" x 11" sheet of paper. Proof of paywent pay be requested by the PA Oepa rtnent of Revenue. BUREAU OF 1NOIVIDWL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 r pennsylvania DEPARTMENT DF gEVENUE REV-1563 E% 4FP (OS-111 PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE N0. 67/eZ"0~{yl AND ACN 12100448 TAXPAYER RESPONSE DATE Di-03-2012 VALARIE A KANE 4005 SULLIVAN ST MECHANICSBURG PA 17050-2174 EST. OF MARLENE R POPLASKI SSN 161-30-4187 DATE OF DEATH 12-Z1-2011 COUNTY YORK REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS 45 NORTH GEORGE STREET YDRK PA 17401-1240 TYPE OF ACCOUNT SAVINGS CHECKING © TRUST CERTIF. MEMBERS 1ST FCU provided the department with the information Del ow. which was used 1n calculating the inhert Lance tax due. Records indicate that at the death of the above-named decedent, you were a jof nt owner/beneficiary of this account. If yaU are the SpOUSe Of the deceased and any amount other then zero is reflected below 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 I below and writing "spouse" in PART 2. If you believe fhe 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 aE SEE REVERSE S3DE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 47846-53 Date 06-24-2011 To ensure proper credit to the account, two - Established copies of this notice roust accoapany Account Balance 2 0 1 4 7 . 4 2 peyaent to the Register of Wills. Make check ~` % payable to "Register of Wills, Agent". Percent Taxable X 100.00 '-" ' NOTES If tax Dayaents are cede within three Amount Subject to Taz ~ 20%147.42 months of the daceeent•s date of death, Tax Rate ~( , 04 ~j deduct a 5 percent discount on the tax due. Amy inheritance tax due will becoae delinquent Potential Tax Due ~ 906.63 nine eonths after the date of death. PART TAXPAYER RESPONSE 0 A. The above infonat ion and tax due is correct. Resit payaent to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoitl interest, or return this notice to the Register of Wills and ONE an off ieial assessaeht will be issued by the PA DeDartaent of Revenue. BLOCK B. ~ The above asset has been or will be reported and tax Daid with the Pennsylvania inheritance tax return 0 NL Y filed by the estate representative. 4. Aaaunt Subject to Tax S. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due PART DATE PAID PAYEE 5 - 6 S 7 X e $ DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION rn ~ r :v N r- a- ~ AMOUNT PAID Under penalties of perjury, I declare that the facts I reported above are true, AC~o rr~1e 1ct awn dC^ c om~ to t~bost of my knowledge and belief. HOME C ) 7hn~`-f~(>+-~ \Vn A !/K/\~l•C~_ WORK Cy~~)~~0~ J ~ ~~ U~ GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information subwiYted by the financial institution. 2. Inheritance tax becomes delinquent nine months after the decedent's tlate of death. 3. A joint account is taxable even whop the decedent's nano was addetl as a natter of convenience. 4. Accounts (including those held between husband and wife) the decedent put in joint names within one year prior to death era fully taxable. ' 5. Accounts established jointly between husband and wife ^ore than one year vrior to death are not taxable. /~ 6. Accounts heltl by a decedent "in trust for" another or others are fully taxable. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the infornation and calculation in the notice are correct and deductions are not being claiwed, place an "X" in Block A of Part 1 of the "Taxpsyer Response" section. Sign two copies and submit thew with a cheek for the awount of tax to the register of wills of the county indicated. The PA Departwent of Revenue will issue an official assesswent (Forty REV-1548 FX) upon receipt of the return from the register of wills. 2. BLOCK 6 - If the asset specified on this notice has been or will be reported end tax paid with the Pennsylvania inheritance tax return filetl by the estate's representative, vlace an "X" in Block B of Part 1 of the "Taxpayer Response'' section. Sign two copies and rotu rn to the resister of wills of the county indicated. 3. BLOCK C - If the notice inf orwation is incorrect and/or deductions are being claiwed, check Block C and cowplete Parts 2 and 3 according to the instructions below. Sign two copies and subwit thaw with your chock for the awount of tax payahle to the register of wills of the county indicated. The PA Departwent of Revenue will issue an official assesswent (Fon REV-1548 EX] upon receipt of the return frow the register of wills. TAX RETURN -PART 2 - TAX CALCULATION LINE 1. Enter the data the account originally was established or titled in the wanner existing at data of death. NOTE: For a decedent who died afterl2/12/82, accounts the decedent put in joint nawes within one year of death are NEB fully taxable. However. there is an exclusion not to exceed 03,000 per transferee, regardless of tby~ylk~ the account or the nupber of accounts h~ld.QQViylj'a'~- If a double asterisk (s~) appears before your first nawe in the address portion of this notice, the 03,060 g~cclutB61~ was deducted frow the account balance as reported by the financial institution, MAR o 101 ~1 2. Enter the total balance of the account including interest accrued to the date of death. 3. Tha percentage of the account that is taxable to each survivor is date Wined as follows: A. The percentage taxable of joint assets established wore than one near prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF MULTIPLIED BY 100 = PERCENT TAXABLE JOINT DWNERS SURVIVING JOINT OWNERS Exasple: A joint asset registered in the nawe of the decedent and two other persons: 1 DIVIDED BY 3 CJOIN7 OWNERS) DIVIDED BY 2 CSURY IVORSS = .167 X 100 = 16.7 percent (TAXABLE TO EACH SURVIVOR) B. The percentage 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 SURVIVING JOINT MULTIPLIED BY 100 = PERCENT TAXABLE DWNERS OR TRUST BENEFICIARIES Exawple: Joint account registered in the nawe of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED 8Y 2 CSURV IVORS) _ .50 X 1D0 = 50 percent (TAXABLE FOR EACH SURY IVOR) 4. Tha awount subject to tax (Line 4) is detarwined by multiplying the account balance CLin• 2) by the percent taxable (Line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. Tha awount taxable CL ins 6) is date rwined by subt ractine the debts and deductions Cline 5) frw the awount subject to tax (line 4). 7. Enter the appropriate tax rate (Line 7) as detarwined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3 percent 6 percent 15 percent 15 percent 01/01/95 to 06/30/00 0 percent 6 percent 15 percent _-_? 'S percent. -~-:v~~----- - 07/01/00 to present 0 percent 4.5 percent ^ 12 percent 15 percent .The tax rat' iwpoaed on the mat value of transfers row 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. The lineal class pf heirs includes grandparents, parents, children and other lineal descendents. "Children" includes natural children whether or not they have bean adopted by others, adopted children and step Children. •'L ineal descendents" includes all children of the natural parents and their descentlents, whether or not they have been adoptetl by others; adopted descendents and their descendants; and step-descentlents. "Siblings" era defined as individuals who have at least one varent in cowmon with the decedent, whether by blood or adoption, the Collateral class of heirs includes all other 6enef iciaries. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are date rw fined as follows: A. You are legal lv responsible for paywent, or the estate subject to adwinistration by a personal representative is insufficient to pay the deductible itews. B. You actually paid She debts after the death of the decadent and can furnish proof of paywent. C. Debts being claimetl ^ust be itewizad fully in Part 3. If additional space is needed, use 8 1/2" x I1" sheet of paper. Proof of paywent may be requested by the PA Deoa rtwent of Revenue. r Pennsylvania DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES April 17, 2012 MR. BRADLEY G. JACOBS REGISTER OF WILLS YORK COUNTY JUDICIAL CENTER 45 N GEORGE ST YORK, PA 17401 Telephone 717 787-8327 Re: Estate of JOAN S. CALVERT File Number: 2112-0167 County: CUMBERLAND Dear ister of Wills: The 'ect decedent leg resided in CUM LA C as of the dat eath. Acco ly, you are auth d to cancel file ber 12-0531. All matters cerning this estate Id be maintaine der CUMBE ND ty File Number 211 67. All original In ce Tax docum or the subj ent should be to the CUMBERLAND County Register of Wills; however, you may wish to retain a copy, including photocopies of all receipts for the collection of Inheritance Taxes in the subject estate which have been issued by your office. Please contact meat the telephone number above if you have any questions, Laurel Fulmer, Supervisor Inheritance Tax Division n ,-- ~~ ~r s m ~v~~ 7G-'~n UDC -~ ~.:, .::, aG. v N ~.J T. Ch G!'1 ~+ n c: r_ = ~~ ~-:. ~: ~~ !;?.ii r,_,;-, 'c^i r T ~~~ rn ti~ 'T7 Department of Revenue I PO Box 2806011 Harrisburg, PA 17128 1 717.787.8327 1 www.revenue.state.pa.us ~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE NO. 67 ~c2-C)s,~l BUREAU OF INDIVIDUAL TAXES Po sox zassBl pennSylvania AND ACN 12110843 HARRISBURG PA 17128-0601 pEnAaTMENTOFHEVENUE TAXPAYER RESPONSE DATE oz-15-2012 EEY-1563 E% AFP (3a-11] KELLY C GUSTAFSON 26 MIRAMICHI TRL MORGANTOWN WV 26508-2928 EST. OF JOAN S CALVERT SSN 171-30-8046 DATE OF DEATH 02-02-2012 COUNTY YORK REMIT PAYNENTAND FORMS T0: REGISTER OF WILLS 45 NORTH GEORGE STREET YORK PA 17401-1240 TYPE OF ACCOUNT ® snvlNGs CHECKING TRUST CERTIF. MEMBERS 1ST FCU 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 yod 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 be1oW and writing "spouse" in PART 2. If you bel7eve 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 717-787-8321 wf th questions. ~ COMPLETE PART I BEL01kSEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS ~ Account No. 341520-0 0 Date 10-17-2008 To ensure proper credit to the account, two Established copies of this notice oust accompany payment to the Register of Wills. Make check Account Balance ~ 3,686.60 payable to "Resister of Wills, Agent". Percent Taxable Amount Subject to Tax Tax Rate Potential lax Due PART X 50.000 $ 1,843.30 X .045 $ 82.95 NOTE: If tax payments are made within th rea months of the decedent's date of death, deduct a 5 vercent discount on the tax due. Am inheritance tax due will become delinguant nine months after the date of death. A. ® The above information and tax due fs correct. Rsmit payment to the Resister of Wills with two copies of this notice to obtain a discount or avoid interrest; or return this notice to the Register of Wills and CHECK DNE [ ~ an official assessment yell be i ssued by the PA Dapartaent of Revenue. BLOCK g, ~ The above asset has been or will be reported and tax paid with the Pennsylvania inhe ri tones tax return 0 N L Y filed by the estate representative. C. ~ The above informs ion is incorrect andlor debts and deductions were paid. Complete PART ~2 antl/or PART 3~ 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 ; X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 S 7. Tax Rate 7 X e. Tax Due 8 $ PART DEBTS AND DEDUCTIONS CLAIMED W r;n DATE P AID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I reported above a re corr tru e e c t and complete to he S of my knowledge and belief. best ~,S~ 'q~ HOME (7"U ~ ~C~^+ G ~ g ) +'"l.~- ~-1 1~7 ~ p , / I K~~~C~~/Y1JV1 °~/`-~ WO R K C ) 3- ~~ y TAXPAYER S TUREr TELEPHONE NUMBER DATE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIA L TAX ASSESSMENT with applicable interest based on infornation subwitted by the financial institution. 2. Inheritance tax becowes delinquent nine wonths after the decedent's date of death. 3. A joint account is taxable even when the decedent's name was added as a natter of convenience. 4. Accounts (including those held between husband and wife) the decedent put in joint names within one year prior to death are fully taxable. 5. Accounts established jointly between husband and wife more than one veer prior to death are not taxable. 6. Accounts held by a decadent "in trust far" another or others are fully taxable. REPORTING INSTRUCTIONS - PART I - TAXPAYER RESPONSE 1. BLOCK A - If the infornation and Calculation in the notice are correct and deductions are not bein8 claimed, place an "X" in Block A of Part 1 of the ^Taxpayer Response" section. Sien two copies and submit then with a check for the awount of tax to the register of wills of the County indicated. The PA Departnent of Revenue will issue an official assesssent (Form REV-1548 EX) upon receipt of the return from the register of wills. 2. 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 estate's representative, place an "X" in Block B of Part 1 of the "Taxpayer Response" section. Sign two copies and return to the register of wills of the county indicated. 3. BLOCK C - If the notice inf orwation is incorrect and/or deductions are being claimed, check Block C and cowplete Parts 2 and 3 according to the instructions below. Sign two copies and submit thew with your check for the awount of tax payable to the register of wills of the county indicated. The PA Departnent of Revenue will issue an official assesswent (Form REV-1548 IX) upon receipt of the return from the register of wills. TAX RETURN - PART 2 - TAX CALCULATION LINE 1. Enter the date the account originally was established or titled in the wanner existing at date of death. NOTE: For a decedent who died of ter l2/12/82, accounts the decedent put in joint names within one year of de e fully taxable. However, there is an exclusion not to exceed 03.060 per transferee, regardless of the ANNE the account or the number of accounts held. If a double asterisk (..) appears before your first nave in the address Do rtion of this notice, the 83,OO~~c1Z~o~,`~ was deducted frow the account balance as reported by the financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The percentage of the account that is taxable to each survivor is da ternined as follows: A. The Dercentage taxable of joint assets established more than ono year prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF MULTIPLIED BY 100 = PERCENT TAXABLE JOIN7 DWNERS SURVIVING JOINT OWNERS Example: A joint asset registered in She name of the decedent and two other parsons: 1 DIVIDED BY 3 CJDINT OWNERS) DIVIDED BY 2 (SURVIVORS) _ .167 X 306 = t6.7 percent (TAXABLE 70 EACH SURVIVOR) B. The percentage 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 SURVIVING JOINT MULTIPLIED BY 100 PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the nave of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BY 2 CSURV IVORS) _ .50 X 100 = 50 percent (TAXABLE FOR EACH SURVIVOR) 4. The awount subject to tax (Line 4) is deterwined by multiplying the account balance Cline 2) by the percent taxable (Line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The awount taxable Cline 6) is deterwined by subt racttn9 the debts and deductions (Line 5) frow the awount subject to tax Cline 4). 7. Enter the apv ropriate tax rate (Line 7) as deterwined below. Date of Death Spouse LSneal Sibling Collateral 07/01/94 to 12/31/94 3 percent 6 percent 15 percent 15 percent 01/01/95 to 06/30/00 0 percent 6 percent 15 percent 15 percent 07/01/00 t0 present 0 percent 4.5 percent ~ 12 percent 15 percent +~The tax rata iwposed on the net value o 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. The lineal class of heirs includes grandparents, parents, children and other lineal descendents. "Children" includes natural children whether or not they have Deen adopted by others, adopted children end step children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others; adopted descendants and their descendants; and step-descendants. "Siblings" are defined as individuals who have at least one varent in cowwon with the decedent, whether by blood or adoption. The Collateral class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are deterwined as follows: A. You are legally responsible for payment, or the estate subject to administration by a personal representative i5 insufficient to pay the deductible itews. B. You actually paid the debts after the death of the decedent and can furnish proof of paywent. C. Debts being Claimed must be itewized fully in Part 3. If additional space. is needed, use 8 I/Z" x il" sheet of paper. Proof of paywent way be requested by the PA Departnent of Revenue. PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE FILE N0. 67 /a-c~53~ BUREAU OF INDIVIDUAL TAXES PO BOX 280601 Pennsylvania AND ACN 12110844 HARRISBURG PA 17125-0601 oEaneTMSwroFaevEHUe TAXPAYER RESPONSE DATE o2-15-2012 REV-1543 E% AFP (05-11) KELLY C GUSTAFSON 26 MIRAMICHI TRL MORGANTOWN WY 26508-2928 EST. OF JOAN S CALYERT SSN lli-30-8046 DATE OF DEATH 02-02-2012 COITNTY YORK RENIT PAYMENT AND FORMS T0: REGISTER OF WILLS 45 NORTH GEORGE STREET YDRK PA 17401-1240 TYPE OF ACCOUNT SAVINGS ® CHECKING. TRUST CERTIF. MEMBERS 1ST FCU provided the deDa rtment with the information Del ow, which was used in calculating the inheritance tax due. Records indicate that at the death of the above-named decedent, you were a joint ownerlbenefl ciary of this account. If y0U are the spouse Of the deceased end any amount other than zero 1s reflected below on the Potential Tax Due line, note no tax may 6e due. but you must notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2. If you beiteve the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return ___it tp the above address. Please call 717-787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 341520-11 Date 10-17-2008 To ensure proper credit to the account, two Established copies of this notice must accompany payment to the Register of Wills. Make check AccountrBalance ~ 7,975.21 payable to "Register of Wills. Agent". Percent Taxable X 50.000 NOTE: If tax payments are made within three Amount Subject to Tax s 3,987.61 months of the decedent's date of death, TaX Rata X . O 45 deduct a 5 Percent discount on the tax due. Any inheritance tax due will become delinquent Potential Sax Dua ~ 1 7 9 . 4 4 nine months after the date of death. A. ® The above infonat ion and tax due is correct. Remit payment to the Register of Wills with two copies of this notf ce to obtain CHECK a discount or avoid interest, or return this notice to the Register of Wills and 0 NE 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 Daid with the Pennsylvania inheritance tax return ON L Y filed by the estate representative. C. ~ The above inf orma eon is incorr ct and/or debts and deductions ware paid. CowDlete PART ~2 and/or PART 3~ 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 8 ~ PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of pa riury, I declare that the facts I reported above are true, ,fcorre cAAt and comple a to the best of my knowledge and belief. HOME C7v 4" ) S~~ ~1Y 7 , -~~~- WORK C ) 3° ~!'(v TAXPAYER I ATU E TELEPHONE NUMBER DATE GENERAL INFORMATION 3. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information submitted by the financial institution. 2. Inheritance tax becomes delinquent nine months after the decedent's date of death. 3. A joint account is taxable even when the decedent's name was added as a matter of convenience. 4. Accounts (including those held between husband and wife) the decedent put in joint names within one year vrior to death are fully taxable. 5. Accounts established jointly between husband and wife Wore than one Year prior to death are not taxable. 6. Accounts held by a decedent "in trust for" another or others are fully taxable. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the information and calculation in the notice ere correct and deductions are not being claimed, place an "X'• in Block A of Part 1 of the ~TaxDayer Response" section. Sign two copies and submit then with a check for the amount of tax to the resister of wills of the county intlicatetl. The PA Department of Revenue will issue an official assessment (Fort REV-1548 IX) upon receipt of the return from the register of wills. 2. BLOCK 8 - If the asset svecified on this notice has been or will be reported and tax paid with the Pennsylvania inheritance tax return filed by the a state's representative, place an "X" in Block B of Part 1 of the "Taxpayer Response" section. Sign two copies and return to the resister of wills of the county indicated. 3. BLOCK C - If the notice inf orration is incorrect and/or deductions are being claired, check Block C and complete Parts 2 and 3 according to the instructions below. Sign two copies and submit then with Your check for the amount of tax payable to the register of wills of the county indicated. The PA Department of Revenue will issue an official assessment CFo rn REV-1548 EX) upon receipt of the return from the resister of wills. TAX RETURN - PART 2 - TAX CALCULATION LINE 1. Enter the data the account original lv was established or titled in the Wanner existing at date of death. NOTE: For a decedent who dietl of ter l2/12/82, accounts the decedent put in joint names within one year of death are fully taxable. However, there is an exclusion not to exceed 13,000 per transferee, regardless of the value of the account or the number of accounts held. l/~- If a tlouble asterisk (sf) appears before your first na.e in the address portion of this notice, the ~~~~~D was deducted frws the account balance as reported by the financial institution. u A q 2. Enter the total balance of the account including interest accrued to the date of death. MAR ~ 2 lull 3. The percentage of the account that is taxable to each survivor is determined as toll owe: A. The percentage taxable of joint assets established Bore than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUNBER OF DIVIDED BY TOTAL NUMBER OF MULTIPLIED BY 100 = PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Example: A ioinL asset registered in thename of the decedent and two other persons: 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) _ .167 X 100 = 16.7 percent (TAXABLE TO EACH SURVIVOR) B. The percentage taxable for assets created within one near of the decedent's death or accounts owned by the decedent but held in trust for another individual(s) (trust beneficiaries): 1 DIVIDED BV TOTAL NUMBER OF SURVIVING JOINT MULTIPLIED BY 1D0 = PERCENT TAXABLE OWNERS OR TRUST BENEFICIARIES Example: Joint account registered in the name of the decedent and two other persons and established within one year of tleath by the decadent. 1 DIY IDED BY 2 CSURV IV ORS) _ .50 X 100 = 50 percent (TAXABLE FDR EACH SURVIVOR) 4. The amount subject to tax (Line 4) is determined by multiplying the account balance Cline 2) by the percent taxable (Line 3). 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 5l from the amount subject to tax (Line 4). 7. Enter the avorovriate tax rate (Line 7) as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3 percent 6 percent 15 percent 15 percent 01/01/95 to 06/30/DO 0 percent 6 percent 15 percent 15 percent 07/01/00 to present 0 percent 4.5 percent s 12 Percent 15 percent The taX rate Smposetl on the net value of transfers from a dec@asem Cn110 L1 years of ape or younger et tleath to or for the use of a natural parent, an atloptive parent or a stepparent of the child is 0 vercent. The lineal class of heirs includes grandparents, parents, children and other lineal descendents. "Children" includes natural children whether or not then have been adopted by others, adopted children and stet/ children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not that have been adovted by others; adovted descendents and their descendants; end stay-descendants. "Siblings" era defined as individuals who have at least one parent in conwon with the decedent, whether by blood or adobtion. The Collateral class of heirs includes all other benaf 3ciaries. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You are lesal ly responsible for payment, or the estate subject to administration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after the death of the decedent and can furnish proof of payment. C. Debts being claimed oust 6e itemizetl fully in Part 3. If additional space is needed, use 8 1/2" x 11" sheet of paper. Proof of payment nay be requested by the PA Department of Revenue. Commorwaesh of PsnnayNsnia Deputrnent of Ravanus REV-1182 EX(11.68) Busau of IndivMuN Taxes P.O. Box 280803 Harti~Way, PA 1772&0803 PENNSYLVANIA INHERITANCE AND ESTATE TAX YK023167 OFFICIAL RECEIPT RECEIVED FROM: KELLY C. GUSTAFSON 26 MIRAMICHI TRAIL MORGANTOWN, WV 26508-2928 SSN: 171-30-8046 FILE NUMBER: 6712-0531 DECEDENT NAME: CALVERT, JOAN, S DATE OF PAYMENT: 03/21/2012 02:33:26 PM POSTMARK DATE: 03/19/2012 COUNTY: YORK DATE OF DEATH: February 02, 2012 REMARKS: 6712-0531 PERSONAL CHECK ACN AMOUNT 12i 10843 $82.95 12110844 $179.44 TOTAL AMOUNT PAID: $262.39 Check Checc # 0923 Amount: $82.95 Check Check #0922 Amount: $179.44 RECEIVED BY: KS 03/21/2012 02:33:26 PM ~k~~~~ Regis of Wills Seal BRADLEY C. JACOBS Register of Wills & Clerk of Orphans' Court My Commission Expires First Monday, January, 2016 This copy: Register of Wills