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~ PENNSYLVANIA INHERITANCE T
INFORMATION NOTICE
BUREAU OF INDIVIDUAL 7AXE AN D
PO BOX 280601 !~
HARRISBURG PA 17128-060 •~~'Lrri' ' '
~j V'~~Pr~M,; Tba ~ TAXPAYER RESPONSE
~~f2 OCT I 0 P~912~ Ob
~-
ORPi-wN°~ ~~u~r
(~JMBERLAND CO., FAA
JEFF SKINNER
6617 FARMLEIGH DR
INDIANAPOLIS IN 46220-4124
FILE N0. 21 12-0896
ACN 12148529
DATE 09-03-2012
EST. OF SUSAN A STADA
SSN
DATE OF DEATH 07-09-2012
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
PNC BANK NA provided Lhe department with the information below, which was used in calculating the inheritance tax due.
Records indicate that at the death of the above named decedent, you were a Point owner/beneficiary of this account. If yoU are the SpOUSe Of the
deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must
notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2.
If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return
it to the above address. Please call 717-787-8327 with questions.
COMPLETE PART 1 BELOW * SEE,R.EYERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
ccount No. 4621048531 Date 02-08-1991
To ensure proper credit to the account, two
Established copies of this notice oust accompany
Account Balance $ 30,894 .00 payment to the Register of Wills. Make check
"
payable to
Register of Wills, Agent".
Percent Taxable X 50 .000
Amount Subject to Tax
$
15,447
.00 NOTE: If tax payments are made within three
months of the decedent's date of death,
Tax Rate ~( , lrj deduct a 5 percent discount on the tax due.
Potential Tax Due $ 2, 317.05 Any inheritance tax due will become delinquent
nine months after the date of death.
PART TAXPAYER RESPONS
E
A. ~ The above inforoation and tax due is correct.
Remit 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 and
0 N E an official assessment will be issued by the PA Department of Revenue.
B L 0 C K ~
0 N L Y g, ~ The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return
filed by the estate representative.
C. ~ The above informs ion is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART 3~ below.
PART If indicating a different tax rate, please state ~~ F~~ ~~ ~ ~~
relationship to decedent: ~ ,DOSE t)t~:Y
TAX RETURN - CALCULATION OF TAX ON JOINTp/TRU/S~T ACCOUNTS ' n 'F .; =: w ~ 7 ~ -
LINE 1. Date Established 1 (~ Z 'gyp - ~~7~! ~ ~~~~ 3~'~:..
2. Account Balance 2 $ 3~~ 37 ~ 00 ^r,;' $ ~ :,
, .~ ~' t'4c § ;.,
3. Percent Taxable 3 X ,~ ,` ~ : ,{ r - ;
4. Amount Subject to Tax 4 $ ~S, 7y7,Od ~ ±''. (, > -
0 ~ T~-~....«+~ ~
5. Debts and Deductions 5 - ~
6. Amount Taxable 6 $ /3 ~ S/~{'7. C3D ~. r'.' i'
7. T a x R a t e 7 X ,. ~ ~, :".;;,,t~s ;.:
8. Tax Due 8__ $ /R~j ~~ 6 `x
g~
PART DEBTS AND DEDUCTIONS CLAIMED ~ ~
0
DATE PAID PAYEE DESCRTPTr(1N aur,,:.,r .,.r„
- zinc ~ yr iax l.O mpULatlOn) $
Under penalties of perjury, I declare that the facts I reported above are true, correct and
complete to the best of my knowledge and belief. HOME C / ) 7,~Q
- WORK ( ~ Z~ ~
T P R GNATURE TELEPHONE NUMBER pT
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information
submitted 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 name was added as a ^otter 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 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 are correct and deductions are not being claimed, place an "X"
in Block A of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them with a check for the amount of
tax to the register of wills of the county indicated. The PA Department of Revenue will issue an official assessment
(Form REV-1546 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
~_____ cooies and return to the register of wills of the county indicated.
3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, 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 Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt
of the return from the register of wills.
TAX RETURN - PART 2 - TAX CALCULATION
4
5
6
7
^The tax rate imposed on the net value of transfers from a deceased child 21 v 9 t
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 been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the
natural parents and their descendents, whether or not they have been adopted by others; adopted descendents and their descendants;
and step-descendants. "Siblings" are defined as individuals who have at least one parent in common 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 payment, or the estate subject to administration by a personal representative is insufficient
to pay the deductible items.
B. You actually Daid the debts after the death of the decedent and can furnish proof of Dayment.
C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use 8 1/2" x 11" sheet of paper. Proof of
,tie .. o~tod by the PA Department of Revenue.
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 12/12/82, accounts the decedent put in joint names within one year of death are
fully taxable. However, there is an exclusion not to exceed fi3,000 per transferee, regardless of the value of
the account or the number of accounts held.
If a double asterisk C~*) appears before your first name in the address portion of this notice, the S3,000 exclusion
was deducted from 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 determined as follows:
A. The percentage taxable of joint assets established ^ore than one year prior to the decedent's death:
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 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 year of the decedent's death ar 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 name 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 SURVIVOR)
The amount subject to tax (Line 4) is determined by multiplying the account balance (Line 2) by the percent taxable (Line 3).
Enter the total of the debts and deductions listed in Part 3.
The amount taxable (Line 6) is determined by subtracting the debts and deductions (Line 5) from the amount subject to tax (Line 4).
Enter the appropriate tax rate (Line 7) as determined below.
PA. pEPA~t~'N~t~Y~1F° Q~E'!3~ ~T:~~'I£8 ~ x~~, ~ ~-
C 71 ~' ~ 7 ~~ ~ . S ~~5. <-- T;AXP~G~.itS WITH ~E~
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
ears 15
of a e percent
or Younger a