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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE INFORMATION NOTICE FILE NO. 21 06-0879
BUREAU OF INDIVIDUAL TAXES AND
DEPT. 280601 ACN 06161741
HARRISBURG, PA 17128-0601 TAXPAYER RESPONSE
DATE 12-15-2006
REV-1545 EX AFP (09-00)
TYPE OF ACCOUNT
EST. OF ROBERT G GOULD ❑ SAVINGS
S. S. NO. 187-16-6177 ® CHECKING
DATE OF DEATH 09-20-2006 ❑ TRUST
COUNTY CUMBERLAND a ❑ CERTIF.
REMIT PAYA~NT AND FORS TO:
ROBERT L GOULD REGISTER OF =llkt~LS K
APT 6 CUMBERLAND CO pURT FUSE
111 N ENOLA DR CARLISLE, PA 7`:_n 3
ENOLA PA 17025
CITIZENS BANK OF PA has provided the Department with the information listed below which has b_q#p used irr-
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joiht owner/bewiciary of '
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, atWb 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 Pennsylvania. Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW * * X SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 6106291916 Date 05-06-2002 To insure proper credit to your account, two
Established (2) copies of this notice must accompany your
Account Balance 32, 637.21 payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax 16,318.61 (3) months of the decedent's date of death,
Tax Rate X .045 you may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
Potential Tax Due 734.34 nine (9) months after the date of death.
PART TAXPAYER RESPONSE
19 ............0 . _
1
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WIS.' U-1 .
A. The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
CHECK a discount or avoid interest, or you may check box "A" and return this notice to the Register of
C ONE Wills and an official assessment will be issued by the PA Department of Revenue.
B LOCK B. he above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
ONLY o be filed by the decedent's representative.
C. ❑ The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART 2❑ and/or PART IE below.
PART If you indicate a different tax rate, please state your OF H. L USA AAF
relationship to decedent:
2
TAX (
RETURN COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
: :::::::::=;=;;?;:=;;:;:;:;i;: ;=itii; ;;i~;sa
LINE 1. Date Established 1
2. Account Balance 2 ?si;i€i?: ;i;
s::= ;?:€tii'•i€ ::':`€i€i;9=€
3. ;i:`€;:;;€;;;;;;€;:.".;;:.................
Percent Taxable 3 X
4 . Amount Sub ect to Tax 4 :
_
5. Debts and Deductions 5
6. Amount Taxable 6
7. Tax Rate 7 X
:::s: i€ iii:€s; :s'... s
8. Tax Due 8
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation) S
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best of IN knowledge and belief. HOME (
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WORK ( ) 1-5--,07
TAXPAYER SIGNAT E TELEPHONE NUMBER DATE
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 becomes delinquent nine months after the decedent's date of death.
3. A joint account is taxable even though the decedent's name was added as a matter of convenience.
4. 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 more than one year prior to death are not taxable.
6. Accounts held by a decedent "in trust for" another or others are taxable fully.
REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE
1. BLOCK A - If the information and computation 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 your 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-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 decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one
copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the
envelope provided.
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 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 12/12/82: 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 $3,000 per transferee regardless of the value of
the account or the number of accounts held.
If a double asterisk CNN) 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 financial institution.
2. Enter the total balance of the account including interest accrued to the date of death.
3. 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 one year prior to the decedent's death:
1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE
JOINT OWNERS SURVIVING JOINT OWNERS
Example: A joint asset registered in the name of the decedent and two other persons.
1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 = 16.7% (TAXABLE FOR EACH SURVIVOR)
B. The percent 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 X 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% (TAXABLE FOR EACH SURVIVOR)
4. The amount subject to tax (line 4) is determined by multiplying the account balance (line 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 5) from the amount subject to tax (line 4).
7. Enter the appropriate tax rate (line 7) as determined below.
Date of Death Spouse Lineal Sibling Collateral
07/01/94 to 12/31/94 3% 6% 15% 15%
01/01/95 to 06/30/00 0% 6% 15% 15%
07/01/00 to present 0% 4.5%* 12% 15%
■The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at
death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is O%.
The lineal class of heirs 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, 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 legally are 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 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 1/2" x 11". Proof of
payment may be requested by the PA Department of Revenue.
TAXPAYER A~S~STANCP:
I CE :CONTACT ANY REGISTER OF WFLES,
YOU NEED FURTHER INFORMATION OR ASSISTAN
PA DEPARTMENT OF:'R.EVENUE DISTRICT OFFICE :tOR CALF. THE: BUREAU OF
INDIV1IIUAL TAXES; TAXPAYER INQUIRY UNIT IN HARRISBURG AT 717) 787,-8327 SERVICES
FOR TAXPAYERS QITH $FECI AL::HEARING ANA SPEAKING NEEDS, 8 04 447 3a2a (TT ONLY).