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INHERITANCE TAX
RECORD ADJUSTMENT
JOINTLY HELD OR TRUST ASSETS
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DEPARTMENT OF REVENUE
REV-1604 EX AFP C12-12)
DATE 12-31-2012
ESTATE OF SIMMONS CAROLINE R
DATE OF DEATH 10-16-2011
FILE NUMBER 21 11-1140
COUNTY CUMBERLAND
SSN/DC
ACN 11170329
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 CDURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE ~'1 RETAIN LOWER PORTION FOR YOUR RECORDS ~-~`
REV-1604 EX AFP C12-12)
** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS **
DATE• 12-31-2012
ESTATE OF: SIMMONS CAROLINE R DATE OF DEATH: 10-16-2011 COUNTY: CUMBERLAND
FILE NO.: 21 11-1140 S.S/D.C. N0.: CN: 11170329
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MEMBERS 1sT Fcu ACCOUNT NO.: 356509-41
TYPE OF ACCOUNT: ( ) SAVINGS C ) CHECKING C ) TRUST CX) TIME CERTIFICATE
DATE ESTABLISHED 05-12-2009
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISIDN
PD BOX 280601
HARRISBURG PA 17128-0601
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
86,615.97
X 0.500
43,307.99
.00
43,307.99
X .045
1,948.86
NOTE: TO ENSURE PROPER CREDIT TO YOUR
ACCOUNT, SUBMIT THE UPPER PORTION
OF THIS NOTICE WITH YOUR TAX
PAYMENT TO THE REGISTER OF WILLS
AT THE ADDRESS SHOWN ABOVE.
MAKE CHECK OR MONEY ORDER PAYABLE
T0: "REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT (+)
INTEREST/PEN PAID (-) AMOUNT PAID
11-17-2011 CD015220 97.44 1,948.86
TOTAL TAX PAYMENT 2,046.30
BALANCE OF TAX DUE 9 .44CR
INTEREST AND PEN. .00
TOTAL DUE
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A
"CREDIT" OCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.
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1
PAYMENT: Detach the top portion of this notice and submit with your payment lade payable to the nave and address
printed on the reverse side.
Make check or coney order parable to: REGISTER OF WILLS, AGENT.
Failure to pay the tax, interest, and penalty due may result in the filing of a lien of record in the
appropriate county, or the issuance of an Orphan's Court citation.
REFUND CCR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" CREV-1313). Applications are available from
the Department's web site, www.revenue.state.oa.us, any Register of Wills or Revenue District Office, or from
the Department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or
speaking needs: 1-800-447-3020 (TT only).
REPLY T0: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau
of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601, or call
(717) 787-6505.
DISCOUNT: If any tax due is paid within three calendar months after the decedent's death, a five percent discount
of the tax paid is allowed.
PENALTY: The 15 percent tax amnesty non-participation penalty is computed on the total of the tax and interest assessed,
and not paid before Jan. 18, 1996, Cthe first day after the end of the tax amnesty period.)
INTEREST: Interest is charged beginning with first day of delinquency or nine months and one day from the date of
death to the date of payment. Taxes which became delinquent before Jan. 1, 1982 bear, interest at the rate of
six percent per annum calculated at a daily rate of 0.000164. All taxes which became delinquent on and after
Jan, 1, 1982 well bear interest at a rate which will vary from year to year with the rate announced by the
PA Department of Revenue. Rates for 1982 through 1999 can be found in the Pennsylvania Resident Instruction
Booklet, (REV-1501) the Pennsylvania Non-resident Instruction Booklet (REV-1736) or on the Pennsylvania
Deptartment of Revenue Web site www.revenue.state.pa.us. The applicable interest rates for 2000 through
2013 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
2000 8% .000219 2001 9Y. .000247 2002 6% .000164
2003 5% .000137 2004 4Y. .000110 2005 5% .000137
2006 7% .000192 2007 8Y, .000219 2008 7Y. .000192
2009 5% .000137 2010 4% .000110 2011-2013 3% .000082
Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINpUENT X DAILY INTEREST FACTOR
Any notice issued after the tax becomes delinquent will reflect an interest calculation to 15 days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
notice, additional interest must be calculated.
REV-1470 Ek1(01-10)
~~ ~ pe1111$~/~Va111t~ INHERITANCE TAX
DEPARTMENT OF REVENUE EXPLANATION
BUREAU OF INDIVIDUAL TAXES OF CHANGES
PO Box 280801
DECEDENTS NAME FILE NUMBER
Caroline R Simmons 2111-1140
REVIEWED BY ACN 11170329
Robin Graff
ITEM EXPLANATION OF CHANGES
SCHEDULE NO.
Separate billing requested on Schedule F #2.
Refund can be expected in 4-6 weeks.
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