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HomeMy WebLinkAbout02-19-13BUREAU UF' INDIVIDUAL TA%ES ~ @tlf1S lvania PO BOX 280601 Pennsylvania Inheritance Tax p Y RARRISBURG PA 1 7128-0 6 01 Information Notice DEPARTMENT OF REVENUE REY-]Si~ EX Oocf%EC (iB-12l And Taxpayer Response FILE NO.217D I ~ _ ~~ ACN 13103281 DATE 01-22-2013 Type of Account Estate of WALTER C RITZIE Savings SSN 1 o hecking Date of Death 01-03-2013 ~ Trust DOUGLAS A RITZIE County CUMBERLAND C O -E.r ertificate 925 S 29TH ST ~ ro m y :o CAMP HILL PA 17 0 11-58 05 rn = n ..~ c+ Syr r-~ rnrn rym r~ ~v a v, z ~, ~ ~ a c' ° „ `= ci r.> ~~ co i- rn r 17 -~ c,) ~ 'rl ~'" C7> MID PENN BK provided the department with the information below indicating that at the death of the above-named decedent you were a joint owner or beneficiary of the account identified. Remit Payment and Forms to: Account No. 309003134 Date Established 01-11-2012 REGISTER OF WILLS Account Balance $126,566.32 1 COURTHOUSE SQUARE CARLISLE PA 17013 Percent Taxable X 100 T 26 32 566 ax Amount Subject to $1 , . Tax Rate X 0.045 ithin three months of the d T If t ' e w s are ma tax paymen NO E : Potential Tax Due $ 5,695.48 decedent's date of death, deduct a 5 percent discount on the tax With 5% Discount (Tax x 0.95) $ (see NOTE') due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1: Please check the appropriate boxes below. 1 A ~ No tax is due. g ~ The information is correct. C ~ The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) D ~ Changes or deductions listed. E Asset will be reported on inheritance tax form REV-1500. I am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed to Step 2 on reverse. Do not check any other boxes. 4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12% I am a sibling of the deceased. 15% All other relationships (including none). The information above is incorrect and/or debts and deductions were paid. Complete Parf 2 and part 3 as appropriate on the back of this form. The above-identified asset has been or wilt be reported and tax paid with the PA Inheritance Tax Return filed by the estate representative. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART z PAVP.P. Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required, you may attach 81/2" x 11"sheets of paper.) rhle Doi"1 Debts and Deductions Description Amount Paid Total Enter on Line 5 of Tax Calculation $ PART 3 1. 2. 3. 4. 5. 6. 7. Tax Calculation If you are making a correction to the establishment date (Line 1) account balance (Line 2), or percent taxable (Line 3), please obtain a written correction from the financial institution and attach it to this form. Enter the date the account was established or titled as it existed at the date of death. Enter the total balance of [he account including any interest accrued at the date of death. Enter the percentage of the account that is taxable to you. a. First, determine the percentage owned by the decedent. i. Accounts that are held "in trust for" another or others were 700% owned by the decedent. ii. For joint accounts established more than one year prior to the date of death, the percentage taxable is 100% divided by the total number of owners including the decedent. (For example: 2owners = 50%, 3 owners = 33.33%, 4 owners = 25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. The amount subject to tax is determined by multiplying the account balance by the percent taxable. Enter the total of any debts and deductions claimed from Part 2. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. your relationship to the decedent: 1. Date Established Under penalty of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. Work ~~%~p Home -7/7-73 ~qa I a,c+-13 Taxpayel ignature Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT CUM6ERLAND COUNTY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 Step 2: Sign and date below. Retum TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to "Register of Wills, Agent" Do not send payment directly to the Department of Revenue. BUREAU OF INDIV IOUAL TAXES PO BOX 280601 HARRISBURG PA 11128-0681 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response Pennsylvania DEPARTMENT OF REVENUE PFY-1393 ES pocE%EC (OB-11) FILE N0.2170 ACN 13103282 DATE 01-22-2013 OOU6LAS A RITZIE 925 S 29TH ST CAMP HILL PA 17011-5805 SUSOUENANNA BANK provided the d. above-named decedent you were a Estate of WALTER C RITZIE SSN Date of Death Ot-03-2013 County CUMBERLAND partment with the information below point owner or beneficiary of the acct Type of Account Savings Checking n ~ Trust ~ O ~ Certifi ~e ~ ~ a ~ ~ r-'; ~ n c'7 A C7 ~' r r $ ~ b G~ y ~ ~ C O ~ ~ Cr j < q C? ~ ;'~ O rj =D "rr r- t .~ '"" rlr co ~ cs 4i' that at the death of the Remit Payment and Forms to: ! Account No. 3000202280 I Date Established 01-23-2012 REGISTER OF WILLS Account Balance $ 31 911.21 1 COURTHOUSE SQUARE , CARLISLE PA 17013 Percent Taxable X 50 Amount Subject to Tax $ 15 61 955 , . Tax Rate X 0.150 f h h h h ' in t ree mont s o t e : If tax payments are made wit NOTE Potential Tax Due $ 2,393.34 decedent's date of death, deduct a 5 percent discount on the tax With 5% Discount (Tax x 0.95) $ (see NOTE') due. Any inheritance tax due will become delinquent nine months after the date of death. PART $tep 1: Please check the appropriate boxes below. 1 A ~ No tax is due. I I am the spouse of the deceased or 1 am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Sfep 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. g ~ The information is correct. C The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) D ~ Changes or deductions listed. E Asset will be reported on inheritance tax form REV-1500. The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed to Step 2 on reverse. Do not check any other boxes. 4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12% I am a sibling of the deceased. 15% All other relationships (including none). The information above is incorrect and/or debts and deductions were paid. Complete Part 2 and part 3 as appropriate on the back of this form. The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax Return filed by the estate representative. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART x Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required, you may attach 81/2" x 11"sheets of paper.) Date Paid Payee Description Amount Paid PART Tax Calculation 3 K you are making a correction to the establishment date (Line 1) account balance (Line 2), or percent taxable (Line 3), please obtain a written correction from the financial institution and attach it to this forth. 1. Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a. First, determine the percentage owned by the decedent. i. Accounts that are held "in trust for" another or others were 100°k owned by the decedent. ii. For joint accounts established more than one year prior to the date of death, the percentage taxable is 100% divided by the total number of owners including the decedent. (For example: 2owners = 50%, 3 owners = 33.33%, 4 owners = 25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. your relationship to the dece t. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due 9. With 59'° Discrount (Tax ease state 1 2 $ 3 X 4 $ 5 - 6 $ 7 X Step 2: sign and date below. Return TWO completed and signed copies to the Register of Wilts listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to "Register of Wills, Agent." Do not send payment directly to the Department of Revenue. Under penalty of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief, Work (~' Home ~r7~7 t-v'-~ ! ~-ter-I Taxpayer S nature Telephone Number Date = YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 17-787-5327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 BUREAU OF INUTYI[IUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response Pennsylvania DEPARTMENT OF REVENUE ccv-sscs ex mcExEC iee.ev FILE N0.2170 ACN 13103283 DATE 01-22-2013 JENNIFER L RITZIE 925 S 29TH ST CAMP HILL PA 17011-5805 SUSQUEHANNA BANK provided the d~ above-named decedent you were a Account No. 3000202280 Date Established 07-23-2012 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due With 5% Discount (Tax x 0.95) Type of Account Estate of WALTER C RITZIE Savings SSN ~" Checking Date of Death 01-03-2013 ° rust County CUMBERLAND n °-~' ertificate C P ~ ~ -n ~ C? ~ ~ rrt s n --+ ~" ~ n r r-- z rn '`' cn ;.' rJ .~ ~ ~ .~ ~ '~T C7 c7 r, c::: ~ ;T ..- .,.. - F~a ~.. ~ _ .: r.~ : -ca I., ~, s .. rn -.] .rent with the information below indicating that at the death of the owner or beneficiary of the account identified. Remit Payment and Forms to: REGISTER OF WILLS i $ 31 911 21 1 COURTHOUSE SQUARE CARLISLE PA 17013 X 50 61 $ 15 955 , . X 0.150 f th hi th d i h ' e w ree mon s o e : If tax payments are ma t n t NOTE $ 2,393.34 decedent's date of death, deduct a 5 percent discount on the tax $ (see NOTE*) due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1: Please check the appropriate boxes below. 1 a ~ No tax is due. l I am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Pmceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. g ~ The information is correct. C ~ The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) D ~ Changes or deductions listed. Asset will be reported on in eritance tax form REV-1500. The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed to Step 2 on reverse. Do not check any other boxes. 4.5% 1 am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12% I am a sibling of the deceased. 15% All other relationships (including none). The information above is incorrect and/or debts and deductions were paid. Complete Part 2 and part 3 as appropriate on the back o/this torn. The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax Return filed by the estate representative. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART Debts and Deductions z Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required, you may attach 81/2" x 11" sheets of paper.) Date Paid Payee Description Amount Paid PART Tax Calculation 3 N you are making a correction to the establishment date (line f) account balance (Line 2), or percent taxable (Line 3), please obtain a written correction from the financial instNUtion and attach it to this form. 1. Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a. First, determine the percentage owned by the decedent. i. Accounts that are held "in trust for" another or others were 100% owned by the decedent. ii. For joint accounts established more than one year prior to the date of death, the percentage taxable is 100% divided by the total number of owners including the decedent. (For example: 2owners = 50%, 3 owners = 33.33%, 4 owners = 25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. your relationship to the decedent: 1. Date Established Under penalty of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. ,.., Work Home'71~ 023 !u Telephone Number IF YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 .St@p 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to "Register of Wills, Agent " Do not send payment directly to the Department of Revenue. BUREAU OF INDTYIDUAI TAXES PD BOX 28D601 HARRISBURG PA 17128-0601 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response jiy Pennsylvania LIT DEPARTMENT OF REVENUE acv-qua [a no~cMec roe-iz~ FILE NO. 2170 ACN 13103284 DATE 01-22-2013 Type of Account Estate of WALTER C RITZIE Savings SSN 1 Checking Date of Death 01-03-2013 Trust DOUGLAS A RITZIE County CUMBERLAND C¢rtificate 925 S 29TH ST CAMP HILL PA 17011-5805 C Cs ~ ~ ~ :.sr '7 7. ~ n `~y :.'2~ O ~ SUSQUEHANNA BANK provided the department with the information below indicatingl~at'at the ~'ath,~ the above-named decedent you were a joint owner or beneficiary of the account identified. r,] ~, a Q-i Remit Payment and Forms to: ' Account No. 3000202063 Date Established 01-19-2012 REGISTER OF WILLS Account Balance $140 565.59 1 COURTHOUSE SQUARE , CARLISLE PA 17013 Percent Taxable X 33.333 Amount Subject to Tax $ 46 854 73 . , Tax Rate X 0.150 i h h f th d hi ' n t ree mont s o e e w t NOTE : If tax payments are ma Potential Tax Due $ 7,028.21 decedent's date of death, deduct a 5 percent discount on the tax With 5% Discount (Tax x 0.95) $ (see NOTE') due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1: Please check the appropriate boxes below. 1 A ~ No tax is due. g The information is correct. C ~ The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) D ~ Changes or deductions listed. E i~ASSet will be reported on ~rinheritance tax form REV-1500. I am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. The above information is correct, no deductions are being taken, and payment wilt be sent with my response. Proceed to Step 2 on reverse. Do not check any other boxes. 4.5°I° 1 am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12°I° 1 am a sibling of the deceased. 15% All other relationships (including none). The information above is incorrect and/or debts and deductions were paid. Complete Part 2 and part 3 as appropriate on the back of this form. The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax Return filed by the estate representative. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART 2 Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required, you may attach 81/2" x 11"sheets of paper.) Date Paid Payee Description Amount Paid PART Tax Calculation 3 If ou are makin a correction to the establishment date line f account balance Line 2 , or y g ( ) ( ) percent taxable (Line 3), please obtain a written correction from the financial Institution and attach it to this form. 1. Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a. Frst, determine the percentage owned by the decedent. i. Accounts that are held "in trust for" another or others were t OD% owned by the decedent. ii. For joint accounts established more than one year prior to the date of death, the percentage taxable is 100% divided by the total number of owners including the decedent. (For example: 2owners = 50%, 3 owners = 33.33%, 4 owners = 25%, etc.} b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4, The amount subject [o tax is determined by multiplying the accoun! balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7, Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. If indicating a different tax rate, pl your relationship to the decedent: 7. Dale Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. bebts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due 3 X X 9. With 5% Discount (Tax x .95) 9 X Step 2; Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to "Register of Wills, Agent:' Do no[ send payment directly to the Department of Revenue. Under penalty of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. /'~ Work ~.~~,__~'~.'ka(.~;.n Home-~t~-73f-o9a] ~_R-t3 Taxpayer gnature Telephone Number Date YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA PARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 7-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS JLY:1-800-447-3020 BUREAU OF INOIYIOUAL TAXES PU BOX 280601 HARRISBURG PA 17128-0601 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response j i~ Pennsylvania ail DEPARTMENT OF REVENUE vev-isaa cx mocx[c ue-sv FILE NO. 2170 ACN 13103285 DATE Ot-22-2013 SANDRA R ALBRIGHT 925 S 29TH ST CAMP HILL PA 17011-5805 SUSQUEHANNA BANK provided the d. above-named decedent you were a Account No. 31100202063 Estate of WALTER C RITZIE SSN Date of Death 01-03-2013 County CUMBERLAND partment with the information below oint owner or beneiiciary of the acct Type of Account Savings Checking Trust X Certificate C? -~ C ~' ~° ~ ~ ~ m m m ~ '~ " a ~n~ Q' cnao .~ Qty ° ~a d p :~ o ~, .,I a r~i g that et,the~e~h of the ~ IrVcntHicrt rrr ~ Remit Payment and Forms to: V Date Established Ot-19-2012 REGISTER OF WILLS Account Balance $ 140 565.59 1 COURTHOUSE SQUARE , CARLISLE PA 17013 Percent Taxable X 33.333 Amount Subject to Tax $ 46,854.73 Tax Rate X 0.150 NOTE': If tax payments are made within three months of the Potential Tax Due $ 7,O2g,21 decedent's date of death, deduct a 5 percent discount on the tax With 5% Discount (Tax x 0.95) $ (see NOTE') due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1: Please check the appropriate boxes below. 1 A ~ No tax is due. g ~ The information is correct. C ~ The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) D ~ Changes or deductions listed. E ~ Asset will be reported on Inheritance tax form REV-1500. 1 am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed to Step 2 on reverse. Do not check any other boxes. 4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12% I am a sibling of the deceased. t 5% All other relationships (including none). The information above is incorrect and/or debts and deductions were paid. Complete PaR 2 and part 3 as appropriate on the back of this form. The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax Return filed by the estate representative. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART z Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required, you may attach S 1/2" x 11"sheets of paper.) Date Paid Payee Description Amount Paid Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 If you are making a corcection to the establishment date (Line 1) account balance (Line 2), or percent taxable (Line 3), please obtain a written correction from the financial institution and attach it to this form. 1. Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3, Enter the percentage. of the account that is taxable to you. a. First, determine the percentage owned by the decedent. i. Accounts that are held "in trust for" another or others were 100% owned by the decedent. ii. For joint accounts established more than one year prior to the date of death, the percentage taxable is 100% divided by the total number of owners including the decedent. (For example: 2owners = 50%, 3 owners = 33.33%, 4 owners = 25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. It moicattng a dmerent tax rate, please your relationship to the decedent: 1. Date Established 1 Under penalty of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. Signature Home ~7~~~Q - Telephone Number YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 17-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS INLY: 1-800-447-3020 St2p 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to "Register of Wills, Agent " Do not send payment directly to the Department of Revenue. BUREAU OF INDIYIOUAI TAXES PO BOX 280601 HARRISBURG PA 1]128-0601 JENNIFER L RITZIE 925 S 29TH ST CAMP HILL PA 17011-5805 SUSQUEHANNA BANK provided the d~ above-named decedent you were a Pennsylvania Inheritance Tax Information Notice And Taxpayer Response pennsylvania T.i~ DEPARTMENT OF REVENUE 0.EY-]54] F% ~ocE%EL IOB-10.] FILE NO. 2170 ACN 13103286 DATE Oi -22-2013 Estate of WALTER C RITZIE S Date of Death 01-03-2013 County CUMBERLAND Went with the information below indi owner or beneficiary of the account Type of Account Savings Checking Trust X Certificate n 4' m cm-, C O ro -n ~ c~ p tf1 ~ CO ~ ~ rn co ~ G' y N A Q - tl n n C~ Q ~ ~ 'I =- n ~, c rn r.,_ ~.,, ~ at thet~eathe ~tlAed Remit Payment and Forms to: Account No. 3000202063 Date Established 01-19-2012 REGISTER OF WILLS Account Balance $140,565.59 1 COURTHOUSE SQUARE CARLISLE PA 17013 Percent Taxable X 33.333 Amount Subject to Tax $ 46 854 73 . , Tax Rate X 0.150 i h f th hi h ' t n t ree mont s o e NOTE : If tax payments are made w Potential Tax Due $ 7,p2g.2t decedent's date of death, deduct a 5 percent discount on the tax With 5% Discount (Tax x 0.95) $ (see NOTEY) due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1: Please check the appropriate boxes below. 1 A ~ No tax is due. g ~ The information is correct. C ~ The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) D ~ Changes or deductions listed. E set will be reported on inheritance tax form REV-1500. I am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed to Step 2 on reverse. Do not check any other boxes. 4.5°I° I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12% I am a sibling of the deceased. 15% All other relationships (including none). The information above is incorrect and/or debts and deductions were paid. Complete Part 2 and part 3 as appropriate on the back of this lorm. The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax Return filed by the estate representative. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART 2 Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid [he debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required, you may attach 81/2" x 11"sheets of paper.} Date Paid Payee Description Amount Paid Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 If yogare making a correction to the establishment date (Line 1) account balance (Line 2), or percent taxable (Line 3), please obtain a written correction from the financial instllution and attach it to this form. 1. Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a. First, determine the percentage owned by the decedent. i. Accounts that are held "in trust for" another or others were 100% owned by the decedent. ii. For joint accounts established more than one year prior to the date of death, the percentage taxable is 100% divided by the total number of owners including the decedent. (For example: 2owners = 50%, 3 owners = 33.33%, 4 owners = 25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from [he amount subject to tax. 7, Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. your relationship to the dece 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due X 5 - X 9. With 5% Discount (Tax x .95) 9 X Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to "Register of Wills, Agent " Do not send payment directly to the Department of Revenue. Under penalty of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. Work Signature Telephone Number YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA :PARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 7-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS JLY:f-800-447-3020 BUREAU OF INDIVIDUAL TAXES PO BOX 280681 HARRISBURG PA 17128-0601 I am the spouse of the deceased or 1 am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed fo Step 2 on reverse. Do not check any other boxes. DOUGLAS RITZIE 925 S 24TH ST CAMP HILL PA 17011-5805 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response Pennsylvania DEPARTMENT OF flEVENUE e[vasas ex oocFxec ,ae-~zz FILE NO. 2170 ACN 13102377 DATE 01-17-2013 Estate of WALTER C RITZIE SSN 167-30-0093 Date of Death Ot-03-2013 County CUMBERLAND Type of Account Savings Checking n Tr t ~iti t w X ca e m ~ rn o? o m=c~ °7 .~~o a ~-mn V' ca ;zl c~ -2c ~ oG co ~ ~ :m -n -+I c"aany 3 .rte :i7 CS r- m _i ~ c,~ r^ to m 'r'I MEMBERS 1sT Fcu provided the department with the information below indicating that at the death of the above-named decedent you were a joint owner or beneficiary of the account identified. Remit Payment and Forms to: Account No. 233021 Date Established 07-19-2011 REGISTER OF WILLS Account Balance $144,161.77 1 COURTHOUSE SQUARE CARLISLE PA 17013 Percent Taxable X 8.333 t to Tax A t S b $ 12 013 00 moun u jec , . Tax Rate X 0.045 ths of the th d ithi If ` n ree mon e w tax payments are ma NOTE : Potential Tax Due $ 540.59 decedent's date of death, deduct a 5 percent discount on the tax With 5% Discount (Tax x 0.95) $ (see NOTE`) due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1: Please check the appropriate boxes below. 1 A ~ No tax is due. g The information is correct. C O The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) D O Changes or deductions listed. E Asset will be reported on inheritance tax form REV-1500. 4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12% I am a sibling of the deceased. 15% All other relationships (including none). The information above is incorrect and/or debts and deductions were paid. Complete Part 2 and part 3 as appropriate on the back of this form. The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax Return filed by the estate representative. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART 2 Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required, you may attach 81/2" x 11"sheets of paper.) Date Paid Payee Description Amount Paid Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 If you are making a correction to the establishment date (Line t) account balance (Line 2), or percent taxable (Line 3), please obtain a written correction from the financial instilutton and attach it to this form. 1. Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account incuding any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a. First, determine the percentage owned by the decedent. i. Accounts that are held "intrust for" another or others were 100% owned by the decedent. ii. For joint accounts established more than one year prior to the date of death, the percentage taxable is 100% divided by the total number of owners including the decedent. (For example: 2owners = 50%, 3 owners = 33.33%, 4 owners = 25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. If indicating a different tax rate, your relationship to the decede 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate S. Tax Due X 9. With 5% Discount (Tax x .95) 9 X St@p 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to "Register of Wills, Agent." Do not send payment directly to the Department of Revenue. Under penalty of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. Work Home ~r~-r'12t Taxpayer Telephone Number Date YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 17-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS iNLY; 1-800-447-3020 BUREAU Of INDIVIDUAL TAXES PO BOX 280601 HARRISBURG pA 17128-0601 lam the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Dc not check any other boxes and disregard the amount shown above as Potential Tax Due. The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed to Step 2 on reverse. Do not check any other boxes. Pennsylvania {~7 DEPARTMEN70FpEVENUE REV.]Sf! ES Oa[E%fC (!!-It, FILE NO. 2170 ACN 13102378 DATE 01-17-2013 SANDRA ALBRIGHT 227 SKYLINE VW CARLISLE PA 17013-8119 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response Estate of WALTER C RITZIE Date of Death 01-03-2013 County CUMBERLAND MEMBERS lsr Fcu provided the department with the information below Indic above-named decedent you were a joint owner or beneficiary of the account Type of Account Savings Checking Trust X Certificate r.. ° ~ .., rn rn o _,., c~ o ~tat,at ~ deaRti~f the r~tecF 1--! m rn Remit Payment and Forms: U? ~ 0 0 Account No. 233021 v o o ='~ 'Tl --i Date Established 07-19-2011 ~ -- REGISTER OF WILLS c~ cy -.~ Account Balance $144 161.77 1 COURTHOUSE SQUARE o ~ m s= m ~ , _I ~ CARLISLE PA 17013 Percent Taxable X 8.333 L, o rn T 13 00 ~ ax Amount Subject to $ 12,0 . Tax Rate X 0.045 NOTE`: If tax payments are made within three months of the Potential Tax Due $ 540.59 decedent's date of death, deduct a 5 percent discount on the tax With 5% Discount (Tax x 0.95) $ (see NOTE") due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1: Please check the appropriate boxes below. 1 A ~ No tax is due. g The intormatlon is correct. C The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) D ~ Changes or deductions listed. E ®Asset will be reported on inheritance tax form REV-1500. 4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12% I am a sibling of the deceased. 15%, All other relationships (including none). The information above is incorrect and/or debts and deductions were paid. Complete Part 2 and part 3 as appropriate on the back of this form. The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax Return filed by the estate representative. Proceed fo Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART z Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required, you may attach S 1/2" x 11"sheets of paper.) Date Paid Payee Description Amount Paid Total Enter on Line 5 of Tax Calculation $ PART 3 1 2 3 4. 5. 6. 7. If indii yourr Tax Calculation If you are making a correction to the establishment date (Line 1) account balance (Line 2), or percent taxable (Line 3), please obtain a written cortection from the financial instltutlon and attach it to this form. Enter the date the account was established or titled as it existed at the date of death. Enter the total balance of the account including any interest accrued at the date of death. Enter the percentage of the account that is taxable to you. a. First, determine the percentage owned by the decedent. i. Accounts that are held "in trust for" another or others were 100° owned by the decedent. ii. For joint accounts established more than one year prior to the date of death, the percentage taxable is 100% divided by the total number of owners including [he decedent. (For example: 2owners = 50°,6, 3 owners = 33.33%, 4 owners = 25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. The amount subject to tax is determined by multiplying the account balance by the percent taxable. Enter the total of any debts and deductions claimed from Part 2. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due 9. With 5% Discount (Tax x Step 2: Sign and date below, Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to "Register of Wills, Agent." Do not send payment directly to the Department of Revenue. Under penalty of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. ,. Work Taxpayer Signature ' Telephone Number YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA PARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 7-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS JLY:1-800-447-3020 BUREAU OF INDIVIDUAL TA%ES PO BOX 280601 HARRISBURG PA 17128-0681 1 am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. j i~ Pennsylvania DEPARTMENT OF REVENUE MEV-156] EF 4e[EXFC (01-12) FILE NO. 2170 ACN 13102379 DATE Ot-17-2013 JENNIFER RITZIE 505 -EUBLER RD CAMP HILL PA 17011-2017 The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed to Step 2 on reverse. Do not check any other boxes. MEMBERS lsr Fcu provided the department with the information below above-named decedent you were a joint owner or beneficiary of the acc Type of Account Savings Checking n ~=> st c ca w ~nificate W -X~ ^~ "n p ~ ~ r cn ~ d r- Z rrt ~ N ~ h..X ca n.t t°~ :sx c.. q • '~ ~ ~ O Q - - 7 C7 f1 C O G' ~l =3 n rp „~~7 ~ ('1 r 'Z7 --1 ' ITI ( a w cn o rn ~ that at the death of the Remit Payment and Forms to: Account No. 233021 Date Established 07.19.2011 REGISTER OF WILLS Account Balance $144,161.77 1 COURTHOUSE SQUARE CARLISLE PA 17013 ~ Percent Taxable X 8.333 Amount Subject to Tax $ 12,013.00 Tax Rate X 0.045 NOTE': If tax payments are made within three months of the Potential Tax Due $ 540.59 decedent's date of death, deduct a 5 percent discount on the tax With 5% Discount (Tax x 0.95) $ (see NOTE`) due. Any inheritance tax due will become delinquent nine months after the date of death. PART St@p 1: Please check the appropriate boxes below. 1 A ~No tax is due. g The information is correct. C ^ The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) D ~ Changes or deductions listed. E Asset will be reported on inheritance tax form REV-1500. Pennsylvania Inheritance Tax Information Notice And Taxpayer Response Estate of WALTER C RITZIE Date of Death Ot-03-2013 County CUMBERLAND 4.5% I am a lineal beneficiary (pazent, child, grandchild, etc.) of the deceased. 12% I am a sibling of the deceased. 15% All other relationships (including none). The information above is incorrect and/or debts and deductions were paid. Complete Part 2 and part 3 as appropriate on the back of this form. The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax Return filed by the estate representative. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART 2 Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required, you may attach 81/2" x 11" sheets of paper.) Date Paid Payee Description Amount Paid Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 K you are making a correction to the establishment date (Line 1) account balance (Line 2), or percent taxable (Line 3), please obtain a written correction from the financial institution and attach it to this form. 1. Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a. First, determine the. percentage owned by the decedent. i. Accounts that are held "intrust for" another or others were 100° owned by the decedent. ii. For joint accounts established more than one year prior to the date of death, the percentage taxable is 100% divided by the total number of owners including the decedent. (For example: 2owners = 50°k, 3 owners = 33.33%, 4 owners = 25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the tote! of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter [he appropriate tax rate from Step 1 based on your relationship to the decedent. Under penalty of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. , Work Home Telephone Number YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA :PARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 7-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS JLY: 1-800-447-3020 Step 2: Sign and date bebw. Return TWO completed and signed copies to the Register of Wilts listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to "Register of WiNs, Agent." Do not send payment directly to the Department of Revenue. BUREAU OF INDIVIDWL TAXES PO BOX 288681 HARRISBURG PA 17128-0681 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response Pennsylvania DEPARTMENT OF REVENUE PEV-154I EX Oa[EREC f08-12] FILE NO. 2170 ACN13102380 DATE 01-17-2013 Type of Account DOUGLAS RITZIE 925 S 29TH ST CAMP HILL PA 17011-5805 Estate of WALTER C RITZIE Date of Death 01-03-2013 County CUMBERLAND P ..n .~ `n -~, ~ CJ ~ „ t9l ~ ~ N O - r1 n ~~o 7~o v ra ~ Cn Savings CFag~king `o w X r edtficate -Y1 ~ Q ~ ~ ~ r+~ ~ c~ .~ S7 C'7 ~ ~ O G~ G ro v MEMBERS 1ST FCU above-named decf Account No. 233021 Date Established 11-26-2010 Account Balance Percent Taxable the department with the information below indicating that at the death of the were a joint owner or beneficiary of the account identified. RemR Payment and Forms to: REGI57ER OF WILLS $14,681.90 1 COURTHOUSE SOUARE X 8.333 CARLISLE PA 17013 Amount Subject to Tax $ 1,223.44 I ~ Tax Rate X 0.045 NOTE*: If tax payments are made within three months of the Potential Tax Due $ 55.05 decedent's date of death, deduct a 5 percent discount on the tax With 5 /° Discount (Tax x 0.95) $ (see NOTE*) due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1; Please check the appropriate boxes below. 1 A ~ No tax is due. g The information is correct. C ~ The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) D ~ Changes or deductions listed. E dAsset will be reported on inheritance tax form REV-1500. 1 am the spouse of the deceased or 1 am the parent of a decedent who was 21 years ofd or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed to Step 2 on reverse. Do not check any other boxes. 4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12% I am a sibling of the deceased. 15% All other relationships {including none). The information above is incorrect and/or debts and deductions were paid. Complete Part 2 and part 3 as appropriate on the back of this (orm. The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax Return filed by the estate representative. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART 2 Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required, you may attach S 1/2" x 11"sheets of paper.) Date Paid Payee Description Amount Paid Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 It you are making a correction to the establishment date (Line t) account balance (Line 2), or percent taxable (Line 3), please obtain a written correction from the financial Institution and attach it to this form. 1. Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of [he account including any interest accrued at the date of death. 3. Enter the percentage of [he account that is taxable to you. a. First, determine the percentage owned by the decedent. i. Accounts that are held "intrust for" another or others were f 00% owned by the decedent. ii. For joint accounts established more than one year prior to the date of death, the percentage taxable is 100% divided by the total number of owners including the decedent. (For example: 2owners = 50%, 3 owners = 33.33%, 4 owners = 25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. your relationship to the dece 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due 9. WRh 5% Discount (Tax 2 $ 3 x 4 $ Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to "Register of Wills, Agent " Do not send payment directly to the Department of Revenue. Under penalty of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. -, _ .-. Work 7~7 =731-~ Taxpayer Telephone Number x/2211 Date = YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 17-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 BUREAU OF INDIVIDUAL TAXES PD BDX 2806D1 HARRISBURG PA 17128-0601 1 am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed to Step 2 on reverse. Do not check any other boxes. pennsytvania DEPARTMENT OF REVENUE vsvasa ex oo~[xsc roeav FILE NO. 2170 ACN 13102381 DATE 01-17-2013 SANORA ALBRIGHT 227 SKYLINE VW CARLISLE PA 17013-6119 Type of Account Savings Checking Trust X Certificate rte; c~ ~ n ~° ~ m csn ~ rn p m °' N ~ scs -l 20 p r r-~ r„ m rzm cn ~o z v'• ~ a G' - ~ C) ~ _~ ~ rt ~ 'xi .r ~ ~ . ...... .... ~ ~ CO ~ Trl. Q ro D G.~ Q) N ~ MEMBERS lsr Fcu provided the department with the information below indicating that at the death of the above-named decedent you were a joint owner or beneficiary of the account identified. Remit Payment and Forms to: Account No. 233021 Date Established ti-26-2010 REGISTER OF WILLS Account Balance $14,681.90 ~ COURTHOUSE SQUARE CARLISLE PA 17013 Percent Taxable X 8.333 T b 44 223 ax Amount Su ject to $ 1, . Tax Rate X 0.045 NOTE": If tax payments are made within three months of the Potential Tax Due $ 55.05 decedent's date of death, deduct a 5 percent discount on the tax With 5% Discount (Tax x 0.95) $ (see NOTE') due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1: Please check the appropriate boxes below. 1 A ~ No tax is due. g ~ The information is correct. C The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.} D ~ Changes or deductions listed. E ~ Asset will be reported on inheritance [ax form REV-1500. Pennsylvania Inheritance Tax Information Notice And Taxpayer Response Estate of WALTER C RITZIE SSN Date of Death Ot-03-2013 County CUMBERLAND 4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of The deceased. 12% I am a sibling of the deceased. 15% All other relationships (including none). The information above is incorrect and/or debts and deductions were paid. Complete Part 2 and part 3 as appropriate on the back of this form. The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax Return filed by the estate representative. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART z Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required, you may attach 81/2" x 11"sheets of paper.) Date Paid Payee Description Amount Paid PART Tax Calculation 3 If ou are makin a correction to the establishment date Line 1 account balance Line 2 , or Y g ( ) ( ) percent taxable (Line 3), please obtain a written correction from the financial instlhrtlon and attach tf to this form. 1. Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a. First, determine the percentage owned by the decedent. i. Accounts that are held "in trust for" another or others were 100% owned by the decedent. ii. For joint accounts established more than one year prior to the date of death, the percentage taxable is 100% divided by the total number of owners including the decedent. (For example: 2owners = Sa%, 3 owners = 33.33%, 4 owners = 25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the peroent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. If indicating a different tax rate, pl your relationship to the decedent: 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due 3 X 5 - 7 X 9. With 5% Discount (Tax x .95) 9 X .St@p 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on [he front of this fam, along w(th a check for any payment you are making. Checks must be made payable to "Register of Wills, Agent." Do not send payment directly to the Department of Revenue. Under penalty of perjury, I declare that the facts I have reported above are true, corcect and complete to the best of my knowledge and belief. Work 'Taxpayer Signature Telephone Number bate IF YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 BUREAU OF INDIVIDUAL TAXES PO BOX 288681 HARRISBURG PA 17128-8601 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response JENNIFER RITZIE 505 DEUBLER RD CAMP HILL PA 17011-2017 AecountNo.233021 Type of Account Savings Checking Trust X Certificate C ~ rn m-° '^ ~a ~n~ C° u~a Z ~ v ~ x ~ 9 ra -'27 ~ z p c -~, ~ _ -ri ro ~ w e:. m m C...7 fn O ~ ~ the department with the information below indicating that at the death of the were a joint owner or beneficiary of the account identified. Pennsylvania ill DEPARTMENT OF REVENUE REV-1543 E% UocE%EC !00-12] FILE NO. 2170 ACN 13102382 DATE 01-17-2013 Estate of WALTER C RITZIE SSN Date of Death 01-03-2013 County CUMBERLAND Remit Payment and Forms to: Date Established 11-26-2010 REGISTER OF WILLS Account Balance $ 14,681.90 1 COURTHOUSE SQUARE CARLISLE PA 17013 Percent Taxable X 8.333 Amount Subject to Tax $ 1,223.44 Tax Rate X 0.045 NOTE": If tax payments are made within three months of the Potential Tax Due $ 55.05 decedent's date of death, deduct a 5 percent discount on the tax With 5% Discount (Tax x 0.95) $ (see NOTE*) due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1: Please check the appropriate boxes below. 1 A ~ No tax is due. g The information is correct. C The [ax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) D ~ Changes or deductions listed. E Asset will be reported on eritance tax form REV-1500. I am the spouse of the deceased or 1 am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tar Due. The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed to Step 2 on reverse. Do not check any other boxes. 4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12% I am a sibling of the deceased. 15% All other relationships (including none). The information above is incorrect and/or debts and deductions were, paid. Complete Part 2 and part 3 as appropriate on the back of this form. The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax Return filed by the estate representative. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART z Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required, you may attach 81/2" x 11"sheets of paper.) Date Paid Amount Paid Payee Description Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 If you are making a correction to the establishment date (Line 1) account balance (Line 2j, or percent taxable (Line 3), please obtain a written correction from the financial Institution and attach tt to this form. 1. Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a, first, determine the percentage owned by the decedent. i. Accounts that are held "intrust for" another or others were 100% owned by the decedent. ri. For joint accounts established more than one year prior to the date of death, the percentage taxable is 100% divided by the total number of owners including the decedent. (For example: 2owners = 50%, 3 owners = 33.33%, 4 owners = 25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. Under penalty of perjury, I declare that the facts I have reported above are true, corcect and complete to the best of my knowledge and belief. Work Home Telephone Number YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA PARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 7-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS JLY; t-800-447-3020 Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to "Register of Wills, Agent." Do not send payment directly to the Department of Revenue. BUREAU OF INDIVIDUAL TAXES ~ enns lvania PO B0S 280601 Pennsylvania inheritance Tax P Y HARR75BURG PA 1]128-0601 Information Notice DEPARTMENT OF REVENUE And Taxpayer Response "~ "`~ E. ~""" <~' "~ S FILE N0.2170 1 `?j -~ S ACN 13102698 DATE 01-18-2013 DOUGLAS A RITZIE 925 S 29TH ST CAMP HILL PA 17011-5805 MID PENN flK above-named 1 am the spouse of the deceased or 1 am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed to Step 2 on reverse. Do not check any other boxes. Type of Account Savings Checking X Trust Certificate ^.; ~o `" rn~ ~ rn ~ ~ pp , ?O rn x o m rn ~ ~ n r r- ~ m ~'' ~ ~ m rn D~~ CO pro a . ~ o ca ~ 'xr --+ rn r° rn r- yy c,T rn o that at the ft@ath of t7~e identified. Remit Payment and Forms to: Account No. 309003161 Date Established 05-21-2012 REGISTER OF WILLS Account Balance $ 78 302.76 1 COURTHOUSE SQUARE , CARLISLE PA 17013 Percent Taxable X 33.333 T t t A S b 100 66 26 ax mount u jec o $ , . Tax Rate X 0.045 nths of the ithi th m d T If ' e w ree o n tax payments are ma NO E : Potential Tax Due $1,174.53 decedent's date of death, deduct a 5 percent discount on [he tax With 5% Discount (Tax x 0.95) $ (see NOTE') due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1: Please check the appropriate boxes below. 1 A ~No tax is due. g The Information is correct. C ~ The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) D ~ Changes or deductions listed. E Asset will be reported on inheritance tax form REV-1500. the department with the information below ii you were a joint owner or beneficiary of the Estate of WALTER C RITZIE SSN Dale of Death 01-03-2013 County CUMBERLAND 4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12% I am a sibling of the deceased. 15 /° All other relationships (including none). The information above is incorrect and/or debts and deductions were paid. Complete Part 2 and part 3 as appropriate on the back o'r this form. ~ - The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax Return filed by the estate representative. Proceed to Sfep 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART z Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required, you may attach 8 1 /2" x 11"sheets of paper.) naro caw Pavee Description Amount Paid __° . __ Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 If you are making a correction to the establishment date (Line 1) account balance (line 2), or percent taxable (Line 3), please obtain a written correction from the financial institution and attach it to this form. 1. Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a. First, determine the percentage owned by the decedent. i. Accounts that are held "in trust for" another or others were 100% owned by the decedent. ii. For joint accounts established more than one year prior to the date of death, the percentage taxable is 100% divided by the total number of owners including the decedent. (For example: 2 owners = 50%, 3 owners = 33.33%, 4 owners = 25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. your reianonsmp to me aece 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 6. Tax Due 9. With 5% Discount (Tar Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to "Register of Wills, Agent." Do not send payment directly to the Department of Revenue. Under penalty of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. Work Taxpayer Home -7f 7.73 (-c Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA" DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ON LY: 1-800-447-3020 BDREAD OF INDIVIDDAL TAXES PD eox zea6BL HARRISBURG PA 17128-0601 SANDRA R ALBRIGHT 277 SKYLINE VW CARLISLE PA 17013 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response Pennsylvania e,.~ DEPARTMENT OF REVENUE PFV-1543 E% YacF%EC (06-12> FILE NO. 2170 ACN 13102699 DATE Ot-18-2013 Estate of WALTER C RITZIE Date of Death Ot-03-2013 County CUMBERLAND Type of Account Savings Checking X Trust Certificate n ~O ~.> ~~ CA ~ -rl Yft n t-+y G7 +. O 2a :%° ht ~ ^t b ,Z U) ~ CD ~,.yT Fr1 G:J R ~ fi7 t~ ~ O T ~ c~ cJ ~ ''~ ..;3 ~ -T9 ~ ~ t~ ~ .. ,. f" rn p MID PENN aK provided the department with the information below indicating that at the de`'~h of th81 above-named decedent you were a joint owner or beneficiary of the account identified. Remit Payment and Forms to: Account No. 309003161 Date Established 05-21-2012 REGISTER OF WILLS Account Balance $ 78,302.76 1 COURTHOUSE SOUARE Percent Taxable X 33.333 CARLISLE PA 17013 Amount Subject to Tax $ 26,100.66 Tax Rate X 0.045 Potential Tax Due $ 1 174 53 NOTE": If tax payments are made within three months of the ' , . decedent s date of death, deduct a 5 percent discount on the tax With 5% Discount (Tax x 0.95) $ (see NOTE`) due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1: Please check the appropriate boxes below. 1 A ~ No tax is due. g The information is correct. C The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) p ~ Changes or deductions listed. E ~ Asset will be reported on inheritance tax form REV-1500. I am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed to Step 2 on reverse. Do not check any other boxes. 4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12% I am a sibling of the deceased. 15% All other relationships (including none). The information above is incorrect and/or debts and deductions were paid. Complete Part 2 and part 3 as appropriate on theback o/this /orm. The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax Return filed by the estate representative. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART 2 Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by [he department. (If additional space is required, you may attach 81/2" x 11"sheets of paper.) Date Paid Payee Description Amount Paid PART Tax Calculation 3 If you are making a correction to the establishment date (Line t) account balance (Line 2), or percent taxable (Line 3), please obtain a written correction from the financial InstRution and attach it to this form. 1 . Enter the date the account was established or titled as it existed at the date of death- 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a; First, determine the percentage owned by the decedent. i. Accounts that are held "in trust for" another or others were 100% owned by the decedent. ii. For joint accounts established more than one year prior to the date of death, the percentage taxable is 100% divided by the total number of owners including the decedent. (For example: 2owners = 50%, 3 owners = 33.33%, 4 owners = 25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. your relationship to the decedent: 1, Date Established 2, Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Ra[e 3 X 8. Tax Due 8 $ 9. With 5% Discount {Tax x .95) 9 X Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to "Register of Wills, Agent." Do not send payment directly to the Department of Revenue. Under penalty of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief/., U_ i ~7l ~/ ~ Work _ _ Taxpayer Signature Telephone IF YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS' DN LY: 1-800-447-3020 BUREAU OF INOIVIOUAL TAXES PO BOX 280681 HARRISBURG PA 17128-0681 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response Pennsylvania DEPARTMENT Of REVENUE xsv-ssa ex m~zxsc ,ae-w FILE N0.2170 ACN 13102700 DATE 01-78-2013 JENNIFER L RITZIE 1513 N 2ND ST HARRISBURG PA 17102-2510 Estate of WALTER C RITZIE SS Date of Death 01-03-2013 County CUMBERLAND MID PENN BK provided the department with the information below indicating above-named decedent you were a joint owner or beneficiary of the account Type of Account Savings Checking X Trust Certificate A c; ~ c... ~ ~ ~ b ~ m n a z r,t .g to :o f... -s cr cv h'r n] p 7'c c> -^~+ C7 O C ~ O ~ .ry ,q ~7 ~ia1~'the de~tA of,~ m Remit Payment and Forms to: ' Account No. 309003161 Date Established 05.21-2012 REGISTER OF WILLS Account Balance $ 78,302.76 1 COURTHOUSE SOUARE CARLISLE PA 17013 Percent Taxable X 33.333 t t T A S b 26 100 66 ax mount u jec o $ , . Tax Rate X 0.045 th f th ithi h d ' ree mon s o e w n t e : If tax payments are ma NOTE Potential Tax Due $ 1,174.53 decedent's date of death, deduct a 5 percent discount on the tax With 5 /° Discount (Tax x 0.95) $ (see NOTE') due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1:Please check the appropriate boxes below. 1 A ~No tax is due. g The information is correct. C ~ The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) D ~ Changes or deductions listed. E Asset will be reported on inheritance tax form REV-7500. I am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Sfep 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed to Step 2 on reverse. Do not check any other boxes. 4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12% I am a sibling of the deceased. 15%, All other relationships (including none). The information above is incorrect and/or debts and deductions were paid. Complete Part 2 and part 3 as appropriate on the back of this form. The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax Return filed by the estate representative. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART z Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid [he debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required, you may attach 8 1/2" x 11"sheets of paper.) uate raid rayee Description Amount Paid Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 If you are making a correction to the establishment date (Line t) account balance (Line 2), or percent taxable (Line 3), please obtain a wNtten correction from the financial institution and attach it to this form. 1. Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a. First, determine the percentage owned by the decedent. i. Accounts that are held "in trust for" another or others were 100% owned by the decedent. ii. For joint accounts established more than one year prior to the date of death, the percentage taxable is 100% divided by the total number of owners including the decedent. (For example: 2owners = 50%, 3 owners = 33.33%, 4 owners = 25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. u muicanng a omerenc your relationship to the 1. Date Established Under penalty of perjury, I declare that the facts i have reported above are true, correct and complete to the best of my knowledge and belief. Work Telephone Number YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 17-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of [his form, along with a check for any payment you are making. Checks must be made payable to "Register of Wills, Agent " Do not Send payment directly to the Department of Revenue. BUREAU OF INDIVIDUAL TAXES PD BOX 280601 HARRISBURG PA 17128-0601 DOUGLAS A RITZIE 925 S 29TH ST CAMP HILL PA 17011-5805 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response ~ Pennsylvania DEPARTMENT OF REVENUE cEV-~sas Ex m.[xcc gas-szs FILE NO. 2170 ACN 13101911 DATE 01-15-2013 Type of Account Savings Checking Trust X Certificate Estate of WALTER C RITZIE SSN Date of Death 01-03-2013 County CUMBERLAND CENTRIC BANK provided the department with the information below above-named decedent you were a joint owner or beneficiary of the Account No. 3052818 Remit Payment and A ~o `" mm ~ 77 -D T t-n ~ C1 C? ^t x n ~ n r- v~ cn ~ --f cr n ~ rr: cne ~ r*r m Irv a v 'x aci i~ttfr~t a`~ th~eari of~he • r- --• to: w u> o V> '*i Date Established 12-14-2011 REGISTER OF WILLS Account Balance $ 73,746.15 1 COURTHOUSE SOUARE CARLISLE PA 17013 Percent Taxable X 8.333 Amount Subject to Tax 43 $ 6 145 , . Tax Rate X 0.045 Potential Tax Due $ 276 54 NOTE": If tax payments are made within three months of the ' . decedent s date of death, deduct a 5 percent discount on the tax With 5°1° Discount (Tax x 0.95) $ (see NOTE`) due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1: Please check the appropriate boxes below. 1 A ~ No tax is due. g ~ The information is correct. C ~ The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) D ~ Changes or deductions listed. E ~sset will be reported on inheritance tax form REV-1500. I am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed to Step 2 on reverse. Do not check any other boxes. 4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12% I am a sibling of the deceased. 15% All other relationships (including none). The information above is incorrect and/or debts and deductions were paid. Complete Part 2 and part 3 as appropriate on the back of this form. The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax Return filed by the estate representative. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART 2 Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of paymen! if requested by the department. (If additional space is required, you may attach 8112" x 11"sheets of paper.) .Date Paid Amount Paid Payee Description Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 If you are making a corzection to the establishment date (Line 1) account balance (Line 2), or percent taxable (Line 3), please obtain a written correction from the financial instftution and attach it to this form. 1. Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a. First, determine the percentage owned by the decedent. i. Accounts that are held "in trust for" another or others were 1009'° awned by the decedent. ii. For joint accounts established more than one year prior to the date of death, the percentage taxable is 100% divided by the total number of owners including the decedent. (For example: 2owners = 50%, 3 owners = 33.33%, 4 owners = 25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. Under penalty of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. Work Home ~ I"7 -'7 Taxpayer Signaltltre U Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to "Register of Wills, Agent " Do not send payment directly to the Department of Revenue. BUREAU DF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 $ 73,748.15 X 8.333 Q 6.145.43 SANDRA R ALBRIGHT 227 SKYLINE VW CARLISLE PA 17013-8119 ~ Pennsylvania DEPARTMENT OF PEVENUE REV.1363 FX PocEYEC (OB-li) FILE NO. 2170 ACN 13101912 DATE Ot-15-2013 Estate of WALTER C RITZIE Date of Death 01-03-2013 County CUMBERLAND Type of Account Savings Checking Trust X Certificate c :v w m o m ao ~' r-'i ~' C ~i~ =" r~ " ~~ r m D ~ ~ r CD rn rTt Xe r~ . R a ~ C1 ~j ~__ '43 ..tt h b -T4 _,_.I _n ~} C. :~:. :CS CA ~°- f11 cENTlttc BANK provided the department with the information below indicating~at at the~att~gfcyle above-named decedent you were a joint owner or beneficiary of the account i entified. rn 't Account No. 3052818 Date Established 12-142011 Account Balance Percent Taxable Amount Subject to Tax Remit Payment and Forms to: REGISTER OF WILLS 1000RTHOUSESOUARE CARLISLE PA 17013 Tax Rate X 0.045 NOTE': If tax payments are made within three months of the Potential Tax Due $ 276.54 decedent's date of death, deduct a 5 percent discount on the tax With 5% Discount (Tax x 0.95) $ (see NOTE') due. Any inheritance tax due will become delinquent nine months after the date of death. PART $tep 1: Please check the appropriate boxes below. 1 A ~ No tax is due. B ~ The information is correct. C ~ The [ax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) D ~ Changes or deductions listed. E ~ Asset will be reported on inherRancetaxform REV-1500. I am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tar Due. The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed to Step 2 on reverse. Do not check any other boxes. Pennsylvania Inheritance Tax Information Notice And Taxpayer Response 4.5 /° I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12°f° I am a sibling of the deceased. 15% All other relationships (including none). The information above is incorrect and/or debts and deductions were paid. Complete Part 2 and part 3 as appropriate on the back of this form. The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax Return filed by the estate representative. Proceed to Step 2 on reverse. De not check any other boxes. Please sign and date the back of the form when finished. PART z Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required, you may attach 8 t/2" x 11"sheets of paper.) Dale Paid Payee Description Amount Paid Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 If you are making a correction to the establishment date (Line 1) account balance (Line 2), or percent taxable (Line 3), please obtain a written correction from the financial Institution and attach it to this form. 1. Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a. First, determine the percentage owned by the decedent. i. Accounts that are held "in trust for" another or others were 100% owned by the decedent, ii. For joint accounts established more than one year prior to the date of death, the percentage taxablers 100% divided by the total number of owners including the decedent. (For example: 2owners = 50%, 3 owners = 33.33°,6, 4 owners = 25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. If indicating a different tax rate, p6 your relationship to the decedent: 1. Date Established Under penalty of pery'ury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. c~c~ 6r Home .2.'F -/ ~/ Ol d=(o I Taxpayer Signature Telephone Number ate IF YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to "Register of Wilts, Agent " Do not send payment directly to the Department of Revenue. BUREAU OP INDIYIDUAI TAXES PO BOX 280601 HARRISBURG PA 17128-0601 I am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. ~ Pennsylvania DEPARTMENT OF REVENUE REV.l56i EX -ecEXFG <YB-1]) FILE NO. 2170 ACN 13101913 DATE 01-15-2013 JENNIFER L RITZIE 505 DEIJBLER RA CAMP HILL PA 17011-2017 The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed to Step 2 on reverse. Do not check any other boxes. Type of Account q Savings C Checking ~ m ~ TiASt ~i>~te te ~ n ~ rn ~ r . r - n z M +--~ --r c0 .zcn~ co rnrn ~a c, .~~ ::o :~- _~ a ~'' ~ o ~ ~ CENTRIC BANK provided the department with the information below indicating that at the death of the above-named decedent you were a joint owner or beneficiary of the account identified. Remk Payment and Forms to: Account No. 3052818 Date Established 12-14-2011 REGISTER OF WILLS Account Balance $ 73,748.15 1 COURTHOUSE SQUARE CARLISLE PA 17013 i Percent Taxable X 8.333 Amount Subject to Tex 145 43 $ 6 . , Tax Rate X 0.045 h * NOTE : If tax payments are made within three months of t e Potential Tax Due $ 276.54 decedent's date of death, deduct a 5 percent discount on the tax With 5% Discount (Tax x 0.95) $ (see NOTE') due. Any inheritance tax due will become delinquent nine months after the date of death. PART $>tep 1: Please check the appropriate boxes below. 1 A ~ No tax is due. g ~ The information is correct. C ~ The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) D ~ Changes or deductions listed. E ~ ;~'gsse[ will be reported on lS~-' inheritance tax form REV-1500. Pennsylvania Inheritance Tax Information Notice And Taxpayer Response Estate of WALTER Date of Death 01-03-2013 County CUMBERLAND 4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12% I am a sibling of the deceased. 15% All other relationships (including none). The information above is incorrect and/or debts and deductions were paid. Complete Part 2 and part 3 as appropriate on the back of this form. The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax Return filed by the estate representative. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART 2 Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of paymenf if requested by the department. (If additional space is required, you may attach 61/2" x 71"sheets of paper.) Date Paitl Payee Description Amount Paid Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 If ou are makin a correction to the establishment date Line 1 account balance Line 2 , or Y 9 ( ) ( ) percent taxable (Line 3), please obtain a written correction from the financial institution and attach it to this form. 1. Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account [hat is taxable to you. a. First, determine the percentage owned by the decedent. i. Accounts that are held "in trust for" another or others were 100% owned by the decedent. ii. For joint accounts established more than one year prior to the date of death, the percentage taxable is 100% divided by the total number of owners including the decedent. (For example: 2owners = 50%, 3 owners = 33.33%, 4 owners = 25%, etc.} b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. your relationship to the decedent: 1. Date Established X Under penalty of perjury, I declare that the facts I have repoRed above are true, correct and complete to the best of my knowledge and belief. Telephone Number YOU~NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA :PARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 7-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS JLY:1-800-447-3020 Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to "Register of Wills, Agent:' Do not send payment directly to the Department of Revenue. BUREAU OF INDIVIDUAL TAXES PD BDX 280681 WIRRISBURG PA 11128-0601 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response pennsylvania ~!J DEPARTMENT OF REVENUE xsv-rsas ex m~exec roe-rz~ FILE NO. 2170 ACN 13102937 DATE 01-21-2013 DOUGLAS A RITZIE 925 S 29TH ST CAMP HLLL PA 17811-5805 SUSQUEHANNA SANK provided the d. above-named decedent you were a Type of Account Estate of WALTER C RITZIE Savings ~ Checking Date of Death Ot-03-2013 C ~„ gust County CUMBERLAND ~ ~ _~ rtificate -b r'^ x n ^I ~ Q u, a~1 rte. )t> r• ~ rrl r-.-+ --i rI~ rn ~ to ~ L7 ;~ _T r.7 ~ ''~ U ry ~.^5 r_~ _.... -n .' ._. . ~~ J:1 ;~ '-~] ~ Trent with the information below indicating that at the death of the owner or beneficiary of the account identified. Remit Payment and Forms to: Account No. 148005050 Date Established 05-21-2004 REGISTER OF WILLS Account Balance $19 699.91 1 COURTHOUSE SQUARE , CARLISLE PA 17013 Percent Taxable X 25 t Sub ect to Tax A $ 4 924 98 moun j . , Tax Rate X 0.150 nths of [he ithi th m d T If ' ree e w n o tax payments are ma NO E : Potential Tax Due $ 738.75 decedent's date of death, deduct a 5 percent discount on the tax With 5% Discount (Tax x 0.95) $ (see NOTE') due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1:Please check the appropriate boxes below. 1 A ~ No tax is due. 1 am the spouse of the deceased or 1 am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. g The information is correct. C ~ The tax rate is incorrect. (Select correct tax rate ai right, and complete Part 3 on reverse.) D ^ Changes or deductions listed. E Asset will be reported on inheritance tax form REV-1500. The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed to Step 2 on reverse. Do not check any other boxes. 4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12% I am a sibling of the deceased. 15°/, All other relationships (including none). The information above is incorrect and/or debts and deductions were paid. Complete Part 2 and part 3 as appropriate on the back of this form. The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax Re[urn filed by the estate representative. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART 2 Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required, you may attach S 1/2" x 11"sheets of paper.) Date Paid Payee Description Amount Paid Total (Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 If ou are makin a wrrection to the establishment date (Line 1 account balance Line 2 or Y 9 ) ( ), percent taxable (Line 3), please obtain a written correction from the financial institution and attach it to this form. 1. Enter the date the account was established or titled as it existed at [he date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a. First, determine the percentage owned by the decedent. i. Accounts that are held "in trust for" another or others were 100% owned by the decedent. ii. For join[ accounts established more than one year prior to the date of death, the percentage taxable is 100% divided by the total number of owners including the decedent. (For example: 2owners = 50%, 3 owners = 33.33%, 4 owners = 25 /°, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to taz. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. Under penalty of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. Work ~3(-~ a t Taxpayer Sit nature " Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to "Register of Wills, Agent." Do not send payment directly to the Department of Revenue. BUREAU Or INDIVIDUAL rAxES Pennsylvania Inheritance Tax ~ Pennsylvania Po eox 29B6UI HARRISBURG PA 17128-0601 Information Notice DEPARTMENT OF REVENUE ~,il a , « ex m Exec ,oe-ix, And Taxpayer Response EV- s i FILE N0.2170 ACN 13102938 DATE Ot-21-2013 SANDRA R ALBRIGHT 227 SKYLINE VW CARLISLE PA 17U13-8119 Estate of WALTER C RITZIE SSN 167-30-0093 Date of Death 01-03-2013 County CUMBERLAND Type of Account Savings Checking X Trust Certificate C c m A c.~ ~ m b ~ nl c~ ~, rn .rr; ~ r,s r,-~1 ~..: .,F,, SUSQUEHANNA BANK provided the department with the information below indicatirii3 that at thexle~th p~Tthe above-named decedent you were a joint owner or beneficiary of the account identified. `~ _n Account No. 148005050 Date Established 05-21-2004 Account Balance Percent Taxable Amount Sub)ect to Tax Tax Rate $19,699.91 X 25 $ 4,924.98 X 0.150 Potential Tax Due $ 738.75 With 5% Discount (Tax x 0.95) $ (see NOTE') Remit Payment and Forms to: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 77013 NOTE': If tax payments are made within three months of the decedent's date of death, deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1; Please check the appropriate boxes below. 1 A ~No tax is due. g ~ The information is correct. C ~ The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) D ~ Changes or deductions listed. E Asset will be reported on inheritance tax form REV-1500. I am the spouse of the deceased or 1 am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed to Step 2 on reverse. Do not check any other boxes. 4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12% I am a sibling of [he deceased. 15% All other relationships (including none). The information above is incorrect and/or debts and deductions were paid. Complete Part 2 and part 3 as appropriate on the back of this form. The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax Return filed by the estate representative. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART z Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by [he department. (If additional space is required, you may attach 8 1!2" x 71"sheets of paper.) Date Paid Payee Description Amount Paid Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 If ou are makin a correction to the establishment date Line Y account balance Line 2 or Y 9 ( ) ( ), percent taxable (Line 3), please obtain a written correction from the financial institution and attach it to this form. 1. Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter [he percentage of the account that is taxable to you. a. First, determine the percentage owned by the decedent. i. Accounts that are held "intrust for" another or others were 100°k owned by the decedent. ii. For joint accounts established more than one year prior to the date of death, the percentage taxable is 100% divided by the total number of owners including the decedent. (For example: 2owners = 50%, 3 owners = 33.33%, 4 owners = 25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. If indicating a different tax rate, pl your relationship to the decedent: 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Ra[e 6. Tax Due 9. With 5% Discount (Tau x .95 .St@p 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to "Register of Wilts, Agent." Do not send payment directly to the Department of Revenue. Under penalty of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. Work If YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION A7 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS !)NLY: 1-800-447-3020 BUREAU OF INDIVIDUAL TAXES PG BOX 280601 HARRISBURG PA 1]128-0601 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response Pennsylvania ail DEPARTMENT OF REVENUE REV-1563 E% ~ocE%FC (EB-l21 FILE NO. 2170 ACN 13102939 DATE 01-21-2013 JENNIFER L RITZIE 505 DEUBLER RD CAMP HILL PA 17011-2017 Estate of WALTER C RITZIE SSN 167-30-0093 Date of Death 01-03-2013 County CUMBERLAND Type of Account Savings Checking X Trust Certificate n ~ O c..; ~ ~ ~~ ~ Mn P~^ b r ~ Gn n 2 rrT ~... ._i t~] ;~ cn ~] co a ~'r nT p X ~~i cra n ~ c~ ~-n o cy SUSQUEHANNA BANK provided the department with the information below indicati tt~t at th,~eas6 the above-named decedent you were a joint owner or beneficiary of the account ide fied. _ ;-= rn Remit Payment and Forms to: V Account No. 148005050 Date Established OS-21-2004 REGISTER OF WILLS Account Balance $ 19,699.91 1 COURTHOUSE SQUARE Percent Taxable X P5 CARLISLE PA 17013 Amount Subject to Tax $ 4,924.98 Tax Rate X 0.150 Potential Tax Due $ 738.75 With 5% Discount (Tax x 0.95) $ (see NOTE`) NOTE`: If tax payments are made within three months of the decedent's date of death, deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent nine months after the date of death. PART Ste 1: Please check the a 1 p ppropriate boxes below. A ~ No tax is due. g ~ The information is correct. C ~ The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) D ~ Changes or deductions listed. EAsset will be reported on ~'4nheritance tax form REV-1500. I am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed to Step 2 on reverse. Do not check any other boxes. 4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12% I am a sibling of the deceased. 15% All other relationships (including none). The information above is incorrect andlor debts and deductions were paid. Complete Part 2 and part 3 as appropriate on the back of this form. The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax Return filed by the estate representative. Proceed tc Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART z Payee Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (!f additional space is required, you may attach S 1/2" x 11"sheets of paper.) Date Paid Debts and Deductions Description Amount Paid PART 3 1. 2. 3. 4. 5. 6. 7. Tax Calculation If you are making a correction to the establishment date (Line 1) account balance (Line 2), or percent taxable (Line 3), please obtain a written correction from the financial institution and attach it to this form. Enter the date the account was established or titled as it existed at the date of death. Enter the total balance of [he account including any interest accrued at the date of death. Enter the percentage of the account that is taxable to you. a. First, determine the percentage owned by the decedent. i. Accounts that are held "in trust for" another or others were 100% owned by the decedent. ii. For joint accounts established more than one year prior to the date of death, the percentage taxable is 100% divided by the total number of owners including the decedent. (For example: 2owners = 50%, 3 owners = 33.33%, 4 owners = 25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. The amount subject to tax is determined by multiplying the account balance by the percent taxable. Enter the total of any debts and deductions claimed from Part 2. The amount taxable is determined by subfracting the debts and deductions from the amount subject to tax. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. If indicating a different tax rate, pli your relationship to the decedent: 1. Date Established Under penalty of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. ~ ,.° ~-~ /~ Work Home Telephone Number IF YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA! DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND(OR SPEAKING NEEDS ON LY: 1-800-447-3020 Stt?p 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to "Register of Wills, Agent." Do not send payment directly to the Department of Revenue. BUREAU OF INDIVIDUAL TAXES Po Box zeosal HARRISBURG PA 17128-0601 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response Pennsylvania DEPARTMENT OF REVENUE RFV-154} EX pocEYFL (YB-I21 FILE NO. 2170 ACN 13102940 DATE 01-21-2013 DOUGLAS A RITZIE 925 S 29TH ST CAMP HILL PA 17011-5805 Estate of WALTER C RITZIE SSN Date of Death 01-03-2013 County CUMBERLAND Type of Account Savings Checking Trust X Certificate n ~ ~ w ~ m ~ m m ~ r~ " o SUSOUEHANHA BANK provided the department with the information below indicatl~~at Itle de~h~f the above-named decedent you were a joint owner or beneficiary of the account id~t' ~ '~! '~ Account No 3000150151 Remit Payment and Forms ~• r' ~ :'a o ° 'n - o' . Date Established 03-26-2010 ~ rx ~3 C REGISTER OF WILLS ~ "`~ ~ c~ Account Balance $ 15,958.26 1 COURTHOUSE SOUARr~b '-'t r"' r•- rn Percent Taxable X 8.333 CARLISLE PA 17013 c,~ ~ p v Amount Subject to Tax $ 1,329.80 -rt Tax Rate X 0.150 Potential Tax Due $ 199.47 NOTE': If tax payments are made within three months of the ' With 5% Discount (Tax x 0.95) $ (see NOTE`) decedent s date of death, deduct a 5 percent discount on the tax due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1: Please check the appropriate boxes below. 1 A ~ No tax is due. I am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. g ~ The information is correct. C ~ The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) p ~ Changes or deductions listed. E Asset will be reported on inheritance tax form REV-1500. The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed to Step 2 on reverse. Do not check any other boxes. 4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12% I am a sibling of the deceased. 15% All other relationships (including none). The information above is incorrect andlor debts and deductions were paid. Complete Part 2 and part 3 as appropriate on the back o/this /orm. The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax Return tiled by the estate representative. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART z Pavee Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required, you may attach 8 1/2" x 11"sheets of paper.) Date Paid Debts and Deductions Description Amount Paid PART Tax Calculation 3 If you are making a correction to the establishment date (Line 1) account balance (Line 2), or percent taxable (Line 3), please obtain a written correction from the financial institution and attach it to this form. 1. Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a. First, determine the percentage owned by the decedent. i. Accounts that are held "intrust for" another or others were 100% owned by the decedent. ii. For joint accounts established more than one year prior to the date of death, the percentage taxable is 100% divided by the total number of owners including the decedent. (For example: 2owners = 50%, 3 owners = 33.339'°, 4 owners = 25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. If indicating a different 1 your relationship to the 1. Date Established Under penalty of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. ~'"\ nn Work 7_~L.LKtn ~.~ .~st Home7t7-~13(•t~-lal ,7-9-13 ^Taxpa~yer ignature Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to "Register of Wills, Agent." Do not send payment directly to She Department of Revenue. BUREAU OF INOIVIOUAL TAXES PO BOX 280601 HARRISBURG PA 1]128-0601 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response Pennsylvania X17 DEPARTMENT OF REVENUE REV-154] ER Oaa'EYEC (OB~t21 FILE NO. 2170 ACN 13102941 DATE Ot-21-2013 SANDRA R ALBRIGHT 227 SKYLINE VW CARLISLE PA 17013-8119 Estate of WALTER 2013 County CUMBERLAND t'7 ~o ~~ ~ b r a,, 2 m ~ ~-' ~ a~ C7O_q O C ~] SUSQUEHANNA BANK provided the di above-named decedent you were a partment with the information b oint owner or beneficiary of the Type of Account Savings Checking Trust Certificate .~ `" ~' m r~ ~ 4 m v] ~a CD rry ~ 76 C:r o ca m ~, T~ ...- '1'i '°': n that a't-tli~ death of the Remit Payment and Forms to: Account No. 3000150151 Date Established 03-26-2010 REGISTER OF WILLS Account Balance $ 15,958.26 1 COURTHOUSE SOUARE Percent Taxable X 6.333 CARLISLE PA 17013 Amount Subject to Tax $ 1,329.80 Tax Rate X 0.150 Potential Tax Due 47 $1 gg NOTE': If tax payments are made within three months of the ' , decedent s date of death, deduct a 5 percent discount on the tax With 5% Discount (Tax x 0.95) $ (see NOTE') due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1: Please check the appropriate boxes below. 1 A ~ No tax is due. g ~ The information is correct. C ~ The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) D ~ Changes or deductions listed. E ~ Asset will be reported on inheritance tax form REV-1500. I am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed to Step 2 on reverse. Do not check any other boxes. 4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12% I am a sibling of the deceased. 15% All other relationships (including none). The information above is incorrect and/or debts and deductions were paid. Complete Part 2 and part 3 as appropriate on the back o/this form. The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax Return filed by the estate representative. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART z Debts and Deduct+ons Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required, you may attach 8 1/2" x 11"sheets of paper.) Date Paid Payee Description Amount Paid Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 If you are making a correction to the establishment date (Line 1) account balance {Line 2), or percent taxable (Line 3), please obtain a written correction from the financial insthution and attach it to this form, i. Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of [he account that is taxable to you. a. First, determine the percentage owned by the decedent. i. Accounts that are held "in trust for' another or others were 100% owned by the decedent. ii. For joint accounts established more than one year prior to the date of death, the percentage taxable is 100% divided by the total number of owners including the decedent. (For example: 2owners = 50%, 3 owners = 33.339'°, 4 owners = 25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step i based on your relationship to the decedent. it indicating a different tax rate, please state your relationship to the decedent: 1. Date Established 1 X X Under penalty of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. Signature Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT, 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to "Register of Wills, Agent." Do not send payment directly to the Department of Revenue. BUREAU DE INDIVIDUAL TAXES PD BOX 280601 HARRISBURG PA 17128-0601 JENNIFER L RITZIE 505 DEUBLER RD CAMP HILL PA 17011-2017 SUSQUEHANNA BANK provided the d~ above-named decedent you were a Pennsylvania Inheritance Tax Information Notice And Taxpayer Response Pennsylvania DEPARTMENT OF REVENUE vev-~saa [x no~sx[c <oenv FILE N0.2170 ACN 13102942 DATE 01-21-2013 Estate of WALTER C RITZIE Date of Death 01-03-2013 County CUMBERLAND Type of Account Savings Checking Trust Certificate C> ~o o `" mm rn ~ 2 ^T' rn o Q tn:o a~ ~ az^I cn ax co +nm c ~ ~~:c _~ x ~ Oo c`a cl ~ .;.7 ~ `Ti ~ c~ c:.c ~ ment with the information below indicatitag that at the, de~hBf the owner or beneficiary of the account identified. ~-7 '1 Remit Payment and Forms to: Account No. 3000150151 Date Established 03-26-2010 REGISTER OF WILLS Account Balance $15,958.26 1 COURTHOUSE SQUARE CARLISLE PA 17013 Percent Taxable X 8.333 Amount Subject to Tax $1 329 80 , . Tax Ra[e X 0.150 Potential Tax Due $199 47 NOTE': If tax payments are made within three months of the ' . decedent s date of death, deduct a 5 percent discount on the tax With 5°f° Discount (Tax x 0.95) $ (see NOTE') due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1: Please check the appropriate boxes below. 1 A ~ No tax is due. g ~ The information is correct. C ~ The tax rate is incorrect. {Select correct tax rate at right, and complete Part 3 on reverse.) D ~ Changes or deductions listed. ill be reported on E inheritance tax form REV-1500. I am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger a1 date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed to Step 2 on reverse. Do not check any other boxes. 4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12% I am a sibling of the deceased. 15% All other relationships (including none). The information above is incorrect and/or debts and deductions were paid. Complete Part 2 and part 3 as appropriate on the back of this form. The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax Return filed by the estate representative. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART z Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required, you may attach 8 1/2" x 11"sheets of paper.) Date Paid Payee Description Amount Paid Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 K ou are makin a correction to the establishment date Line 1 account balance Line 2 or y g ( ) ( ), percent taxable (Line 3), please obtain a written correction from the financial inatitutfon and attach it to this form, 1. Enter the date the account was established or tilled as it existed at the date of death. 2. Enter [he total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a. First, determine the percentage owned by the decedent. i. Accounts that are held "in trust for" another or others were 100% owned by the decedent. ii. For joint accounts established more than one year prior to the date of death, the percentage taxable is 100% divided by the total number of owners including the decedent. (For example: 2owners = 50%, 3 owners = 33.33%, 4 owners = 25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. n indicating a ditterent tax rate, pt your relationship to the decedent: 1. Date Established X Under penalty of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. /'~ ,/~ l~/ i1 / ~~ Work Signature Telephone Number YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 17-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS INLY: 1-800-447-3020 .St@p 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to "Register of Wills, Agent." Do not send payment directly to the Department of Revenue. BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 1]128-0601 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response Pennsylvania ~i7 DEPARTMENT OF REVENUE xsvans ex nooexsc ,oeaz~ FILE NO. 2170 ACN 13102943 DATE 01-21-2013 DOUGLAS A RITZIE 925 S 29TH ST CAMP HILL PA 17011-5805 SUSQUEHANNA BANK provided the di above-named decedent you were a Estate of WALTER C RITZIE Date of Death 01-03-2013 County CUMBERLAND partment with the information below indi oint owner or beneficiary of the account Type of Account Savings Checking X Trust Certificate Q o m o zc'~ m m ~ o ~ n r- r- z t» ~ i--. tt~ .:nx~ --t c.y : + ~i ~ , i ~at:iat the?de~1 ~ the Remit Payment and Forms tpn ""t ~" ' - - Account No. 403500005133 a`-' r+I c,~ Date Established 11-06-2007 REGISTER OF WILLS 'J cn 'rr Account Balance $ 30,764.28 1 COURTHOUSE SQUARE Percent Taxable X 33.333 CARLISLE PA 17013 Amount Subject to Tax $10,254.66 Tax Rate X 0.150 Potential Tax Due $1,538.20 NOTE': If tax payments are made within three months of the decedent's date of death, deduct a 5 percent discount on the tax With 5% Discount (Tax x 0.95) $ (see NOTE') due. Any inheritance tax due will become delinquent nine months after the date of death. PART Ste 1: Please check the a 1 p ppropriate boxes below. A ~ No tax is due. g ~ The information is correct. C ~ The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) D ~ Changes or deductions listed. E Asset will be reported on inheritance tax form REV-1500. I am the spouse of the deceased or 1 am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed to Step 2 on reverse. Do not check any other boxes. 4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12% I am a sibling of the deceased. 15% All other relationships (including none). The information above is incorrect and/or debts and deductions were paid. Complete PaR 2 and part 3 as appropriate on the back o/this form. The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax Re[urn tiled by the estate representative. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART z Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required, you may attach 8 1/2" x 11"sheets of paper.) Date Paid Payee uescnpnon Hmounc rain Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 If you are making a correction to the establishment date (Line 1) account balance (Line 2), or percent taxable (Line 3), please obtain a written correction from the financial Instkution and attach it to this form. 1. Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a. First, determine he percentage owned by the decedent. i. Accounts that are held "in trust for" another or others were 100% owned by the decedent. ii. For joint accounts established more than one year prior to the date of death, the percentage taxable is 100% divided by the total number of owners including the decedent. (For example: 2owners = 50%, 3 owners = 33.33%, 4 owners = 25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. your relationship to the decedent: _ 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 7. Tax Rate 8. Tax Due 9. With 5% Discount (Tax x Step 2: sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to "Register of Wills, Agent " Do not send payment directly to the Department of Revenue. Under penalty of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. Work Home T. Telephone Number -~i-I Date IF YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17120-0601 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response pennsylvania ~iT DEPARTMENT OFREVENUE eev~~me ex m~exec roe-~zo FILE NO. 2170 ACN 13102944 DATE 01-21-2013 SANDRA R ALBRIGHT 227 SKYLINE VW CARLISLE PA 17013-8119 SUSQUEHANNA BANK provided the d~ above-named decedent you were a Account No. 403500005133 Date Established 11-06-2007 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due With 5% Discount (Tax x 0.95) Estate of WALTER C RIT21E Date of Death 01-03-2013 County CUMBERLAND Type of Account Savings Checking X Trust Certificate (7 c; _ ment with the information below indicating t~n'a~$tKt~1 r'h e ~th E? t~' owner or beneficiary of the account identifj~i~ r- `~'' ~~ Remit Payment and Forms to: ~ ti ~ co rrr +Tr REGISTER OF WILLS o c ~ ~ -''~' i 1000RTHOUSESQUARE a $ 30,764.28 CARLISLE PA 17013 ~ A ~ =' n X 33.333 a r- r'h $10,254.66 c`1 ~ o X 0.150 NOTE`: If tax payments are made within three months of the $1,538.20 decedent's date of death, deduct a 5 percent discount on the tax $ (see NOTE`) due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1: Please check the appropriate boxes below. 1 A ~ No tax is due. g The information is correct. C ~ The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) D ~ Changes or deductions listed. E ~ Asset will be reported on inheritance tax form REV-15D0. I am the spouse of the deceased or 1 am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed to Step 2 on reverse. Do not check any other boxes. 4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12% I am a sibling of the deceased. 15% All other relationships (including none). The information above is incorrect and/or debts and deductions were paid. Complete Part 2 and part 3 as appropriate on the back ofthis /orm. The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax Return filed by the estate representative. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART z Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts affer the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required, you may attach 81/2" x 11"sheets of paper.) Date Paid Payee Description Amount Paid Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 If you are making a correction to the establishment date (Line 1) account balance (Line 2), or percent taxable (Line 3), please obtain a written comection from the financial Institution and attach it to this form. 1 . Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enierthe percentage of the account that is taxable to you. a. First, determine the percentage owned by the decedent. i. Accounts that are held "in trust for" another or others were 100% owned by the decedent. ii. For joint accounts established more than one year prior to the date of death, the percentage taxable is 100% divided by the total number of owners including the decedent. (For example: 2owners = 50%, 3 owners = 33.33%, 4 owners = 25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. If indicating a different tax rate, please state your relationship to the decedent: 1. Date Established 1 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable X 7. Tax Rate 7 X 8. Tax Due 8 $ 9. With 5% Discount (Tax x .95) 9 X Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to "Register of Wills, Agent " Do not send payment directly to the Department of Revenue. Under penalty of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. /~ ~-., n Work 0 Taxpayer Signature Telephone IF YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY:1-800-447-3020 BUREAU OF INDIVIDUAL TAXES PO BO% 280601 HARRISBURG PA 1]128-0601 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response Pennsylvania DEPARTMENT OF REVENUE 9EV-1561 E.[ YaeECEC tY9 13) FILE NO. 2170 ACN 13102945 DATE 01-21-2013 JENNIFER L RITZIE 505 DEUBLER RD CAMP HILL PA 17011-2017 Estate of WALTER C RITZIE Date of Death 01-03-2013 County CUMBERLAND Type of Account Savings Checking X Trust Certificate C1 ~. c:. CU .~D R1 2 c> rTn m G7 p cn ~a ~ H r- ~ Rt r-. --k ~.s r.1' r'E7 ~ ~ :l7 CD ;:ri Cr C] ~., x .r 6 K_Y SUSQUEHANNA BANK provided the di above-named decedent you were a partment with the information below it oint owner or beneficiary of the accou of the Remit Payment and For to: t,~ N o Account No. 403500005133 v -~ Date Established 11-06-2007 REGISTER OF WILLS Account Balance $ 30,764.28 1 COURTHOUSE SQUARE Percent Taxable X 33.333 CARLISLE PA 17013 Amount Subject to Tax $10,254.66 Tax Rate X 0.150 Potential Tax Due $1,538.20 NOTE': If tax payments are made within three months of the decedent's date of death, deduct a 5 percent discount on the tax With 5% Discount (Tax x 0.95) $ (see NOTE`) due. Any inheritance tax due will become delinquent nine months after the date of death. PART $tep 1: Please check the appropriate boxes below. 1 A ~ No tax is due. g The information is correct. C ~ The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) D ~ Changes or deductions listed. E ~ Asset will be reported on inheritance tax form REV-1500. I am the spouse of the deceased or I am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as Potential Tax Due. The above information is correct, no deductions are being taken, and payment will be sent with my response. Proceed to Step 2 on reverse. Do not check any other boxes. 4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12% I am a sibling of the deceased. 15% All other relationships (including none). The information above is incorrect and/or debts and deductions were paid. Complete Part 2 and part 3 as appropriate on [he back of this form. The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax Return filed by the estate representative. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. PART 2 Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment, and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required, you may attach 8 1/2" x 11"sheets of paper.) uate raid Nayee Description Amount Paid Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation 3 If ou are makin a correction to the establishment date Line 1 account balance Line 2 , or Y 9 ( ) ( ) percent taxable (Line 3), please obtain a written correction from the financial institution and attach it to this form. 1. Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a. First, determine the percentage owned by the decedent. i. Accounts that are held "in trust for" another or others were 100% owned by the decedent. ii. For joint accounts established more than one year prior to the date of death, the percentage taxable is 100% divided by the total number of owners including the decedent. (For example: 2owners = 50%, 3 owners = 33.33%, 4 owners = 25%, etc.) b. Next, divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject to tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. your relationship to the tlecE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 6 ~ 7. Tax Rate 7 X 8. Tax Due 8 $ 9. With 5% Discount (Tax x .95) 9 X .St@p 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to "Register of Wills, Agent " Do not send payment directly to the Department of Revenue. Under penalty of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. Work Home -'71~ a3E yJ`! Telephone Number IF YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS DNLY: t-800-447-3020