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HomeMy WebLinkAbout02-20-13BUREAU DF 1HOwIDUAI TAXES Pennsylvania Inheritance Tax PD BOX 280601 HARRISBURG PA 17126-0601 RECORDED Qr ~f2~~bf~Payer Response RECis-rER o~ ~~;~f_s CLERK Ci' ORPHANS' COt;RT tBERLAND CO., PA DODGLAS A RITZIE 925 S 29TH ST CAMP HILL PA 17011-5805 Pennsylvania !AT DEPARTMENT OF REVENUE vsv-isos Ex oo~ExEC ,sa-,z, FILE NO. 2113-0055 ACN 13107048 DATE 02-13-2013 Estate of WALTER C RITZIE Date of Death 01-03-2013 County CUMBERLAND Type of Account Savings Checking Trust X Certificate ORRSTOWN 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. Remit Payment and Forms to: Account No. 4000037725 Date Established 05-21-2010 REGISTER OF WILLS Account Balance $ 33,822.45 1 COURTHOUSE SOUARE CARLISLE PA 17013 Percent Taxable X 8.333 T b 18 42 2 ax ject to Amount Su $ ,8 . Tax Rate X 0.045 ee months of the ithin th d T If ' e w r tax payments are ma NO E : Potential Tax Due $ 126.83 decedent's date of death, deduct a 5 percent discount on [he tax Wiih 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 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 EV-1500. I am the spouse of the deceased or I 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 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 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 Amoun[ 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 tinanclal 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. If indicating a different tax rate, pleas your relationship to the decedent: 1. Date Established 1 2. Account Balance E 3. Percent Taxable 4. Amount Subject to Tax 4 5. Debts and Deductions `. 6. Amount Taxable E 7. Tax Rate ~ state 8. Tax Due 8 a 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 -731-o~tr~ I oZ~lo~l Taxpayer Si~lature () 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 BUREAU OF INDIVIDUAL TAXES PD BOX 260601 HARRISBURG PA 1]128-0601 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response REGISTER OF t? 2013 FEB 20 PFl 4 16 CLERKQF JENNIFER L RITZIE ORPHANS' COURT 505 DEUBLER RD CAMP HILL Pa I70II-Sl~•fd+BERLAND GO., PA Pennsylvania DEPARTMENT Or REVENNE RFY-1543 E% Oa<E%EC IOB-13) FILE NO. 2113-0055 ACN 13107049 DATE 02-13-2013 Estate of WALTER C RITZIE Date of Death 01-03-2013 County CUMBERLAND Type of Account Savings Checking Trust X Certificate oRRSrowN 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. AccounlNo.4000037725 Date Established 05.21-2010 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due With 5% Discount (Tax x 0.95) $ 33,822.45 X 8.333 $ 2,818.42 X 0.150 $ 422.76 $ (see NOTE') Remit Payment and Forms to: REGISTER OF WILLS 1000RTHOUSESOUARE CARLISLE PA 17013 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. F~set will be reported on "~`J 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 comect, 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°J° I am a sibling of the deceased. 15% All other relationships iincluding 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 8 1/2" x 11"sheets of paper.) uate raid Payee Description Amount Paid Total Enter on Line 5 of lax Calculation $ PART Tax Calculation 3 !f 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 [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. If indicating a different tax rate, ply your relationship to the decedent: 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions state 2 $ 3 X 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 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. ' /~) /~ //// /L Work Signature Telephone Number YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA EPARTMENT 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 BOX 280601 HARRISBURG PA 17128-0601 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response cISTER 01: Pennsylvania DEPARTMENT OP REVENUE REV-1563 EY po<EREC IOR-ll) FILE NO. 2113-0055 ACN 13107050 DATE 02-13-2013 Estate of WALTER C RITZIE S Date of Death 01-03-2013 County CUMBERLAND ~~13 fE8 20 P(i `i 17 CLERK CF SANDRA R AL BRIGHT ORPHANS' CCURT CARLISLEIPA iiol3-BI~}~gERLAND CO.R PA Type of Account Savings Checking Trust X Certificate oRRSrowN 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. Remit Payment and Forms to: Account No. 4000037725 Date Established 05-21-2010 REGISTER OF WILLS Account Balance $ 33,822.45 1 COURTHOUSE SQUARE Percent Taxable X 8.333 CARLISLE PA 17013 Amount Subject to Tax $ 2,81 g.q2 Tax Rate X 0.150 Potential Tax Due $ g2P 78 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 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 [he 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 nmoun[ Naitl 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 "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 [he 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, pleas your relationship to the decedent: _ 1. Date Established 1 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 4 5. Debts and Deductions E 6. Amount Taxable E 7. Tax Rate 7 8. Tax Due F 9. With 5% Discount (Tax x .95) £ 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 /, 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 INUIVIOUAL TAXES PO 6UX 280601 HARRISBURG PA 17126-0601 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response ~ i~j Pennsylvania DEPARTMENT OF REVENUE x[v-~sa [x m~exec roe-~zo FILE NO. 2113-0055 ACN 13107051 DATE 02-13-2013 213 FEB 20 PEl `i 16 CLERK Cr DOUGLAS A RITZIE ORPHANS COURT 925 S 29TH ST CAMP HILL PA I7oII-~lCpBERLAND CO., PA Estate of WALTER C RITZIE SSN 167-30-0093 Date of Death Ot-03-2013 County CUMBERLAND Type of Account Savings Checking Trust X Certificate ORRSTOWN 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. Remit Payment and Forms to: Account No. 4000038640 Date Established 08.09-2010 REGISTER OF WILLS Account Balance $ 7 519.72 1 COURTHOUSE SOUARE , CARLISLE PA 17013 Percent Taxable X 8.333 Amount Subject to Tax $ 626 62 . Tax Rate X 0.045 i i h h ' e : If tax payments are made w th n three mont s of t NOTE Potential Tax Due $ 28.20 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. t 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.) 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 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 1 f"sheets of paper.) uare rasa rayee 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 "intrust for" another or others were t OOq° 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 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 7 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 Home ~11"7-73i-o~o?\ Taxpayer Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WILLS, PA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANGE 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 Pennsylvania Inheritance Tax PO BOX 280601 HARRISBURG PA 17128-0601 Information Notice And Taxpayer Response CLERK CF JENNIFER L RITZIE ORPHANS' COURT 505 DEUBLER RD CAMP HILL PA I7oII-~At1fMBERLAND CO., PA CORDEO~OFF4CE OF 2013 FEB ZO F~ 4 15 Pennsylvania DEPARTMENT OF REVENUE pEV-1543 E% Oo<E%EC (0013) FILE NO. 2113.0055 ACN 13107052 DATE 02-13-2013 Estate of WALTER C RITZIE SSN 167-30-0093 Date of Death 01-03-2013 County CUMBERLAND Type of Account Savings Checking Trust X Certificate DRRSrowN 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. Account No. 4000038640 Remit Payment and Forms to: Date Established 08-09-2010 I REGISTER OF WILLS Account Balance $ 7,519.72 1 COURTHOUSE SOUARE Percent Taxable X 8.333 CARLISLE PA 17013 Amount Subject to Tax $ 626.62 Tax Rate X 0.150 NOTE': If tax payments are made within three months of the Potential Tax Due $ 93.99 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 fs due. I I 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. _ a ~I The information is =-~j correct. C ~ The tax rate is incorrect. (Select correct tax rate at right, and complete Part 3 on reverse.) D ~ Changes or deductions /lis/ted. E ~~/I Asset will be reported on ~1 inheritance tax form REV-1500. above inf o^_ P ^, ('r2§T,€Sli`Cd49 b@ 5@^~t i my response. Proceed to Step 2 on reverse. Do not check any other boxes. 4.5°1° 1 am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 12°!° I am a sibling of the deceased. 15 f 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 farm. 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 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 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. If indicating a different tax rate, pleas your relationship to the decedent: 1. Date Established 1 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax ~ 5. Debts and Deductions `. state 6. Amount Taxable 6 ~ 7. Tax Rate ~ X B. lax Due - --~-~ 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. Home rl I '~ 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 BUREAU OF INDIVIDUAL TAxES Penns Ivania Inheritance Tax Y PO BOX 288601 HARRISBURG PA 1 7128-06 8 1 Information Notice And Taxpayer Response RECORDED OFFICE 0 'iij3 FEB 20 P(~ 'i 16 Pennsylvania .1 DEPARTMENT OF REVENUE xev-sae zx no~exse wean FILE NO. 2113-0055 ACN 13107053 DATE 02-13-2013 Estate of WALTER C RITZIE SSN 167-30-0093 Date of Death 01-03-2013 County CUMBERLAND CLERK OF SANDRA R AL BRIGHT ORPHdNS' COURT 227 SKYLINE VW CARLISLE PA I7DIa-~fi•.!j~yBERLAND CO., PA Type of Account Savings Checking Trust X Certificate oRRSrowN 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. Account No. 4000038640 Date Established 08-09-2010 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Remit Payment and Forms to: REGISTER OF WILLS $ 7,519.72 1 COURTHOUSE SQUARE X 8.333 CARLISLE PA 17013 $ 626.62 X 0.150 Potential Tax Due $ 93.99 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 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 the back 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 the department. (If additional space is required, you may attach 6 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 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 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. If indicating a different tax rate, pleas your relationship to the decedent: _ 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 X 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 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. /1 ~-~ ~ Work -/s4L/ Od //5 // 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 BUREAU DF INDIVIDUAL rAxES Pennsylvania Inheritance Tax Po Box zaosol HARRISBURG PA 1]128-0601 Information Notice And Taxpayer Response RECORDED O~FICE OF ~ Pennsylvania DEPARTMENT OF REVENNE xev-~san ex m.exe~ ,oa-ix, FILE NO. 2113-0055 ACN 13107054 DATE 02-13-2013 '013 FEB 20 P(~ 'i 16 CLERK OF~ DOUGLAS A RITZIE ORPHANS' COURT 925 S 29TH sT CUMBERLAND CO., PA CAMP HLLL PA 17011-5805 Estate of WALTER C RITZIE SSN 167-30-0093 Date of Death 01-03-2013 County CUMBERLAND Type of Account Savings Checking Trust X Certificate oRRSrowN 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. Remit Payment and Forms to: Account No. 40000311668 Date Established 08-11-2010 REGISTER OF WILLS Account Balance $15 054.44 1 COURTHOUSE SOUARE , CARLISLE PA 17013 Percent Taxable X 8.333 Amount Subject to Tax $ 1,254.49 Tax Rate X 0.045 Potential Tax Due $ 56 45 NOTE': If tax payments are made within three months of the ' . s date of death, deduct a 5 percent discount on the tax decedent 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 IX I 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 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.) 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 tinanclal institution and attach h 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 1 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 2 $ 3 X 4 $ 6 $ 7 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 731-O~a~ ~1{~I('3 Taxpayer 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 BUREAU OF INDIVIDUAL TAxes Pennsylvania Inheritance Tax Po Box zaosBl HARRISBURG PA 17}Zg-gWl RECORDED OF iC~ deformation Notice Taxpayer Response REGISTzR OF 's'.1 .~~ CLERK 0;' ORPHANS' COllRT CUMBERLAND CO.. PA JENNIFER L RITZIE 505 DEUBLER RD CAMP HILL PA 17011-2017 pennsylvania DEPARTMENT OF REVENUE REV-1545 E% pacEYEC (OB-12) FILE NO. 2113-0055 ACN 13107055 DATE 02-13-2013 Estate of WALTER C RITZIE SSN 167-30-0093 Date of Death Ot-03-2013 County CUMBERLAND Type of Account Savings Checking Trust X Certificate oRRSrowN 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. Account No. 4000038668 Date Established 08.11-2010 Account Balance $ 15,054.44 Percent Taxable X 8.333 Amount Subject to Tax $ 1,254.49 Tax Rate X 0.150 Potential Tax Due $188.17 With 5% Discount (Tax x 0.95) $ (see NOTE' Remit Payment and Forms to: REGISTER OF WILLS 1 COURTHOUSE SOUARE CARLISLE PA 17013 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 sset will be reported on i eritance tax form REV-1500. 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. 4.5% I am a lineal beneficiary (parent, child, grandchild, etc.) of the deceased. 72% I am a sibling of the deceased. 15% All other relationships (including none). The intormation 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 Debts and Deductions. 2 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 o4 are maknn 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 Instftution and attach it to this form. t . 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 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. 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 Par[ 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 2 $ 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 $ 5. Debts and Deductions 5 - 6. Amount Taxable 6 $ 7. Tax Rate 7 X 8. Tax Due 8 $ 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 a Work 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: 7 -800-447-3020 BUREAU OF INDIVIDUAL ]AxFS Penns Ivania Inheritance Tax PO BD% 2806D1 y HARRISBURG PA 1]128-0601 Information Notice And Taxpayer Response RECCRBgD CFF !CE OF t~13 fE8 20 P(~ 4 16 CLERK CF SANDRA R ALBRIGHT ORPHANS CCURT CARLISLEIPA iiols-BI16UbIBERLAND CC., PA Pennsylvania DEPARTMENT OF REVENUE xevasu sz m~[zsc ,aeaz, FILE NO. 2113-0055 ACN 13107056 DATE 02-13-2013 Estate of WALTER C RITZIE SSN 167-30-0093 Date of Death 01-03-2013 County CUMBERLAND Type of Account Savings Checking Trust X Certificate ORRSTOWN 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. Remit Payment and Forms to: Account No. 4000038668 Date Established 08-11-2010 REGISTER OF WILLS Account Balance $ 15,054.44 1 COURTHOUSE SQUARE Percent Taxable X 8.333 CARLISLE PA 17013 Amount Subject to Tax $ 1,254.49 Tax Rate X 0.150 Potential Tax Due $ 188.17 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 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. 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. 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 8 1/2" x 11"sheets of paper.) Date Paid Payee uescription Hmount raio 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: 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 reianonsnip to me cecea~ 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 .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. /) _ ~ i7 , Work Home /7/7 ~a Signature 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 BUREAU OE INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response R OF yILLS ?013 FEB 20 P(~ `i 18 CLERK OF DOUGLAS A RITZIE ORPHANS' COURT 925 S 29TH ST CAMP HILL PA I7oII-6lIO~BERLAND 00., PA Pennsylvania DEPARTMENT OF REVENUE acv-,say Ex m~exee <oe-,x~ FILE NO. 2113-0055 ACN 13107057 DATE 02-13-2013 Estate of WALTER C RITZIE SSN 167-30-0093 Date of Death Ot-03-2013 County CUMBERLAND Type of Account Savings Checking Trust X Certificate ORRSTOWN 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. Account No. 4000039476 Date Established 10-12-2010 Account Balance $144,357.60 Percent Taxable X 8.333 Amount Subject tD Tax $ 12,029.32 Tax Rate X 0.045 Potential Tax Due $ 541.32 With 5%, Discount (Tax x 0.95) $ (see NOTE') Remit Payment and Forms to: REGISTER OF WILLS 1 COURTHOUSE SOUARE CARLISLE PA 17013 NOTE': If tax payments are made within three months of the decedents 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 ~sset will be reported on inheritance tax form EV-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 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 Paitl 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 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 Rate ease state 1 2 $ 3 x 4 $ 5 - 6 $ 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. Work Home ~~ ~'] • 73 f -o~i a l o? ~ i o} Taxpayer Si 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 BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 RECORD Pennsylvania Inheritance Tax Information Notice And Taxpayer Response Ifii3 FEB 20 P(~ 'i 18 CLERK OF JENNIFER L RITZIE ORPHANS' COl1RT CAMPDHILLEPARD7011-28'ItMBERLAND CO., PA pennsylvania ~iT DEPARTMENT OF REVENUE REV-1543 E% RocE%EL (88-12) FILE NO. 2113-0055 ACN 13107058 DATE 02-13-2013 Estate of WALTER C RITZIE SSN 167-30-0093 Date of Death 01-03-2013 County CUMBERLAND Type of Account Savings Checking Trust X Certificate ORRSTOWN 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. Account NO. 4000039476 Date Established 10-12-2010 Account Balance $ 144,357.60 Percent Taxable X 8.333 Amount Subject to Tax $ 12,029.32 Tax Rate X 0.150 Potential Tax Due $ 1,804.40 With 5% Discount (Tax x 0.95) $ (see NOTE` Remlt Payment and Forms to: REGISTER OF WILLS 1 COURTHOUSE SOUARE CARLISLE PA 17013 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 y :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 p N Asset will be reported on nheritance tax form EV-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°/L, 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 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 rela[IOnShip [0 the tlecetl 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 (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 1- - ~? /S 3 pay r Signature Telephone Number D e IF YOYJ 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 TA%ES PO BOX 288601 HARRISBURG PA 17128-8681 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response REGISTER OE'3liLLS _L'~13 FEB 20 Pal y 18 SANDRA R ALBRIGHT CLERK OE 227 SKYLINE vw ORPHANS' COURT CARLISLE PA I7BIS-Bl;tl~AgERLAND CO., PA Pennsylvania DEPARTMENT OP REVENUE aev-isu ez oo~exec <oeav FILE NO. 2113-0055 ACN 13107059 DATE 02-13-2013 Estate of WALTER C RITZIE SSN 167-30-0093 Date of Death 01-03-2013 County CUMBERLAND Type of Account Savings Checking Trust X Certificate DRRSTDWN 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. Account No. 4000039476 Date Established 10-12-2010 Account Balance Percent Taxable Amount Subject to Tax Tax Rate $ 144,357.60 X 8.333 $12,029.32 X 0.150 Potential Tax Due $1,804.40 With 5% Discount (Tax x 0.95) $ (see NOTE`) Remit Payment and Forms to: REGISTER OF WILLS 1 COURTHOUSE SOUARE CARLISLE PA 17013 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 $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 [ax 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 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 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 pr others were 100% owned by the decedent. ii. For joint accounts established more than on~ 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. Amcunt Subject to Tax 5. Debts end Deductions 6. Amount Taxable 7. Tax Rate 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, AgeQt." Do not send payment directly to the Department of Revenue. Under penalty of perjury, I declare that the facts I have report¢d above are true, correct and complete to the best of my knowledge and belief. ~~ ,~ ~ :. Work Signature Teleohorie Number = YOU NEED FURTHER ASSISTANCE, CONTACT CUMBERLAND COUNTY REGISTER OF WIt~LS, PA EPARTMENT OF REVENUE DISTRICT O1=FICE, OR THE INHERITANCE TAX DIVISIbN AT 17-787-$327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR PEAKING NEEDS ONLY: 1-800-447-3020 BUREAU OF INDIVIDWI TAXES PO BOX 280601 HARRISBURG PA P128-0601 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response REGISTER OF 'tYILLS tU13 FEB 20 PFI `i 18 DOUGLAS A RITZIE CLERK OF 9zs s z9rH sr ORPHANS' COURT CAMP HILL PA I7oIIO~RLAND CO., PA Pennsylvania iii DEPARTMENT OF REVENUE xev-nu ex oe~exec <oenv FILE NO. 2113-0055 ACN 13107060 DATE 02-13-2013 Estate of WALTER C RITZIE SSN 167-30-0093 Date of Death 01-03-2013 County CUMBERLAND Type of Account Savings Checking Trust X Certificate ORRSTOWN 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. Account No. 4000039781 Date Established 11.10-2010 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due With 5% Discount (Tax x 0.95) $107,017.11 X 8.333 $ 8,917.74 X 0.045 $ 401.30 $ (see NOTE') Remit Payment and Forms to: REGISTER OF WILLS 1 COURTHOUSE SOUARE CARLISLE PA 17013 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 nheritance 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 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 Nmourn raw 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 "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, please state 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 6 $ 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. Work I ?-73 r' -v9 a 1 Taxpayer 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 BUREAU OF INDIVIDUAL TAXES PO BOX 260601 HARRISBURG PA 17126-0601 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response "IGE OF 2013 FEB 20 Pal `i 17 CLERK Or JENNIFER L RITZIE ORPHANS' COURT 505 DEUBLER RD CAMP HILL PA I7oII-@n~ggERLAND G~., P.4 Pennsylvania ail DEPARTMENT OF REVENUE vsv-is~s cx m~sxsc <asaa FILE NO. 2113-0055 ACN 13107061 DATE 02-13-2013 Estate of WALTER C RITZIE SSN 167-30-0093 Date of Death 01-03-2013 County CUMBERLAND Type of Account Savings Checking Trust X Certificate ORRSTOWN 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. Account No. 4000039781 Date Established 11-10-2010 Account Balance Percent Taxable Amount Subject to Tax Tax Rate $ 107,017.11 X 8.333 $ 8,917.74 X 0.150 Potential Tax Due $1,337.66 With 5% Discount (Tax x 0.95) $ (see NOTE`) Remit Payment and Forms to: REGISTER OF WILLS 1000RTHOUSESOUARE CARLISLE PA 17013 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. sset will be reported on i eritance tax form R V-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 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 If ou are makin a corcection 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 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 = 33.33%, 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 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. ~~~/.~~~ Work Home X1'1 n23~ ~ 3 `~ 9 n2~/~~/ 3 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 iN LY: 1-800-447-3020 BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG PA 17128-0601 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response Pennsylvania !. DEPARTMENT OF REVENUE REV-1543 E% OocE%EC (OB-li) FILE NO. 2113-0055 ACN 13107062 DATE 02-13-2013 REGISTER OF ''=,YIL?_S Type of Account IOi3 FE8 20 D~ ~~ l~state of WALTER C RITZIE Savings SSN 167-30-0093 Checking CLERK 0 Date of Death Dt-03-2013 Trust 227DSKYRINEBVWGHT ORPHANS' COURT County CUMBERLAND X Certificate CARLISLE PA I7oIa-BII9CUM8ERLAND CO., PA ORRSTOWN 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. Remit Payment and Forms to: Account No. 4000039781 Date Established 11-10-2010 REGISTER OF WILLS Account Balance 017.11 $ 107 1 COURTHOUSE SQUARE , CARLISLE PA 17013 Percent Taxable X 8.333 nt S t to Tax bj A $ 8 817 74 mou ec u , . Tax Rate X 0.150 f the i hi h th d ' ree mon e w n t s o : If tax payments are ma t NOTE Potential Tax Due $1,337.66 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 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. 75/° All other relationships (including none). The information above is incorrect andJor debts and deductions were paid. Complete Part 2 and part 3 as appropdate on the back o/this /orm. The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax I Return filed by the estate representative. Proceed to Step 2 on 2verse. 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.) ware rata rayee 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 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. If indicating a different tax rate, please state 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 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. L~ ---~ .. Work Taxpayer Signature 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 BUREAU OF INDIVIDUAL TAXES PD BOX 280601 HARRISBURG PA 11128-0601 Pennsyivania Inheritance Tax Information Notice And Taxpayer Response REGISTER OF t`~ILI.S 'G13 FEB 20 P(~ '1 1? CLERK OF 925GSA29THRSTZIE ORPHANS COURT CAMP HILL PA v~}MLAND CO., PA Pennsylvania T DEPARTMENT OF REVENUE xev-~saa Ex uo~Excc <oe-~z, FILE NO. 2113-0055 ACN 13107063 DATE 02-13-2013 Estate of WALTER C RITZIE SSN 167-30-0093 Date of Death 01-03-2013 County CUMBERLAND Type of Account Savings Checking Trust X Certificate ORRSTOWN BANK provided the department with the information below indicating that at the death of the ahnve-named decedent you were a joint owner or beneficiary of the account identified. Remit Payment and Forms to: Account No. 4000043136 Date Established 01.03-2012 REGISTER OF WILLS Account Balance 851 96 $ 39 1 COURTHOUSE SQUARE . , CARLISLE PA 17013 Percent Taxable X 8.333 t T S b $ 3 320 86 o ax Amount u ject . , Tax Rate X 0.045 NOTE`: If tax payments are made within three months of the Potential Tax Due $149.44 decedent's date of death, deduct a 5 percent discount on tfie 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 i :Please check the appropriate boxes below. 1 A ~ No tax is due. I 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.) D ^ Changes or deductions listed. E I XI Asset will be reported on lam-'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 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.) 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 institution and attach k 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 = 33.33%, 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 2 $ 3. Percent Taxable 3 x 4. Amount Subject to Tax 4 $ 5. Debts and Deductions 5 - 6. Amount Taxable 6 $ 7. Tax Rate 7 x 8. Tax Due 8 $ 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 Taxpayer Telephone Number ~./~ -1 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 .AXES Penns Ivania Inheritance Tax PO BOX 280601 y HARRISBURG PA 17128-0601 Information Notice And Taxpayer Response RECORD~D OFFICE OF 1013 FEB 20 Pfd y 17 Pennsylvania DEPARTMENT OF REVENUE aEV-,sc~ Ex oo~exec ,oe-iz, FILE NO. 2113-0055 ACN 13107064 DATE 02-13-2013 Estate of WALTER C RITZIE CLERK OF SSN 167-30-0093 ORPHANS' COi1RT CountyCUMBERLANDI3 JENNIFER L RITZIE 505 DEUBLER RD G~JMBERLAND CO., PA CAMP HILL PA 17011-201 Type of Account Savings Checking Trust X Certificate oRRSrowN 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. Account No. 4000043136 Remit Payment and Forms to: Date Established 01-03-2012 REGISTER OF WILLS Account Balance $ 39,851.96 1 COURTHOUSE SQUARE Percent Taxable X 8.333 CARLISLE PA 17013 Amount Subject to Tax $ 3,320.86 Tax Rate X 0.150 Potential Tax Due $ 498.13 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 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.) p ~ Changes or deductions listed. E ,~SA et 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 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 raid 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 [he 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, please state your relationship to the decedent: 1. Date Established 1 2. Account Balance 2 $ 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 .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. / ,~ ~~ ,/ ~ it Work 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 BUREAU OF INDIVIDUAL TAXES PD Box zeoeDl HARRISBURG PA 17128-06D1 Pennsylvania Inheritance Tax Information Notice And Taxpayer Response ED OFFICE OF pennsylvania ail DEPARTMENT OF REVENUE XFV-1363 E% YecE%EC (E8-Itl FILE NO. 2113-0055 ACN 13107065 DATE 02-13-2013 ?013 FE8 20 P(~ y 7 Estate of WALTER C RITZIE CLERK Gr: SSN 167-30-0093 ORPHANS COURT CountyCUMBERLANDI3 SANDRA R ALBRIGHT CARLISLEIPA 17013-8119 CUMBERLAND CO., PA Type of Account Savings Checking Trust X Certificate oRRSrowN 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. Account No. 4000043136 Remit Payment and Forms to: Date Established 01-03-2012 REGISTER OF WILLS Account Balance $ 39,851.96 1 COURTHOUSE SQUARE Percent Taxable X 8.333 CARLISLE PA 17013 Amount Subject to Tax $ 3,320.86 Tax Rate X 0.150 Potential Tax Due $ 498.13 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 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 rn( Asse[ will be reported on 7"" 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% Ali 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 [he 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 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 ofthe 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 [he appropriate tax rate from Step 1 based on your relationship to the decedent. your relationship to the decedent: _ 1. Dale Established 1 2. Account Balance f 3. Percent Taxable 4. Amount Subject to Tax ~ 5. Debts and Deductions F 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due 9. With 5% Discount (Tax .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. ri Work Taxpayer Signature T 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