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COMMONWEALTH OF PENNSYLVANIA
. DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
*
INFORMATION NOTICE
AND
TAXPAYER. RESPONSE
FILE
ACN
DATE
0'5
NO.21 g& .) uq
05105712
02-23-2005
REV-15~5 EX AFP {O~-oOJ
EST,. OF. AGNES I ORR
S'. g. . Ntf! 148-30-5293
DATE OF DEATH 08-29-2004
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
IX] CHECKING
D TRUST
D CERTIF.
JO S DEEDS
8 HELEN AVE
MECHANICS BURG PA 17055
REHIT PAYHENT AND FDRHS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PNC BANK has provided the Departllent with the inforllation listBd below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, YOU were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a COpy
to this for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. Questions lIay be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW
Account No. 5140047831
. . . SEE
Date
Established
REVERSE SIDE FOR
10-01-1969
FILING AND PAYMENT INSTRUCTIONS
Account Balance 820 . 04
Percent Taxable X 50.000
Allount Subject to Tax 410.02
Tax Rata X .15
Potantial Tax Due 61 .50
PART TAXPAYER RESPONSE
[!]lllllil!l;~~~!I~llil~llili~_ili~i~~~lilil_~lilil~lilil.lill.I~~l~~~lllii~.IIIII~."IIIIIl.!I.lli!.~~!lli.~R1llilII
To insure proper credit to your account, two
(2) copies of this notice must acco.pany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, AQent".
NOTE: If tax payments are .ade within three
(3) months of the decedent's date of death,
you may deduct a 5~ discount of the tax due.
Any inheritance tax due will becolIB delinquent
nine (9) .onths after the date of death.
[CHECK ]
ONE
BLOCK
ONLY
A. D The above information and tax due is correct.
I. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
Wills and an official asses~ent will be issued by the PA Depart.ent of Revenue.
B. 0 The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
C. ~he above information is incorrect and/or debts and deductions were paid by you.
You must co.pletB PART 0 and/or PART [I] below.
1, Date Established
2. Account Balance
3. Percant Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF TAX ON JO
1_-.lL2 0
2
3 X
4
5
6
7
8
NT/TRUST ACCOUNTS
PART
@]
TAX RETURN - COMPUTATION
If you indicate a different tax rate} please state your
relationship to decedent:
LINE
o
Sl).ooD
4-IO,02zt.
~.O
'Sl:::l[" ATI1'\ute:b
DEBTS AND DEDUCTIONS CLAIMED
PART
~
DATE PAID
~ol/
PAYEE
IIYlAlfL"1">" Hi~L.flo.,ut
IFU~
TOTAL (Enter on Line S of Tax COMputation)
DESCRIPTION
/at.Pe..Jse;
AMOUNT PAID
K.w .df-
I
$
Under penalties of perjury} I declare that the facts I
co.plet. to the best of IIY knowledge and belief.
/1 1. 7'1 u tLJ
TAXPAYER ~ATU~
have reported above are
HOME I 17
WORK (
TELEPHONE
correct and
0-
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSI1ENT with applicElblB inters$t based on information
submittsd by the financial institution.
2. Inheritance tax beeo.es delinquent nine .onths aftsr the decedent's date of death.
3. A joint account is taxable even though the decedent"s name was added 8S a matter of convenience.
4. Accounts (including those held between husband and wife) which the decedent put in joint haNes within one year prior to
death are fully taxable as transfers.
5. Accounts established jointly between husband and wife _ore than one yesr prior to death are not taxable.
6. Accounts held by a decadent nin trust for" another or others ara taxable fully.
REPORTING INSTRUCTIONS - PART
1
- TAXPAYER RESPONSE
1. BLOCK It - If the information and cJ)JIputation in the notice are correct and deductions lSlre not being clili.ed, place an "X"
in block "An of ~art 1 of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of
tax to the Register of Wills of the county indicated. The ~A Department of Revenue will issue an official assess.snt
(ForN REV-1S48 EX) upon receipt of the return fro. the Register of wills.
2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance
Tax Return filed by the decedent.s representatJve, plaes an "X" in block "S" of Part] of the "Taxpayer- Response" section. Sign one
copy and r-eturn to the PA Depart.ent of ReVenue, Bureau of Individual Taxes. Dept 280601, HarriSburg, PA 17128-0601 in the
envelops providad.
3. BLOCK C - If the notice inforllatian is incorrect and/or deductions are being Claimed, check block "C" and complete Parts 2 and 3
according to the instructions below. Sign two copies and SUbNit them with your check for the amount of tax payable to the Register
of Wills of the county indicated. The PA Department of ReVenue will issue an official assessment (Form REV-IS48 EX) upon receipt
of the retu~n fro. the Register of Wills.
TAX RETURN - PART
z
- TAX COMPUTATION
LINE
1. Enter
NOTE:
the date the account originally was established or titled in the aanner existing at date of death.
For a decedent dying after 12/12/82: Accounts which the decedent put in jOint naNes within one (1) year of death are
taxable fully as transfers. However, there is ~n exclusion not to exceed $3.000 pel'" transferee regardless of the value of
the account or the nu.ber of acuounts hsld.
If a double asterisk (MM) appears before your first name in the address por-tion of this notice, the $3,000 exclusion
already has been deducted frOM the account balance as reported by the financial instItution.
2. Enter the total balance of the account including interest accrued to the date of death.
3. The percent of the account that is taxable for each survivor Is dete....ined as follows:
A. The percent taxable for joint assets established More than one yea~ prior to the decedent"s d8ath:
1 DIVIDED BY TOTAL NUMBER OF
JOINT OWNERS
EXaNplet A joint asset re9iste~ed
DIVIDED BY TaTAL NUMBER OF X lDD PERCENT TAXABLE
SURVIVING JOINT OWNERS
in the naMe of the decedent and two other persons.
1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100
16.77. (TAXABLE FOR EACH SURVIVOR)
8. The percent taxable for assets created within one ~ear of the decedent's death or accounts owned by the decadent but held
in trust for anothg~ individual(s) (trust beneficiaries):
1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT
OWNERS OR TRUST BENErICIARIES
X 100
PERCENT TAXABLE
Example: Joint account registered in the naMe of the decedent and two other persons and established wJthin coa year of death by
the decedent.
I DIVIDED BY 2 (SURVIVORS) '" .50 X 100 507. (TAXABLE FOR EACH SURVIVOR)
4. The aMount subject to tax (line 4) is deterMined by multiplying the account balance (line 2) by the percent taxable (line 3).
S. Enter the total of the debts and deductions listed in Part 3.
6. The aNount taxable (line 6) is deterMined by subt~acting the debts and deductions (line 5J from the amount subject to tax Cline 4).
7. Enter the appropriate tax rate (line 7) as deterNined below.
Date of D..ih Spouse Lineal Sibling COllaieral
U7/U1/94 to 12/31/94 3); 6% 15X 157.
U1/01/95 to U6/3U/oo UX 6X 15X 157.
U7/01/OO to present U7. 4.57._ 12X 157.
JfThe tax rate .1mpo$8d an the not value of transfers frog a deceased ch.1ld twenty-one years of age or y
ounger at
death to 01'" for the use of a natural parent, an adoptive parent, 01'" a stapparent of the child is ax.
The lineal class of heirs includes grandpar-ents, parents, children, and lineal descendents. "Children~ includes natural children
whether 01'" not they have baen adopted by others, adopted children and step children. ~tineal descsndsnts" includes all children of the
natural parents and their descendents, whether 01'" not they have been adopted by others, adopted descendents Bnd their descendants
and step-descendants. "Siblingsn are definlild as individuals who have at least one parent in common with the decedent, whether by blood
01'" adoption. The "Collateral" class of heirs includes aU other beneficiades.
CLAIMED DEDUCTIONS
PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and deductions are detQrmined as follows:
A. You legally Bre rs~sjbl8 for pay.ant, or the estate subject to administration by a personal representative is insufficient
to pay the deductible items.
B. You actually paid the debts after death of the decedent and can furnish proof of payment.
C. Debts being claimsd /lUst be !tSllizliId fully in Part 3. If additional space is needed, use plain paper 8 1/2" x 11". P~oof of
pay.ent may be requested by the PA Depart.ent of Revenue.