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HomeMy WebLinkAbout03-22-05 ~...~..., "G .-, ~0 "c.." 1\ " . ',,---.... * \ .. ;'.'. hi, ~~1 , hi ~~~' 1 ~ ~~1 ~~<;t ~~~ ~ ~ ~ , 77 /O:\Vdvv t""l ...)',.j - - - - - - - - - ::: - - == - '''.\ {]I (I) ,', \. ..... \"t) .... o \'" .... COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 dtOt c INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 05 d.l,pLJ 05106584 03-01-2005 Rn-1545 EX ifP, l'~a- ") ^~ t~ ;:1:.1) ,., ",.. J Ilhl\ LL EST. OF MARIE A THIEME 5.5. NO. 180-01-4596 DATE OF DEATH 11-10-2004 COUNTY CUMBERLAND TYPE OF ACCOUNT D SAVINGS IX] CHECKING D TRUST D CERTlF. HERBERT C THIEME JR 15 MANOR DR MECHANICS BURG PA 17055 Ct' ORPf-' C' ,"')' Uiii:_ " REHIT PAYHENT AND FORHS TO, REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 PSECU has provided the Departllent with the infor.ation listed 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 infor.ation is incorrect, please obtain written correction from the financial institution, attach a copy to this forll and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pannsylvania. Quastions lIay ba answarad by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0180014596-54 Date 12-09-2000 Established To insure propar credit to your account, two (2) copies of this notica must acco.pany your pay.ant to the Register of Wills. Make check payable to: "Register of Wills, Agent". Account Balance 8 , 192 . 74 Percent Taxable X 16.667 Allount Subject to Tax 1,365 . 48 Tex Rete X .045 Potential Tax Due 61.45 PART TAXPAYER RESPONSE [!]!!i!i!I'~~.llll.I!!!"'!l!II~~~llli!II.~!!!!!~llIII~lli!1.~I~gl!!!l~.i!I!~.._l!!lg.!!l!~lll!ll!~~!I!!.~~.I!II! NOTE: If tax pay.ents are made within threa (3) .onths of the decedent's date of death, YOU .ay deduct a 51. discount of the tax due. Any inheritance tax due will beco.a delinquent nine (9) months after the date of death. [CHECK ] ONE BLOCK ONLY A. The above information and tax due is correct. 1. You lIay choose to remit payment to the Register of Wills with two copies of this notice to obtein a discount or avoid interest, or you may check box "An and return this notice to the Register of Wills and an official assesSllent will be issued by the PA Dapartment of Revenue. B. c=J 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. 0 The above information is incorrect and/or debts and deductions ware paid by you. You must cOlllplete PART 0 and/or PART @] below. PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED If you indicate a different tax rate, please state your relationship to decedent: PART @J TAX RETURN - COMPUTATION OF LINE 1. ~AtR E$tebl!shed 1 2. Account Balance 2 3. Percent Taxable 3 4. Allount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax R.te 7 8. Tax Due 8 TAX ON JOINT/TRUST ACCOUNTS X X PAYEE DESCRIPTION AMOUNT PAID I- TOTAL CEnter on Line 5 of Tax Computation) I $ that the facts I have reported above are truel correct end and belief. HOME WORK TEL ( ( GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based an information subllitted by the financial institution. z. Inheritance tax becomes delinquent nine months after the decedent's date of death. 3. A joint account is taxable Bven though the decedent's na.a was added as a !latter of convenience. 4. Accounts (including those held betwBsn husband and wife) which the decedent ~ut in joint names within ana ysar prior to death ere fully taxable as transfers. 5. Accounts established jointly betwesn husband and wife ~ore than one year prior to death are not taxable. 6. Accounts held by 1!I dscedent "in trust far" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 TAXPAYER RESPONSE 1. BLOCK A - If the inforsation and c~tation in the notice are correct and deductions are not being claimed~ place an nX" in block "A" of Part 1 of the nTl!lxpllIyer Response" section. Sign two copies and subllit the. with your ~heck for the _aunt of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an offi~ial assBss_ent (Form REV-1548 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 tha decedent's representative~ place an "X" in block n8" of Part 1 of the "TBxpaY8~ Response" section. Sign one COpy and return to the PA Depart_ent of Rev8nue~ Bureau of Individual Taxes~ Dapt 280601~ Harrisburg~ PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice infor.aUon is incorrect and/or deductions are being clai.ed~ ~heck block "C" and co.plete Parts 2 and 3 according to the instructions below. Sign two copies and subllit them with your check for the a.ount of tax payable to the Register of Wills of the county indicated. The PA Depart_ent of Revenue will issue an official assess.ent (For. REV-1548 EX) upon receipt of the return from the Register of Wills. LINE 1. Enter NOTE: TAX RETURN - PART 2 - TAX COMPUTATION the date the account originallY was established or titled in the .anner existing at data of death. For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one (1) year of death are taxable fully as transfers. However~ there is an exclusion not to exceed $3~00Q per transferee regardless of the value of the account or the nu.ber of accounts held. If a double asterisk (MM) appears before your first na.e in the address portion of this notice~ the $3~OOO exclusion already has been deducted fro. the account balance as repOrted by the ~inancial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets established .ore than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF JOINT OWNERS EXa~ple: A joint asset registered DIVIDED BY TOTAL NUMBER OF X lOa PERCENT TAXABLE SURVIVING JOINT OWNERS in the nalAe of thB decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 16.7% (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one ~ear of the decedent's death or accounts owned by the decedent but held in trust far another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE Example: Joint account registered the decedent. 1 DIVIDED BY Z (SURVIVORS) = .50 in the nalle of the decedent and two other persons and established within one year of death by X 11111 50% (TAXABLE FOR EACH SURVIVOR) 4. The aMount subject to tax (line 4) is detar_ined by multiplying the account balance (line 2) by the percant taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. Tha a.ount taxable (line 6) is determined by subtracting the debts and deductions (line 5) frolA the a.ount subject to tax (line 4). 7. EntBr the appropriate tax nlte (line 7) as deter.ined below. Oat. of Death Spouse Lineal Sibling Collateral 07/01/94 to 1Z/31/94 37- 6X 157- 157- 01/01/95 to 06/30/00 07- 67- 157- 157- 07/01/00 to present 07- 4.5%_ 1Z7- 157- MThe tax rate I.-pD$8d on the net value of transfers from a deceased ChIld twBnty-one years of age or . ounger at death to or for the use of a natural parent~ an adoptive parent~ or a stepparent of the child is 0%. The lineal class of heirs includes grandparents~ parents~ <::hildren~ and lineal descendents. "Children" includes natural children whether or not they have been adapted by others~ adopted chIldren and step children. "Lineal descendentsW includes all children of the natural parents and their descendents, whether Or not they have been adopted by others~ adopted descendents and their descendants and stap-descendants. nSiblings" are defined es individuals who have at least ana parent in COIA.on with the decedent~ whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible for p8~snt~ or the estate subject to am.inistraUon by a personal representative is insufficient to pay the deductible ite~s. B. You actually paid the debts after death of the decadent and cen furnish proof of pay.ent. C. Debts being clai_d IlUst be it&llized fully in Part 3. If addJtional space is needed~ use plain pap.r 8 1/2" )( 11". Proof of pa~lIent .ay be requested by the PA Department of Revenue. COMMONWEAL1H OF PENNSYI...VANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128,0601 REV-1162 EX( 11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT THIEME HERBERT C JR 15 MANOR DR MECHANICSBURG, PA 17055 --------1016 ESTATE INFORMATION: SSN: 180-01-4596 FILE NUMBER: 2105-0264 DECEDENT NAME: THIEME MARIE A DATE OF PAYMENT: 03(22(2005 POSTMARK DATE: 03/21/2005 COUNTY: CUMBERLAND DATE OF DEATH: 11(10(2004 NO. CD 005105 ACN ASSESSMENT CONTROL NUMBER AMOUNT 05106584 I $61.45 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 5298 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $61.45 GLENDA FARNER STRASBAUGH REGISTER OF WILLS -~',' , ,Il. " . ~~'''''''':~' .:~ . [ '\ "'-, <.""'~:~~.~ ~.:;, ~" "", ;-;, r::-) ....."/ '\ \'Q;2/ ~;2. ,- \' r-l . ~ . \-.' \'Ii pI', ~1~ ~~~ ~ 4 ~-- r1 ~!:~ ~ ~ :;; ~ ':: -< .. .~\ Hl ~~~ -- ~ --:. --;. -- - :::-;. ~ - '"1 - "1 ~ - -\ ~ ~ -::: -... "'\ t. ~I \~~ \- --. \"') ... Cl I"~ ... COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG~ PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYERRE;SP9I'~~E;f .. FILE ACN JDATE NO. 21 05 cJ lol( 05106587 03-01-2005 REW-1545 EX AFP en-gol . j i\.<. JANE A THIEME 15 MANOR DR MECHANICSBURG PA 17055 TYPE OF ACCOUNT ~~Y~]2~;:m'~~8t['~~~t B ~::~~~:G DATE OF ~EATH 11-10-2004 0 TRUST COUNTOR:} ~i~~'t~~~R_LAND IX] tERTIF. ('I' '0~V~'R3iIT PAYHENT AND FORHS TO: v RESi&lER\OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PSECU has providBd thB DepartmBnt with thB information listed bBlow which has bBBn uSBd in calculating the potential tax due. Their records indicatB that at thB dBath of the above dBcedent~ you WBre a joint ownBr/beneficiary of this account. If you feBl this infor_ation is incorrBct~ please obtain written corrBction fro~ thB financial institution~ attach a copy to this for. and return it to the above address. This account is taxable in accordance with the InheritancB Tax Laws of thB Commonwealth of Pennsylvania. Questions .ay bB answered by calling (717) 787-8327. COMPLETE PART 1 BELOW R . R SEE REVERSE SIDE FOR FiLiNG AND PAYMENT INSTRUCTIONS Account No. 0180014596-551 Oat. Established 12-09-2000 To insure proper credit to your account~ two (2) copiBs of this notice .ust accompany your payment to the Register of Wills. MakB check payable to: "RegistBr of Wills~ Agent". Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due x 101,943.16 16.667 16,990.87 .045 764.59 NOTE: If tax payments arB made within thrBB (3) months of thB dBcedBnt.s datB of dBath~ you .ay deduct a 5% discount of the tax due. Any inheritance tex due will become delinquent nine (9) months after the date of death. x PART TAXPAYER RESPONSE mlliliill~~i.lili~lill._liii~~~~11111_~!iiil~~li!i.11!1~1m~~!~I!III!l~.!iiii~~."liiilg~li!i.i!il.~liiiill~mi!i~ A. ~ The above infor_ation and tax due is corrBct. 1. You _ey choose to re_it pay.ent to the RBgistBr of Wills with two copiBs of this noticB to obtain a discount or avoid interBst~ or you may check box "An and return this noticB to the Register of Wills and an official assBssment will bB issuBd by thB PA DBpartment of RBvenue. [CHECK ] ONE BLOCK ONLY B. D The above asset has beBn or will be rBported and tax paid with the Pennsylvania Inheritance Tax return to be filBd by thB decedent's representativB. C. c=J ThB above inforMation is incorrBct and/or debts and deductions were paid by you. You must complete PART 0 and/or PART ~ below. PART @] TAX RETURN - COMPUTATION OF TAX ON lINE 1. Date Established 1_..........""-"'._. 2. Account Balance 2 3. Percent Taxable 3 X 4. Amount Subiect to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 1. Tax Rate 1 X 8. Tax Due 8 JOINT/TRUST ACCOUNTS If you indicate a different tax rate, please state your relationship to decedent: PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on line 5 of Tax Computation) periury, I declare that the facts I nowledge and belief. I $ have reported above ara true, correct and HOME (1~7)' ?7-0Y7j- WORK ( ) TELEPHON NUMBE :t.W 05 AXPAYER GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on Information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decedent's date of death. 3. A ioint account is taxable even though the decedent's name was added as a .atter of convenience. 4. Accounts (inclUding those held between husband and wife) which the decedent put in ioint names within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife more than one year prior to dasth ara not taxable. 6. Accounts held by a decedent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the infor.ation and co.putatlon in the notice are correct and deductions are not being clai.ed, place an "X" In block "A" of Part 1 of the "Taxpayer RliIsponse" section. Sign two copies and subllit thlilll with your chlilck for the a.ount of tax to the RegIster of Wills of the county indicated. The PA Departlllilnt of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register of Wills. 2. BLOCK 8 - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by tha decedant~s representativl!I, place an "X" in block "8" of Part 1 of the "Taxpayer Response" saction. Sign one copy and return to the PA Dapart.ent of Ravenue, Bureau of Individual Taxlils, Dept 280601, Harrisburg, PA 17128-0601 in the envelops provided. 3. BLOCK C - If the notice infor.ation is incorrect anel/or deductions are being clai.ed, check block "COO and co.plete Parts 2 and 3 according to the instructions below. Sign two copies and subllit them with your check for the a.ount of tax payable to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assBsS1lent (Far. REV-l548 EX) upon receipt of the return fro. the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter NOTE: the date the account originallY was established or titled in the manner existing at date of death. For a decedent dying after 12/12182: Accounts which the decedent put in joint na.es within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to excBed $3,000 pal'" transfereB regardless of the value of the account or the nUllber of accounts held. If a double asterisk (MM) appears before your first name in the address portion of this notice, the $3,000 exclusion already has been deducted fro" the account balance as reported by the Unsncial 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 taxabls for each survivor is dete....lned as follDws: A. The percent taxable for joint assets established ~ore than one year prior to the decedent's dsath: 1 DIVIDED BY TOTAL NUMBER OF JOINT OWNERS Exa.ple: A joint assat registered DIVIDED BY TOTAL NUMBER ClF X SURVIVING JOINT OWNERS in the name of the decedent and two other IDD PERCENT TAXABLE ~ persons. 1 DIVIDED BY 3 (~OINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 16.7X (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedent's death Dr accounts owned by the decedent but held in trust for another lndivldual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE Exampls: Joint account registered ths decedent. 1 DIVIDED BY Z (SURVIVORS) ~ .50 in the name of the decedent and two other persons and established within one year of death by X 100 50X (TAXABLE FOR EACH SURVIVOR) 4. The ~ount SUbject to tax (line 4) is dete,...ined by mUltiplying the account balance (line Z) by ths percent taxable (line 3). 5. Entsr the total of the debts and deductions listBd in Part 3. 6. The aqount taxable (line 6) is deterllined by subtracting the debts and deductions (line 5) fro.. the a.aunt subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as determined below. mpo ounger at death to or for the use of a natural parent, an adoptiva parent, or a stepparent of the child is Or.. The linesl class of heirs includes grandparents, parants, children, and lineal descendents. "Children" includes natural children whether or not they have bean adopted by othlilrs~ adopted children and step chlldrsn. "Lineal descendants" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendents. "Siblings" are defined as individuals who have at least one parent in co...on with the decedent, whethlilr by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3X &X 15r. 15X 01/01/95 to 06/30/00 OX 6r. 15X 15r. 07/01100 to p....sent Or. 4.5%- 1Zr. 15X tfT'""he tax ra'"s J sad on the net valua of transfers fro~ a declil8sed Chl1d twenty-one years of age or y CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and dsductions aI'S determined as follows: A. You legally are responsIble for payaent~ Dr the estate subject to ad.inistration by a parsonal representative is insufficient to pay the deductible ite.s. B. You actually paid the debts after death of the dlilcedent end can furnish proof of p~y.ent. C. Debts belng clai~d .ust be it..ized fully in Part 3. If additional space is needed, use plain paper 8 l/l" x 11". Proof of PQy.ent .ay blil requested by the PA Depart.ent of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128.0601 REV-1162 EX(11-96} RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT THIEME JANE A 15 MANOR DR MECHANICSBURG, PA 17055 nU__n lold ESTATE INFORMATION: SSN: 180-0' -4596 FILE NUMBER: 2105-0264 DECEDENT NAME: THIEME MARIE A DATE OF PAYMENT: 03/22/2005 POSTMARK DATE: 03/21/2005 COUNTY: CUMBERLAND DATE OF DEATH: 11/10/2004 NO. CD 005106 ACN ASSESSMENT CONTROL NUMBER AMOUNT 05106587 I $764.59 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 5297 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $764.59 GLENDA FARNER STRASBAUGH REGISTER OF WILLS ... .,1 C~ .,. (..t- ..... ir.l '~J lit N - - 7. '>2 Pi1 I: 0) ,.. c "\ [T}~f OF C.L.r '('1"'1 '~T '.,'.,1 v'-;;"<~ , ..J Q. '- l.J ~o;:r Hf . 0 ~ ' ~ , ~ " o ~ ~ . ~ ~~.- ~ ~ .' '1 r: ,'" "9' ,~:::;-, . c U' J > ' / . 11. .> COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG~ PA 17128-0601 *' INFORMATION NOTICE "...__" AND 'TAXPAYER RESPONSE FILE ACN DATE NO.21 oS U/ot{ 05106583 03-01-2005 REV-1S45 EXAFP (U9.U) 22 P Ii 1i!:!it7 OF MAR I E A TH I EME 5.5. NO. 180-01-4596 DATE OF DEATH 11-10-2004 Hlj:OUNTY CUMBERLAND TYPE OF ACCOUNT IX] SAVINGS D CHECKING D TRUST D CERTIF. JANE A THIEME 15 MANOR DR MECHANICSBURG PA 17055 C1 r'p~/ nc L_,_' H\ \~" ex} REHIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PSECU has provided the Department with ths information listed below which has been used in calculating the potential tax due. Their records indicats that at the dsath of ths above decedent~ YOU were a joint owner/bensficiary of this account. If you feel this infor.ation is incorrsct~ plsass obtain writtsn correction froRl the financial institution~ attach a copy to this for. and rsturn it to the above address. This account is taxable in accordancs with ths Inhsritancs Tax Laws of ths Commonwsalth of Pennsylvania. Questions may bs answsrsd by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILINQ AND PAYMENT INSTRUCTIONS Account No. 0180014596-51 D.t. 12-09-2000 Established Account Balance 41 } 1 02 . 69 Percent Taxable X 16.667 Allount Subject to Tax 6 }850. 59 Tax Rate X ,045 Potential Tax Due 308.28 PART TAXPAYER RESPONSE [!]'i!I!I!~~~~.IIII.IIII"'IIIII~~~IIIII.Il~II!I!~II!I!~I,!1!I~m~~~I!lll!~ill!i!~.I!_!I!I.mllll.II!I~~~~I!II~I~~~1[1111 To insurs propsr credit to your account~ two (2) copies of this notice .ust accompany your pay.ent to ths Resistsr of Wills. Make check payable to: "Register of Wills~ Agent". NOTE: If tax paymsnts ars mads within three (3) .onths of the decedsnt's dats of death~ you .ay deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. [CHECK ] ONE BLOCK ONLY A. ~ Ths abovs information and tax dus is corrsct. ~ 1. You .ay choose to re.it payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest~ or you lIay check box "A" and return this notice to ths Resistsr of Wills and an official asssssment will be issusd by ths PA Department of Revsnue. B. c=J The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filsd by the decsdent's reprssentative. C. c=J Ths abovs information is incorrect and/or debts and deductions wsrs paid by you. You IIUSt cOlllplete PART 0 and/or PART ~ below. PART ~ TAX RETURN - COMPUTATION OF LINE 1_ Date ES~8blished 1 2. Account Balance 2 3. Percent Taxable 3 4. Allount Subject to Tax 4 5. Debts and Deductions 5 6. A.ount Taxable 6 7. Tax Rate 7 8. Tax Due 8 TAX ON JOINT/TRUST ACCOUNTS If you indicate a different tax rate} please state your relationship to decedent: x x PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I declare that the facts I beli.f. I $ have reported HOME (7 I 7> WORK ( > TELEPHONE N MBER above are true} correct and ro97-tJ'itS 31~ /05 ATE TAXPAYER SIGN GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSI1ENT with applicable interBst based on inforllation sub.ittsd by the financial institution. 2. Inheritance tax baeo.es delinquent nine lIonths after the decedent.s date of death. 3. A joint account is taxable even though the decedent's na.s was added as a matter of convenience. ~. Accounts (including those held between husband and wife) which tha decedent put in joint na.es within ons year prior to death ara fully taxable as transfers. 5. Accounts established jointly between husband and wife .ore than one year prior to death are not taxable. 6. Accounts held by a decedant "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the infor.stion and cOMPutation in the notice are correct and deductions are not being clai.ed, place an "X" in block ftA" of Part 1 of the "Taxpayer Response" section. Sign two copies and sub. it the.. with your check for the aMount of tax to the Register of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official asseSSMent [ForM REV-1548 EX) upon receipt of the return from the Register of Wills. 2. BLOCK B _ If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's represantative, place an "X" in block "B" of Part 1 of the "Taxpayer Responsa" section. Sign one copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice inforMation is incorrect and/or deductions are being claimed, check block "C" and cOllplete Parts 2 and 3 according to the instructions below. Sign two copies and sub.it them with your check for the amount of tax payable to the Register of Wills of the county indicated. The PA DepartMent of Revenue will issue an official asseSSMent [ForM REV-1548 EX) upon receipt of the return frOM the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter NOTE: the date the account originallY was established or titled in the Manner existing at date of death. For a decedent dying after 12/12/82: Accounts which the decedent put in joint naaes within one [I) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of the account or the number of accounts held. If a double asterisk [MM) appears before your first naMe in the address portion of this notice, the $3,000 exclusion already has bean deducted froll the account balance as reported by the financial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is deterMined as follows: A. The percent taxable for joint assets established 1I0re than one year prior to the decedent's death: DIVIDED BY TOTAL NUMBER OF JOINT OWNERS ExaMple: A joint asset registered DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE SURVIVING JOINT OWNERS in the naae of the decedent and two other persons. I DIVIDED BY 3 [JOINT OWNERS) DIVIDED BY 2 [SURVIVORS) - .167 X 100 16.7X [TAXABLE FOR EACH SURVIVOR) B. The psrcent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held in trust for another Individual[s) [trust benefIciaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT DWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE Exallple: Joint account registered the decedent. 1 DIVIDED BY 2 [SURVIVORS) = .50 in the name of the decedent and two other persons and established within one year of death by X 100 sox [TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is deterained by aultiplying the account balance [line 2) by the percent taxable [line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The aaount taxable [line 6) is deterained by subtracting the debts and deductions [line 5) froll the allount subject to tax [line 4). 7. Enter the appropriate tax rate [lIne 7) as determined below. death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is ox. The lineel class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether or not they have been adopted by others, adopted children and step children. "Lineel descendents" includes all children of the natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants and step-descendants. "Siblings" are defined as individuals who have at least one parent in co..on with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3Y. 6Y. 15Y. 1.5% 01/01/95 to 06/30/00 OY. 6Y. 15Y. 15Y. 07/01/00 to present OY. 4..5%- 12Y. 15Y. _The tax rate laposed on the not value of transfers fro. a deceased chIld twenty-one years of age or y ounger at CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible for pay.ent, 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 cleimed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 1/2" x 11". Proof of payaent may be requested by the PA DepartMent of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 REV-1162 EX(1,-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT THIEME JANE A 15 MANOR DR MECHANICSBURG, PA 17055 ----,--- fold ESTATE INFORMATION: SSN: 180~Ol ~4596 FILE NUMBER: 2105-0264 DECEDENT NAME: THIEME MARIE A DATE OF PAYMENT: 03/22/2005 POSTMARK DATE: 03/21/2005 COUNTY: CUMBERLAND DATE OF DEATH: 11/10/2004 NO. CD 005107 ACN ASSESSMENT CONTROL NUMBER AMOUNT 05106583 I $308.28 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 5296 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $308.28 GLENDA FARNER STRASBAUGH REGISTER OF WillS