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HomeMy WebLinkAbout03-31-05 ~'\ ''q" (;- <-..: ;. -, \ \ #- 0 C., ' 0- y} \-;\~. -~~/ '~ C \D ") j o 1 '" J J '- s , .~ \0- <:J ~ f'r\ o \' () -J ..... ;) ::) . \\ "'t ~ :J G 1- "- " .J.. J I.u oJ J ~ \.0\.1 "I \- 'Cl J '" ~ .,;. " <:t:. v ~ W ..) V "-,;( .) .- .- ~ ~ ~ ..- "'" -<< '(f,p.. ,.J "'" . ~=:=a .,,~,: O<J)P- .0S ~~U ~ 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 05 20S 05108365 03-03-2005 REY-1543 EX 'FP (D'~8Dl EST. 'QF ADA L ZEAR L EY S.S. NO. 200-01-7904 DATE OF DEATH 09-08-2004 COUNTY CUMBERLAND TYPE OF ACCOUNT IX] SAVINGS o CHECKING o TRUST o CERTIF. THOMAS A ELIAS 410 S 22ND ST CAMP HILL PA 17011 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has provided the Depart.ent 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 fro~ 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 .ay be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 205878-00 Oat. 06-07-2001 Established PART [!] 2,386.46 16.667 397.75 .045 17.90 TAXPAYER RESPONSE illiii~I~~l!li!i!~!!!ill_ili!I~~~!!!i!.II~i!!!!~I!I!!~~iiii~.~I~g!i!!!~~I!!!i~~..~!!!!.gj!!!!.!!!i~I~~!!ii.~~lliiii' Account Balance Percent Taxable AMount Subject to Tax Rate Potential Tax Due To insure proper credit to your account, two (2) copies of this notice must Bcco.pany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". x x NOTE: If tax pay.ents 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 become delinquent nine (9) months after the date of death. Tax [CHECK ] ONE BLOCK ONLY A. The above infor.ation and tax due is correct. 1. You .ay 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 "An and return this notice to the Register of Wills and an official assessment will be issued by the PA Depart~ent of Revenue. B. D 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. D The above information is incorrect and/or debts and deductions were paid by you. You .ust co.plate PART 0 and/or PART ~ below. PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PART @] TAX RETURN - COMPUTATION If you indicate a different tax rate~ please state your relationship to decedent: I.INE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax S. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 PAYEE DESCRIPTION AMOUNT PAID I $ I TOTAL (Enter on Line S of Tax COMPutation) Under penalties of perjury~ I declare that the facts I ete to the best of MY knowledge end belief. 5:~ < hev. reported above are true~ correct and HOME C1 r J) ?? u - '7 '-( ) J WORK (7(?) {.<o:>-/2...I,.3 TELEPHONE "'~ ER $/.t.~,/ as- DATE . GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on infor.atian sub.itted by the financial institution. Z. Inheritance tax bBCD~es delinquent nine months after the decedent's date of death. 3. A joint account is taxable even though the decedent's name was added as a .attar of convenience. 4. Accounts (including those held betwasn husband and wife) which the decedent put in joint 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 death arB 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 information and computation in the notice are correct and deductions are not baing claimad, place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and subMit them with your chack for the aMount of tax to the Registar of Wills of the county indicated. The PA Department of Revenue will issue an official asseSSMent (For. 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 representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" 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 complete Parts Z and 3 according to the instructions below. Sign two copies and SUbMit them with your check for the amount of tax payable to the Register of Wills of the county indicated. The PA Department of Revenua will issue an official asseSSMent (Form REV-1548 EX) upon raceipt of the return from tha Register of Wills. TAX RETURN PART 2 - TAX COMPUTATION LINE 1. Enter NOTE: tha 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 names within one (1) year of death are taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee ragardless 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 notica, the $3,000 exclusion already has bean 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 determined as follows: A. Tha percent taxable for joint assets astablished .ore than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF JOINT OWNERS Example: A joint esset registered DIVIDED BY TOTAL NUMBER OF X 100 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 16.7X (TAXABLE FOR EACH SURVIVOR) B. The percent 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 OWNERS DR TRUST BENEFICIARIES X 100 PERCENT TAXABLE ExaMple: Joint account registered the decedent. 1 DIVIDED BY 2 (SURVIVORS) = .50 in the na.e of the decedent and two other persons and established within one year of death by 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). 5. Enter the total of the debts and deductions listed in Part 3. 6. The amount taxable (line 6) is determinad by subtracting the debts and deductions (line 5) from the aMount subject to tax nine 4). 7. Enter the appropriate tax rate (line 7) as determined below. The rate pose e y y 9 ounger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is OX. The lineal 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. "Lineal 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 Mho have at least one parent in co..on with the d8cBdent~ 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 3% 6% 15% 15% 01/01/95 to 06/30/00 07. 67. 157. 157. 07/01/00 to present 07. 4.5%- 127. 157. . tax .. danth n.t value of transfers fro. a deceased child twent -one ears of a e or y CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions ere deterMined as follows: A. You legally are responsible for payment, or the estate subject to ad.lnistration 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 claiMed Must be iteMized fully in Part 3. If additional space is needed, use plain paper 8 1/Z" x 11". Proof of payment 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 *' INFORMATION NOTICE AND TAXPAVE~ RESPONSE FILE ACN DATE NO.21DS "3OS 05108363 03-03-2005 REV-1545EXAFPC09-00l JlST'.,OP'AI@ L ZEARLEY S.S. NO. 200-01-7904 DATE' OF DEATH 09-08-2004 COUNTY CUMBERLAND TYPE OF ACCOUNT D SAVINGS IX] CHECKING D TRUST D CERTIF. THOMAS A ELIAS 410 S 22ND ST CAMP HILL PA 17011 REHIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST Feu has provided the Depart.ent with the information listed below which has been used in calculating the potential tax due. Their records indicate thet 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 fro. the financial institution~ attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co..onwealth of Pennsylvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 205878-11 Oata 06-07-2001 Established PART [!] 3,732.29 16.667 622.06 .045 27.99 TAXPAYER RESPONSE !tit!t!l~~.IJ!!I!~I!tll~._~!!~~~~!IIII..~I!I!I~llltl.!!11~.~I~g!t!tl~~II!I!~~~~g_II!I.IIIIIIBIIII.~~!II!.~gltlilt Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due To insure proper credit to your account~ two (2) copies of this notice .ust acco.pany your payment to the Register of Wills. Make check payable to: "Register of Wills~ Agent... x x NOTE: If tax payments are made 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 become delinquent nine (9) months after the date of death. Tax [CHECK ] ONE BLOCK ONLY A. The above infor.ation and tax due is correct. 1. You .ay 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 assessment will be issued by the PA Depart.ent 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. c=J The above information is incorrect and/or debts and deductions were paid by you. You must complete PART 0 and/or PART ~ below. PART @J DATE PAID DEBTS AND DEDUCTIONS CLAIMED If you indicate a different tax rat., please state your relationship to decedent: PART @] TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1, O.t. Established I 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 PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ perjury~ I declare that the facts I my knowledge and belief. ~~~ have raported above are true, correct and HOME (,() c '-'{ 'tJJ WORK (7 ('1 ) c.,C:' -( L (3 ELEPHONE R C>T 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 beco.es delinquent nine .onths after the decedant's date of death. 3. A joint account is taxable even though the decedent's nallle was added as a matter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife lIIore than onB year prior to death are not taxable. 6. Accounts held by a decedent Win trust forR another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the information and co.putation in the notice are correct and deductions are not being claimedl place an nX" in block nAn of Part 1 of the nTaxpayer Response" section. Sign two copies and submit 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 asses~ent (For~ REV-1548 EX) upon recsipt 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 representativel place an "X" in block nB" of Part 1 of the "Taxpayer Re$ponsen section. Sign one copy and return to the PA Depart~ent of Revenuel Bureau of Individual Taxesl Dept 2806011 Harrisburgl PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice inforlllation is incorrect and/or deductions are being clailledl check block "C" and complete Parts 2 and 3 eccording to the instructions below. Sign two copies and sub.it thelll 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 assessment (For. REV-1548 EX) upon receipt of the return from 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 .anner existing at dats of death. For a decedent dying after 12/12182: Accounts which the decedent put in joint names within one (1) year of death are taxable fully as transfers. HONeverl there is an exclusion not to exceed $31000 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 n~e in the address portion of this notice I the $31000 exclusion already has been deducted from the account balance as reported by ths financial institution. 2. Enter the total balance of the account inCluding interest accrued to ths date of dsath. 3. Ths percent of the account that is taxabls for each survivor is deter.ined as follows: A. The percent taxable for joint assets sstablishsd 1lI0re than one year prior to the decsdent's death: 1 DIVIDED BY TOTAL NUMBER OF JOINT OWNERS Exa.ple: A joint asset registered DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE SURVIVING JOINT OWNERS in the nallls of ths decedent and two othsr persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) - .167 X 100 16.7Z (TAXABLE FOR EACH SURVIVOR) B. Ths percent taxable for assets created within ons year of the decsdsnt's death or accounts owned by the decsdent but hsld in trust for another individua1(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE Exa~ple: 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 50Z (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is deterlllined by .ultiplying the account balance (line 2) by the percent taxabls (line 3). 5. Enter the total of the debts and dsductions listed in Part 3. 6. The ~ount taxable (line 6) is detsrmined by SUbtracting the debts and deductions (line 5) from ths amount subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as deterlllined below. death to or for the use of a natural parentI an adoptive parentI or a stepparent of the child is OZ. The lineal class of heirs includes grandparentsl parents I chlldrenl and lineal descendents. "Children" includes natural children whether or not they have been adopted by othersl adopted children and stlillP childrlilln. "Lineal descendents" includes all children of the natural parents and their descendents I whether or not they have been adopted by others I adopted descendents and their descendants and step-descendants. "Siblingsn are defined as individuals who have at least one parent in co..on with the decedentl whether by blood or adoption. The "Collateral" class of hsirs includes all other beneficiaries. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3X 6X 15X 15X 01101/95 to 06130/00 OX 6X 15X 15X 07/01100 to present OX 4.5Xtf 12X 15X .. he tax rate 1.IlIposed on the not valuB of transfers from a deceased chIld twenty-one years of age or y ounger at CLAIMED DEDUCTIONS PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions ars deter.inBd as follows: A. You legally ars responsible for paymentl or the Bstate subject to administration by a personal representative is insufficient to pay the deductible ite.s. B. You actually paid the debts after death of the dBcedent and can furnish proof of paYMent. C. Debts being claiMed must be its.ized fully in Part 3. If additional space is neededl use plain paper 8 1/2. x II". Proof of paY.Bnt .ay be requested by the PA Depart.ent of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1712B-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ELIAS THOMAS A 410 S 22ND ST CAMP Hill, PA 17011 -------- told ESTATE INFORMATION: SSN: 200-01-7904 FILE NUMBER: 2105-0305 DECEDENT NAME: ZEARlEY ADA l DATE OF PAYMENT: 03/31/2005 POSTMARK DATE: 03/30/2005 COUNTY: CUMBERLAND DATE OF DEATH: 09/08/2004 NO. CD 005142 ACN ASSESSMENT CONTROL NUMBER AMOUNT 05108365 I $17.90 05108363 I $27.99 I I I I I I I TOTAL AMOUNT PAID: $45.89 REMARKS: CHECK# 2041 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WillS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG~ PA 17128-0601 .~.. .. 'faN' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO.21 OS 30:)- 05108362 03-03-2005 REV-1543EXAfPC09-00> 1" t'-'" EST. OF ADA L ZEARLEY S.S. NO. 200-01-7904 DATE OF DEATH 09-08-2004 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS IX] CHECKING o TRUST o CERTIF. ,'-- , CHERYL L ELIAS 410 S 22ND ST CAMP HILL PA 17011 REHIT PAYHENT AND FDRHS TO: REGISTER OF WILLS CUMBERLAND CD CDURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST Feu has provided the Department with the information 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 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 . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 205878-11 Oat. 06-07-2001 Established To insure proper credit to your account~ two (2) copies of this notice Must aCCOMpany your payment to the Register of Wills. Make check payable to: "Register of Wi11s~ Agent". Account Balance 3 ~ 732.29 Percent Taxable X 16 . 667 A.ount Subject to Tax 622.06 Tax Rata X .045 Potential Tax Due 27.99 PART TAXPAYER RESPONSE [!]i~i!if,I~~!lI!!I!m!iiill":i!!I~~~!I!!!II.~!!ilil~li!I!.!ili~~~I~~~!!!il~.!i!I!~._mi.!m!j!!.ili!.~~I!ili.~.!! NOTE: If tax payments are Made within three (3) Months of the decedent's date of death~ you lIay deduct a 5% discount of the tax due. Any inheritance tax due will beCOMe delinquent nine (9) Months after the date of death. A. The above inforMation and tax due is correct. 1. You .ay 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 "An and return this notice to the Register of Wills and an official assessment will be issued by the PA DepartMent of Revenue. [CHECK ] ONE BLOCK ONLY 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. c=J The above inforMation is incorrect 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. D.t. Estab1ish.d 1 2. Account Balance 2 3. Percent Taxable 3 X 4. AMount Subject to Tax 4 5. Debts and Deductions 5 6. A.ount Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 JOINT/TRUST ACCOUNTS If you indicate a different tax rat.~ please state your relationship to decedent: PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID , TOTAL (Enter on line 5 of Tax Comput.tlon) , $ Under penalties of perjury, I decl.re th.t the facts I to the best of .y knowledge and belIef. ;1 ~~ n~ AT RE have reported .bove are true~ correct HDME (1 ) 730- 'I*"3 WORK (7/7) ~3J b7'6 TELEPHON NUM R and GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with appliceblB intBrest basad on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine .onths after the decedent's dats of death. 3. A joint account is taxable Bven though the decadent.s name Has added as a matter of convenience. 4. Accounts (inCluding those held between husband and wife) which the decedent put in joint names within one yesr prior to death are 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 declJdent "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are corract and deductions are not being clai.ed~ place an "X" in block "'A" of Part 1 of the "T!lxpa)'er Responsa" saction. Sign two copias l!lnd sub.it thell with your check far the amount of tax to the Register of Wills of the cQunty indicated. The PA Departmant of Revenua will issue an official 8sses~ent (Forll REV-1548 EX) upon receipt of the return fro. the Register of wills. 2. BLOCK B - If tha assat spacified on this notice has baen or will ba raported and tax paid with tha Pennsylvania Inheritance Tax Return filad by the decedant.s representativBJ place an "X" in block "B"' of Part 1 of the "Taxpayar Response" saction. Sign one copy and return to the PA Dapartmant of Revenue~ Bureau of Individual Taxes~ Dept 28D6Dl~ Harrisburg~ PA 17128-0601 in tha anvelope provided. 3. BLOCK C .;. If the notice information is incorrect andlor deductions are baing claimad~ check block "c" and complate Parts 2 and 3 according to the instructions below. Sign two copies and submit them with your check far the amount of tax payable to the Ragister of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official assessment (Farm REV-1548 EX) upon receipt of the retUrn from the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter NOTE: tha date the account originally Wi!lS established or titled in the manner existing at date of death. For i!l decedent dying after 12/12/82: Accounts which the dQcedent put in joint names within one (1) year of death are taxable fully as transfers. Hawever~ there is an exclusion not to exceed $3~000 per transferee regardless of the valua of the account or the number of accounts held. If a double asterisk (MM) appears before your first oa.e in the address portion of this notice~ the $3JOOO exclusion already has been deducted frail the account balance as reported by the financial insUtution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the ac~ount that is taxable for each survivor is deterllined as fOllows: A. The percent taxable for joint assets establiShed more than one year prior to the decedent"s daath: 1 DIVIDED BV TOTAL NUMBER OF JOINT OWNERS Exallple: A joint asset ragistered DIVIDED BY TOTAL HUMBER OF X 100 PERCENT TAXABLE SURVIVING JOINT OWNERS in the na.e of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 16.7Z (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 for another individual(s) (trust beneficiaries): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS DR TRUST BENEFICIARIES X 100 PERCENT TAKABLE EXa~ple: 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 deBth by X 100 sox (TAXABLE FOR EACH SURVIVOR) 4. The allount subject to tax (line 4) is determIned by multiplYing the account balance (line 2) by the percent taxable (line 3). 5. Enter the total of the debts Bnd deductions listed in Part 3. 6. The amount taxable (line 6) is deter.ined by SUbtracting the debts and deductions (line 5) fro. the amount subject to tax Cline 4). 7. Enter the appropriate tax rate (line 7) as determined below. he tax rate IlIpaS on )' g 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 hairs includes grandparents~ parents~ children~ and lineal descendents. "Children" includes natural children whether or not they havs been adopted by others~ adopted children ana step children. "lineal descendants" includes all childrsn of the natural parents and thair descendents~ whether or not they have been adapted 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 dacedent~ whather by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. Date of Death Spouse lineal Sibling Collateral 07101/94 to 12/31/94 37- 67- 157- 157- 01101195 to 06/30/00 07- 67. 157. 157. 07101100 to present 07. 4.57,- 127. 157. .T< sd the nst value of transfers froll a deceased ch lld twent -one years of a e or Y 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 ad.inistration b)' a personal representative is insufficient to pa)' ths deductible items. B. You actually paid the debts after death of the decedent and can furnish proof of pay.ent. C. Oebts being claimed MUst be !t8llJzed fully In Part 3. If additional space is neaded~ use plain paper 8 1/2" x IIn. Proof of p.y~ent ma)' be requested by the PA Depart.ent of Revenue. COMMONWEALTH OF PENNSVLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRIS8URG~ PA 17128-0601 '*' INFORMATION NOTICE AND TAX~~X~R RESPONSE FILE ACN DATE NO. 2105 305 05108364 03-03-2005 REV-1545 EX AFP (D9-UJ c, .EST; ~F ADA L ZEARLEY 5.5. NO. 200-01-7904 -DATE OF DEATH 09-08-2004 COUNTY CUMBERLAND TYPE OF ACCOUNT IX] SAVINGS o CHECKING o TRUST o CERTIF. CHERYL L ELIAS 410 S 22ND ST CAMP HILL PA 17011 REHIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST Feu 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 decedBnt~ 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 for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Co.monwealth of Pennsylvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING A~D PAYMENT I~STRUCTIONS Account No. 205878-00 Data 06-07-2001 Established To insure proper credit to your account~ two (2) copies of this notice must acco.pany your pay.ent to the Register of Wills. Make check payable to: nRegister of Wills~ Agent". Account Balance 2 ~ 386 . 46 Percent Taxable X 16.667 Allount Subject to Tax 397.75 Tax Rate X .045 Potential Tax Due 17.90 PART TAXPAYER RESPONSE [!]iiilii~~~~.ilil.il!I~"ilill~~~I!III~_~lilll~lliilglili.~i~~I~.I!I!I~~~liilllll.!mliiig~.!I!I.!!li~I~lillllll~~~i!!!!! NOTE: If tax pay.ents are .ads within three (3) lIonths of the decedent.s date of death~ YOU may deduct a SZ 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. he above inforNation and tax due is correct. 1. You may choose to re.it pay_ent 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 the Register of Wills and an official assessment will be issued by the PA Department 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 were paid by you. You must complete PART 0 and/or PART @J below. PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED PART @] TAX RETURN - COMPUTATION If you indicate a different tax rate, please state your relationship to decedent: lINE 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 OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ declare that the facts I and belief. HOME WORK TE a~ove 3~ ~~~.ct -676'7 and TAXP GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with ~p1icab18 intBrest based on information submitted by tha financial Institution. 2. Inheritance tax becomes delinquent nine .onths aftar the decedent's date of death. 3. A joint account is ta~ablB even though the decedent"s nawe was addad 8S a .atter of convenience. 4. Accounts (including those held betwasn husband and wife) which the decadent put in joint names within one year prior to death are fully taxable as transfars. 5. Accounts established jointly between husband and wife more than one YBar prior to death are not taxable. 6. Accounts held by a decedent njn trust forn anothSr or others are taxable fully. REPORTING INSTRUCTIONS PART 1 TAXPAYER RESPONSE 1. BLOCK A - If the information and computation in the notice are correct and deductions are not being clai.ed~ place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit the. with your check far the allount of tax to the Register of Wills of the county indicated. The PA Depart.ant of Revenue will issue an official assessmant (ForM REV-1548 EX) upon receipt of the return frail tha Register of Wills. 2. BLOCK B - If the asset specified on this notice has been Dr will be reported and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent.s representative~ pl~ce an "X" in block liB" of Part 1 of the "Taxpayer Response" 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 inforllation is incorrect and/or deductions are being c1l!l.imed~ check block "C" and complete Parts 2 and :5 according to tha instructions below. Sign two copies and SUbMit 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 CForm REV-lS48 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 Bstablished or titled in the manner existing at date of death. For a deoedent 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 $3~000 per transferee regardless of the value of the acoount or the nu~er of accounts held. If a double asterisk (M.) appears before your first na.e in the address portion of this nDtice~ the $3~000 exolusion already has been deducted fro. the account balance as reported by the finilmcial institution. 2. Enter the total balance of the account including interest accrued to the date of death. 3. The percent of the acoount that is ta~able 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 HUMBER OF JOINT OWNERS Exallp1e: A joint asset registersd DIVIDED BY TOTAL HUHBER OF X lDO 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 16.72 (TAXABLE FOR EACH SURVIVOR) B. The percent taxabls 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 BV TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES x lOa PERCENT TAXABLE ExaMple: 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 100 502 (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]. 5. Enter ths total of the debts and deduotions listed in Part 3. 6. The aMount taxable Uine 6) is deter.ined by subtracting the debts and deductions Cline 5) from f::ha a.ount subjeot to tax Cline 4). 7. Enter the appropriate tax rate (line 7) as deter.insd beloN. D.te of O..th Spouse Lineal Sibling Colla-teral 07/01/94 to 12/31/94 3Y. 6% 157- 15% 01/01/95 to 06/30/00 OY. 6% 15Y. 15Y. 07/01/00 to present OY. ct.5X- 12Y. 15Y. _The tax rate ~mpoS8d on the not value of transfers fro. a deceased child twenty-one years of age or y ounger at death to or for the use of a natural parent~ an adoptive parent, or a stepparent of ths child is 0%. The lineal class of heirs lncludss grandparents~ parents~ children~ and lineal desoendents. "Children" includes natural children whether or not they havs been edopted by Qthers~ adopted children and step children. nLineal descendents" includes aU children of the natural parents and their descendents~ whether or not they have been adopted by others~ adopted descendents and their deSCBndants and step-descendants. "Siblings" are defined as individuals who have at least one parent in COM.on with the decadent~ whether by blood or adoption. The "Collateral" olass of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS PART 3 DEBTS AND DEDUCTIONS CLAIMED AlloNable debts and deductions are determined as follows: A. You legally are responsible for paYMent~ or the estate subject to ad.inistration by a personal representative is insufficient to pay the deductible items. B. You actually paid the debts after death of the deoedent and can furnish proof of pay.ent. C. Debts being clai~d must be iteMized fully in Part 3. If additional space is needed~ use plain paper 8 1/2" x 1100. Proof of peYMent 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-1' 62 EX(' 1-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ELIAS CHERYL l 410 S 22ND ST CAMP Hill, PA 17011 -------- lold ESTATE INFORMATION: SSN: 200-01-7904 FILE NUMBER: 2105-0305 DECEDENT NAME: ZEARlEY ADA l DATE OF PAYMENT: 03/31/2005 POSTMARK DATE: 03/30/2005 COUNTY: CUMBERLAND DATE OF DEATH: 09/08/2004 NO. CD 005143 ACN ASSESSMENT CONTROL NUMBER AMOUNT 05108362 I $27.99 05108364 I $17.90 I I I I I I I TOTAL AMOUNT PAID: $45.89 REMARKS: CHECK# 2042 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WillS