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COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
*'
INFORMATION NOTICE
AND
:TAXPAYER RESPONSE
FILE
ACN
DATE
NO.21 05 308'
05104524
02-22-2005
~El/-1541 Ell-AFP U,.ODl
.._c.l
EST. OF ROBERT B TAYLOR
S.S. NO. 093-18-5201
DATE OF DEATH 10-23-2004
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
!Xl CHECKING
o TRUST
o CERTIF.
DEBORAH E SGRIGNOLI
640 ERFORD RD
CAMP HILL PA 17011
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
"E"BERS 1ST FCU has provided the Department with the information listed below which has been used in
calculating the potential tax due. Thair records indicate that at tha death of the above decedent, YOU were a ioint owner/beneficiary of
this account. If YOU feel this infor.ation is incorrect, please obtain written corrBction from the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the InhQritance Tax Laws of the Coqmonwealth
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. 7908-11 Dat. 01-19-1982
Established
Account Balance 6 , 418 . 77
Percent Taxable X 16.667
Allount Subi.ct to Tax 1,069.82
Tax Rat. X .045
Potential Tax Due 48.14
PART TAXPAYER RESPONSE
[!]il!!i!;I~,_!i!!g!!!I..~m!.~~!!l!!"~l!!!!~lmlD!i!!_1~.!!!!!~~I!!!!I!!~i!!~!!!!.!ll!.I)I!!;.;~~I!!i!!;
To insure proper credit to your account, two
(Z) copies of this notice must Bcco_pany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
NOTE: If tax pay_ents ar-e .ade within three
(3) months of the daced~nt's data of daath,
YOU gay deduct a 5~ discount of tha tax due.
Any inheritance tax due will beco.a dalinquent
nine (9) months after the date of death.
[CHECK ]
ONE
BLOCK
ONLY
A. The abovs infor.ation and tax dYe is correct.
1. You may choose to remit payment to the Register of Wills with two capias of this notice to obtain
!l discount or avoid intarest, or you _lilY check box "A" and return this notice to the Ragistar of
Hills and an official assess.ant will be jssued by the PA Depart.ant of Revanue.
B. 0 The above asset has been or will be reportlad and tax paid with the Pennsylvania Inheritance Tax raturn
to be filed by the decedent's representative.
C. 0 The abovs inforllJaUon is incorrflct and/or debts and deductions were paid by you.
You lIIust complete PART 0 and/or PART ~ below.
DEBTS AND DEDUCTIONS CLAIMED
PART
~
TAX RETURN - COMPUTATION OF
If you indicat. a different tax rate, please state your
relationship to decedent:
TAX ON JOINT'TRUST ACCOUNTS
LINE l. ~t. Established 1
2. Account Balance 2
3. Perceni Taxable 3
4. Allount Subject to Tax 4
5. Debts and Deductions 5
6. Allount Taxable 6
7. Tax Rate 7
8. Tax DUB B
PART
[!]
DATE PAID PAYEE
X
X
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on line 5 of Tax COMPutation)
I
$
perjury, I declere that the facts I have reported above are true, correci and
IIY knowledge and belief.
~
HOME (
WORK (
TELEPHONE
)
)
UMBER
~
\t
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interlilst based on information
submitted by the financial institution.
2. Inheritance tax becomes delinquent nine months after tha decedent.s date of dsath.
3. A joint account is taxable even though the decedent.s name 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 _ora than one year prior to death are not taxable.
6. Accounts held by a decedent "in trust for" another or othSiS 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 claimed~ place an "X"
in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submjt them with your check for the adount of
tax 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.
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 rBpresentative~ 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 andlor deductions are being claimed~ check block "C" and complete Parts 2 and 3
according to tha instructions below. Sign two copies and submit them with your check for tha amount of tax payable to tha Register
of Wills of the county indicatad. The PA Dapart.ent of Revenue will issua an official assessment (Form REV-1548 EX) upon raceipt
of the return from the Ragister 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 names within one (I) year of death are
taxable fully as transfers. However~ there is an exclusion not to exceed $3~OOO per transferee regardless of the value of
the account or the number of accounts held.
If a double asterisk (..) appears before your first name in the address portion of this notice~ the $3~OOO 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 determined as follows:
A. The percent taxable for joint assets established more than one year prior to the decedent's death:
1 DIVIDED BY TOTAL NUMBER OF
JO INT OWNERS
Example: A joint asset 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 OR TRUST BENEFICIARIES
X 100
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 1011
sox (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 determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4).
7. Enter the appropriate tax rate (line 7) as determined below.
P ounger at
death to or for the use of a natural parent~ an adoptive parent~ or a stepparent of the child is IIX.
The lineal class of heirs includes grandparents~ parents~ children~ and lineal descendents. "Children" includes natural children
whether or not they have been adopted by othBrs~ adopted children and step children. "Lineal descendents" includes all children of the
natural parents and their descandents~ whether or not they have been adopted by others~ adopted descendents and their descendants
and step-dascendants. "Siblings" are defined as individuals who have at least one parent in co~mon with the decedent~ whether by blood
or adoption. The "Collateral" class of heirs includes all other beneficiaries.
Date of Death Spouse Lineal Sibling Collat.....l
07/01/94 to 12/31/94 3Y. 67- 15Y. 15Y.
01/01/95 to 06/30/00 OY. 6% 15% 15Y.
07/01/00 to p....sent OY. 4.5%- 12Y. 15Y.
.The 'tax rate 1. osed on the not value Df transfers fro. a deceased child twenty-one years of age Dr y
CLAIMED DEDUCTIONS - PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and deductions are determined as follows:
A. You legally are responsible for payment~ 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 pay.ent.
C. Debts being clai.ed must be ite.ized fully in Part 3. If additional space is need8d~ use plain paper 8 1/2" 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. 260601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
SGRIGNOLl DEBORAH E
640 ERFORD RD
CAMP HILL, PA 00000
--------Iold
ESTATE INFORMATION: SSN: 093-18-5201
FILE NUMBER: 2105-0308
DECEDENT NAME: TAYLOR ROBERT B
DATE OF PAYMENT: 04/01/2005
POSTMARK DATE: 03/31/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 10/23/2004
NO. CD 005146
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
05104524 I $48.14
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TOTAL AMOUNT PAID:
$48.14
REMARKS:
CHECK# 2035
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS