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HomeMy WebLinkAbout04-12-05 ffcl '^ '" V) _0 ~-:'\ - Y' (D '::f ""1 -oP----- jl 0 -n ~. ... ....I () C..l. !~:.I ,) (..f I.il N - - (i ,..J 0 "" <J-J )/ v .., --Y' 1? ~ f' h," .-.~ ' '.-1' : ',~ . .~.~ ~ V) "~' x c 3-2: S ~~ ~C1Y' 8~~ ~ " " ::I 0...... ~ ~. '" ~~a -s:~ Cl' w i$ I I I " ~) ,/~,~ ~ , t' f ~l r(!.c" i (: ,-:.';:; 3:. '": u' ~ "bi '" .( 0 p\ iJ Ifllll' '. 1 ~ . :; , " ) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG; PA 17128-0601 *' rNF9RMA~rON NOTICE -'AND TAXPAyeR RESPONSE FILE ACN DATE NO. 21 Cl5 343 05107384 03-02-2005 REV.154S EX lFP (U9.UOl , " "''''3 :'.' .) EST. OF JAMES N STUDER S;S. NO. 198-44-8135 DATE OF DEATH 11-14-2004 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS IX] CHECKING o TRUST o CERTIF. JOHN R STUDER 135 GRANDVIEW RD HUMMELSTOWN PA 17036 REHIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 WAYPOINT BANK has provided the Departllent with the info....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 information is incorrect; please obtain written correction fro. the financial institution; attach a copy to this fonm and return it to the above address. This account is taxable in accordance with tha Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions Nay be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW Account No. 100185867 JI JI JI SEE Oat. Established REVERSE SIDE FOR 03-18-2002 FILING AND PAYMENT INSTRUCTlllNli Account Balance 476.83 Percent Taxable X 8.333 Allount Subject to Tax 39.73 Tax Rate X .15 Potential Tax Due 5.96 PART TAXPAYER RESPONSE [!]liliiilti~~.1ili.!i!i~!i!il~~~i!I!!IIII~!i!!!~I!I!!.i!i!.!~~i~.!li!i~II1!!i!g.~_!!I!_I!!!j~!I!I.~~!I!i.~.!il!Ii To insure proper credit to your account; two (2) copies of this notice /lust accompany your payment to the Register of Wills. Make check payable to: "Register of Wills; Agent... NOTE: If tax pay.ents are .ade within three (3) 1I0nths of the decedent's date of death; yoU /lay deduct a 5% discount of the tax due. Any inheritance tax due will becolle delinquent nine (9) months after the date of death. [CHECK ] ONE BLOCK ONLY A. The above information and tax due is correct. 1. You Nay choose to remit paYllent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest; or you lIay 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. 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 infor.ation is incorrect and/or debts and deductions were paid by you. You must cOllplete PART 0 and/or PART @] below. DEBTS AND DEDUCTIONS CLAIMED PART @] TAX RETURN - COMPUTATION If you indicate a different tax rat.; please state your r.lationship to decedent: OF TAX ON JOINT/TRUST ACCOUNTS LINE l. Date EstRblished 1 2. Account Balance 2 3. Percent Taxabl. 3 4. Allount Subject to Tax 4 5. Debts and Deductions 5 6. Allount Taxable 6 7. Tax Rate 7 8. Tax Due 8 PART [!) DATE PAID PAYEE x x DESCRIPTION AMOUNT PAID I TOTAL (Ent.r on Line S of Tax COllput.tion) perjury, I declare that the facts I my knowledge and belief. I $ have reported above are true; correct and S~~ OybS HOME (/1'7) WORK ( ) T LEPHO NUMB R ~/d~ \)' DATE ~ 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.8$ dalinquent nine months after the decedent's date of death. 3. A joint account is taxable even though the decedent"s naNe was added as a matter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint naNes within one year 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 decedent "in trust for" another Dr others are taxable fully. REPORTING INSTRUCTIONS - PART 1 TAXPAYER RESPONSE 1. BLOCK A - If the infaraUon and co.putation in the notice ere correct and deductions are not being claiaed, place an "X" in block dAn of Part 1 of the nTQxpayer Response~ section. Sign two copies and subait them with ~our check for the ..ount of tax to the Registar of Wills of the county indicated. Tha PA Depart.ent of Revanue will issue an official assess.ent (Fora REV-1548 EX) upon receipt of the return from the Register of Wills. Z. BLOCK B - If the asset specified on this notice has baan or will be raported and tax peid with the Pennsylvania Inharitanca Tax Return filed by the dacadent"s repressntativa, place an "X" in black "B~ of Part 1 of the "Taxpayer Responsa" section. Sign one COpy and raturn to the PA Depart_ant of Revenue, Bureau of Individual Taxes, Dept Z8D601. Harrisburg. PA 171Z8-0601 in the envelope providsd. 3. BLOCK C - If tha notice information is incorrect and/or deductions are being claiaed, check block "C" and complete Parts Z and 3 according to the instructions below. Sign two copies and submit thea with your check for the ~ount of tax payable to the Register of Wills of the county indicated. Tha PA Depart.ent of Revenue will issua an official assessment (Fo~ REV-lS48 EX) upon rscsipt of the return from the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE I. Enter NOTE: the date the account originallY was Bstablishsd or titled in the .anner existing at date of death. For a decedent dying after lZ/Iz/8Z: Accounts which the decedent put in joint naaes within one (1) year of death are taxable fully as transfers. However. there is an axclusion not to exceed $3,000 per transferae regardless of the value of the account or the number of accounts held. If a doubla asterisk (..) appears before your first nama in the address portion of this notice, tha $3,000 exclusion already has been deducted frail the account balance as reportsd by the financial institution. Z. Enter the total balanca of the account including intarest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is dsterrdnsd as follows: A. The percent taxable for joint assets established ~ore than one year prior to the decedent's death: I DIVIDED BV TOTAL HUMBER OF JD INT OWNERS E~ample: A joint asset registared DIVIDED BY TOTAL NUHBER OF X IOD PERCENT TAXABLE SURVIVING JOINT OWNERS in the na.a of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BV Z (SURVIVORS) '" .167 X 100 16.7~ (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created Mithin one year of the decedent's desth or accounts awned 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 100 PERCENT TAXABLE Example: Joint account ragistered the decedent. 1 DIVIDED BY Z (SURVIVORS) '" .50 in tha nama of the dlilcedent and two othar persons and estabI.ished within DnS yesr of cfsath by X 100 50~ (TAXABLE FOR EACH SURVIVOR) 4. The Bmount subject to tax (line 4) is deter.ined by multiplying the account balance (line Z) by the percent taxable (line 3). S. Enter the total of tha debts and deductions listed in Part 3. 6. The amount taxable (line 6) is determined by Subtracting the dabts and deductions (line 5) fro. the a.aunt subject to tax (line 4). 7. Enter tha appropriate tax rate (line 7) as deterained below. IIIp ounger at de8th to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0%, Tha 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 st8P children. "Lineal descendents" includes all children of the natural parents and their descendents, whether or not they have baan adopted by others, adopted descendents and their descendants and step-descendants. nSiblings~ are defined as individuals who have at least one parent in coamon with the decedent, whather by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. Date of De.th SpOUSfI lineal Sibling COllaieral 07/01/94 to 12/31/94 3Y. 6% 157- 15X 01/01/95 to 06/30/00 OX 6X 15X 15X 07/01/00 to present OX 4..5%- 12X 15X .IfThi tax rate .1 olRld on the neT: value Df transfers frOM a deceased child twenty-one years of age D' y CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally ars re~sjbls for pay.ant~ or tha estate subjact to administration by B personal represant~tive is insufficient to pay the daductible items. 8. VOU actually paid the debts after death of the decedent and can furnish proof of pay.ent. C. Debts being claimed must be itS8ized fully in Part 3. If additional space is needed, use plain paper 8 l/Z" x 11", Proof of pay_ent may be requested by the PA Depart.ent of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIOUAl TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT STUDER JOHN R 135 GRANDVIEW RD HUMMElSTOWN, PA 17036 ____un told ESTATE INFORMATION: SSN: 198-44-8135 FILE NUMBER: 2105-0343 DECEDENT NAME: STUDER JAMES N DATE OF PAYMENT: 04/12/2005 POSTMARK DATE: 04/11/2005 COUNTY: CUMBERLAND DATE OF DEATH: 11/14/2004 NO. CD 005191 ACN ASSESSMENT CONTROL NUMBER AMOUNT 05107384 I $5.96 I I I I I I I I TOTAL AMOUNT PAID: $5.96 REMARKS: CHECK#316 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WillS COMMONWEALTH OF PENNSVLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG~ PA 17128-0601 *' INFORMATION NOTICE (~'70;- rcAND TAXPAYER RESPONSE FILE ACN DATE NO.21 05 3'-13 05107385 03-02-2005 REV-154!EXAFPI09-ODl ;1-:. , E~:r .3 ~F JAMES N STUDER S.S. NO. 198-44-8135 DATE OF DEATH 11-14-2004 COUNTY CUM8ERLAND TYPE OF ACCOUNT o SAVINGS IX] CHECKING o TRUST o CERTIF. DORIS C STUDER 135 GRANDVIEW RD HUMMELSTOWN PA 17036 REHIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUM8ERLAND CD COURT HOUSE CARLISLE, PA 17013 WAYPOINT BANK 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 abova 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 CO.Monwealth 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. 100185867 Oat. 03-18-2002 Established PART [!] 476.83 8.333 39.73 .15 5.96 TAXPAYER RESPONSE iliiii~~~~.i!i!.!ili"'iilil~~~ii!!!~~!li!l~!l!i!.!!!l.~~i~g!i!I!~D!i!i!I~.~_lili"!I!lai!!!.~~II!I!.~.!lil! 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 aCCOMpany your paYMent to the Register of Wills. Make check payable to: "Register of Wills~ Agent". x x NOTE: If tax paYMents are made within thrae (3) .onths 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) .onths after the date of death. Tax [CHECK ] ONE 8LOCK ONLY A. The above information and tax due is correct. 1. 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 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 @] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PART @J TAX RETURN - COMPUTATION If you indicate a different tax rate) please state your relationship to decedent: LINE 1. D.t. Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax R.te 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 CEnter on Line 5 of Tax Computation) I $ Under penalties of perjury} I declare that the facts I complete to the best of My knowledge and belief. Ta~SI~T<U~(ffi-~ have reported above .re true} correct and HOME (7/7) S~,{; cJt;/tU ~A WORK ( ) TELEPHONE NUMBER -xu GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable intBrsst based on infer.ation submittad by the financial institution. Z. InhBritencB tax becomes delinquent nine Banths aftar the decedent's data of death. 3. A joint account is taxabla BveR though the decsdent.s name was added as a matter of convenience. 4. Accounts (inCluding thOSB held batwsBn husband and wife) which the decedent put in joint na.as within one year prior to death arB fully taxable as transfers. 5. Accounts established jointlY between husband and wife .ore than ona 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 bsing clal~ed, place an "X" in block "A" of Part 1 of the "Taxpayer 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 Department of Revenue will issue an official assess.ent (Form REV-1548 EX) upon receipt of ths 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 fUsd by the decedent.s representative, place an "X" in block "8" of Part 1 of the "Taxpayer Response" section. Sign one copy and return to the PA Depart.ent of Revenue, Bureau of Individual Taxes, Dept 28D601, Harrisburg, PA 17128-0601 in the envelope providsd. 3. BLOCK C _ If the notice infor.ation is incorrsct andlor deductions are being claimed, check block "C" and co.plete Parts 2 and 3 according to the instructions below. Sign two copiss and sub_it the. 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 (Form REV-1548 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 12/12/82: 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 transferse regardless of the value of the account or the nu~ber of accounts held. If a double asterisk (MM) appears before your first nams in the address portion 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 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 JOINT OWNERS Exa.ple: A joint asset registered DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE SURVIVING JOINT OWNERS in the name of the decedsnt and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 16.77. (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): I 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 100 507. [TAXABLE FOR EACH SURVIVOR) 4. The amount subjsct to tax [line 4) is determined by mUltiplying the account balance [line Z) 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 rats [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 07.. The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whather 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, "hether 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 COllllllon 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 3X 6X 157. 157. 01/01/95 to 06/30/00 OX 6X 15X 15X 07/01100 to present OX 4.57.- 12X 15X MThe tax rate 1111POsed on the not value a' transfers frolll a deceased child twenty-one years of age a, y ounger at CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are deter.ined 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 payment. C. Debts being claimed must be it~ized fully in Part 3. If additional space is needed, use plain paper 8 1/2" x Iln. Proof of payment may be requested by the PA Depert.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 STUDER DORIS C 135 GRANDVIEW RD HUMMElSTOWN, PA 17036 _n_nn fold ESTATE INFORMATION: SSN: 198-44-8135 FILE NUMBER: 2105-0343 DECEDENT NAME: STUDER JAMES N DATE OF PAYMENT: 04/12/2005 POSTMARK DATE: 04/11/2005 COUNTY: CUMBERLAND DATE OF DEATH: 11/14/2004 NO. CD 005192 ACN ASSESSMENT CONTROL NUMBER AMOUNT 05107385 I $5.96 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 316 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $5.96 GLENDA FARNER STRASBAUGH REGISTER OF WillS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG~ PA 17128-0601 *' IN~ORMA~ION NOTICE . AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 05 3L/3 05107386 03-02-2005 REV-1545fXAFPIU9-UUJ :''-'. TYPE OF ACCOUNT o SAVINGS [Xl CHECKING o TRUST o CERTIF. TO: EST. OF JAMES N STUDER ScS. NO._ 198-44-8135 DATE OF DEATH 11-14-2004 COUNTY CUMBERLAND CAROL E STUDER 135 GRANDVIEW RD HUMMELSTOWN PA 17036 REMIT PAYMENT ANO FORMS REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 WAYPOINT BANK 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 may be answared by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 100185867 Oat. 03-18-2002 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 Wills~ Agent". Account Balance 476 . 83 Percent Taxable X 8.333 Allount Subject to Tax 39.73 Tax Rate X .15 Potential Tax Due 5 . 96 PART TAXPAYER RESPONSE [I)i!i!~IIl~~.!!i!~!!!!~I~_!!!!I~~~!!!!!~_~!!!!!~~!!!!.!!!!.~I~~~!!!!!~.!!!!!~~._!!!!II.!!!!.!!!!~I~I!!!!.~I!!!!!!j; NOTE: If tax payments are made within three (3) .onths of the decedent's date of death, you may deduct a Sr. discount of the tax due. Any inheritance tax due will becoNe delinquent nine (9) months after the date of death. [CHECK ] ONE BLOCK ONLY A. The above information and tax due is correct. 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 "An and return this notice to the Register of Wills and an official assess.ent 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 lIust co.plete 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 @] TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS lINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 X ~. Amount Subject to Tax ~ 5. Debts and Deductions S 6. Allount Taxable 6 7. Tax Rate 7 x 8. Tax DUB 8 PAYEE DESCRIPTION AMOUNT PAID I I TOTAL (Enter on line S of Tax Computation) $ declare th.t the facts I have reported above are tru~~Eqr~.ct and I? . and b.li.f. HOME (1/7) S66tZL!!..) ~A# /();<<>>5 WORK () 7'"' TELEPHON NU BE DATE TA GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSI1ENT with appliCeble interest based on inforllation submitted by the financial institution. Z. Inheritance tax bec~8S delinquant nins .ooths after the decedent's date of death. 3. A joint account is taxable Bvan though the decedent's na.e was added as B matter of canvenienca. 4. Accounts (including those held between husband and wifg) which the decedent put in joInt oa.as within one year prior to death are fully taxabh as transfers. 5. Accounts established jointly between husband and wife .are than one year prior to death are not taxable. 6. Accounts held by a decedent ftin trust forft another or others arB taxable fully. REPORTING INSTRUCTIONS - PART 1 TAXPAYER RESPONSE 1. BLOCK A - If the information and coaputation 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 sub.it them with your check for the amount of tax to the Register of Wills of the county indicated. The PA Depart.ent of Revenue will issUB an official assessment (For. REV-1548 EX) upon receipt of the return from the Register of Wills. Z. BLOCK B - If the asset specified on this notice has been Dr will be reported and tax paid with the Pennsylvania Inheritance Tax Rlaturn filed by the decedent's representativs, place an "X" in block "B" of Part I of the "Taxpayer Response" section. Sign one COpy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept Z80601, Harrisburg, ~A 171Z8-0601 in the envelope provided. 3. BLOCK C - If the notice inforllation is incorrect andlor deductions are being clai.ed, check block "C" and co.plete Parts Z and 3 according to the instructions below. Sign two copies and subllit them with your check for the ~ount of tax payable to the Register of Wills of the county indicated. The PA Depart.ant of Revenue will issue an official assess.ant (For. 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 .anner existing at date of death. For a decedent dying after IZ/IZl8Z: Acco~nts which the decedent put in joint nalles 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 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 $3JOOO excl~sion already has been deducted fro. the account balance as reparted by the financial institution. Z. 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 detengined as fOllows: A. The percent taxable for jaint assets established mora than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBE~ OF JOINT OWNE~S ExaMple: A joint asset registered DIVIDED BY TOTAL NUHBER OF X 100 '= PERCENT TAXABLE SURVIVING JOINT OWNERS in the na.e of the decedant and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 16.7% (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of the decedant"s daath 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 TAKABLE Example: Joint account registered th8 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 100 50% (TAXABLE FOR EACH SURVIVOR) 4. The alllount subject to tax Cline 4) is deterllined by lIultiplying the account balance Cline Z) by the percent taxable (I1ne 3), 5. Enter the total of the debts and deductions listed in Part 3. 6. The a.ount taxable (lIne 6) is deter.lned by subtracting the debts and deductions (line 5' ~ro. the amount subject to tax Cline 4). 7. Enter the appropriate tax rate Uine 7) as deterllined below. po ounger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is Dr.. The lineal class of heirs includes grandparents, parents# children, and lineal descendents. "Children" includes natural children whethar or not they hava been adopted by others, adopted childr.n and' step children. "LJneal 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 com.on with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. D.t. of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3X 6X 15X 15X 01/01/95 to 06/30/00 OX 6X 15X 15X 07/01/00 to present OX 4.5%- 12X 15X ..rite tax rate 1. sed on the net value of transfers from a deceased Chlld twenty-one years of age or y CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are deter.ined as follows: A. You legally are responsible for pay~t# or the estate subject to ad.inistration by a personal representative is insufficient to pay the deductible ite.s. B. You actually paid the debts 8fter death of the decedent and can furnish proof of p~y.ent. C. Debts being clai_ad IIUst be H_ized fUlly in Part 3. If additional space is need8d, use plain paper 8 In" x 11". Proof of payment .ay be raquested by the PA Departllent of Revenu.. 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 STUDER CAROL E 135 GRANDVIEW RD HUMMElSTOWN, PA 17036 -------- fold ESTATE INFORMATION: SSN: 198-44-8135 FILE NUMBER: 2105-0343 DECEDENT NAME: STUDER JAMES N DATE OF PAYMENT: 04/12/2005 POSTMARK DATE: 04/11/2005 COUNTY: CUMBERLAND DATE OF DEATH: 11/14/2004 NO. CD 005193 ACN ASSESSMENT CONTROL NUMBER AMOUNT 05107386 I $5.96 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 316 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $5.96 GLENDA FARNER STRASBAUGH REGISTER OF WillS