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COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT DF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 05-0018
05114809
04-08-2005
REV.lli45 EX AFP U9~D8)
TAWNYA A SULLIVAN
130 RELLIM ST
CARLISLE PA 17013
TYPE OF ACCOUNT
EST. OF BARBARA A SWEENEY [Xl SAVINGS
S.S. NO. 186-32-7441 D CHECKING
DATE OF DEATH 12-27-2004 D TRUST
COUNTY CUMBERLAND D CERTIf.
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 inforllation listed beloN which has been used in
calculating the potential tax dUB. Their records indicate that at the death of the above decedent, you were a joint Dwner/bsneficiary of
this account. If you feel this infor.ation is incorrect, please obtain written correction froll the financial institutionl attach a copy
to this for. and rsturn it to ths abovs addrsss. This account is taxabls in accordancs with ths Inhsritancs Tax laws of ths COMMonwealth
of PsnnsYlvania. Questions may be answsred by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 170625-00 D..te 09-09-1997
Est..blished
TG insure proper crsdit to your accountl two
(2) copies of this no tics must accompany your
payment to the Register of Wills. Make check
payabls to: "Register of Willsl Agent".
Account Balance 916 .53
Percent T..x..ble X 50.000
Allount Subject to T..x 458 . 27
T..x Rete X .045
Potenti..l Tax Due 20.62
PART TAXPAYER RESPONSE
[!] !!!!!!II~I.!!!!.!!!!!lIIIR!I!!I~I~!I!:i~_~!!!!!~I!!!!.!!i!.~I~.!I!lil.!I!!..I.!!!!..IIII.!!!:.~lllil.~~II!111
NOTE: If tax payments are made within three
(3) .onths of the decedent's date of deathl
you .ay deduct a 5X 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 information and tax dus 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 I or you .ay check box IIA" and return this notice to the Register of
Wills and an official assess_ent will be issusd by the PA Departmsnt of Revenus.
B. [] Ths abovs assst has been or will be rsported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent"s representative.
C. [] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
OF TAX ON JOINT/TRUST ACCOUNTS
PART
~
TAX RETURN - COMPUTATION
If you indicate.. different tex r..te, pl....s.. st..te your
rel..tionship to dec..dent:
LINE 1. Dete Est..blished 1
2. Account B..l..nce 2
3. Percent T..x..bl.. 3 X
4. Allount Subject to T..x 4
s. Debts ..nd Deductions 5
6. Allount T..xable 6
7. T..x R..te 7 X
8. T..x Due 8
PART
[!]
DATE PAID
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of T..x Conput..tion)
I
$
Under pen..lties of perjury, I decl..re th..t the f..cts I h..ve r..portad above are trua, correct and
cOllplata to the best of IIY knowledga and beliaf. HOME (., \.,) 2<-{ q _ g Lf 3A
WORK ( )
TELEPHONE NUMBER
~~D It'),
TE
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAll ASSESSMENT with applicable interest based on information
sub.itted by the financial institution.
2. Inheritance tax beco.es delinquent nine months after the decedent.s date of death.
3. A ioint account is taxablB 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 na.es within one year prior to
death are fUlly taxable 85 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 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 claimed, place an "K"
in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit the. with your check for the a.ount of
tax to the Register of Wills of the county indicated. Tha PA Depart.ant of RQvenue will issue an official assBs~ent
(Form REV-1548 EX) upon receipt of the raturn from tha Registar of Wills.
2. BLOCK 8 - If the asset specified on this notice has been or will be ~eported and tax paid with the Pennsylvania Inheritance
Tax Return filad by the decedent's representative, place an "K" in block "'B'"' of Part I o-f 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 info~.ation is incor~ect andlor deductions are being cIBimed, check block "e" and complete Parts 2 and 3
according to the instructions below. Sign two copies and submit the. with your check for the amount of tax payable to the Register
of Wills of the county indicated. The PA Depa~t.ent 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 na.es 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 nU~er of accounts held.
If a double asterisk C..] appears before your first na.e 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 taKable for each survivor is deter.ined as follows:
A. The percent taxable for joint assets established More than one year prior to the decedent.s death:
DIVIDED BY TOTAL HUMBER OF
JOINT OWNERS
Example: A joint asset registered
DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE
SURVIVING JOINT OWNERS
in the nage of the 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 year of the decedent.s death or accounts ownsd 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
1 DIVIDED
Joint account registered
the decedent.
BY Z (SURVIVORS) = .50
in the name of the decedent and two other persons and established within one year of death by
Example:
X 100
50~ (TAXABLE FOR EACH SURVIVOR)
4. The amount subject to tax (line 4) is determined by .ultiplying 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) frog the amount Subject to tax (line 4).
7. Enter the appropriate tax rate (line 7) as dstermined below.
Date of Death Spouse Lineal Sibling Collateral
07101/94 to 12/31/94 37- 67- 157- 157-
01/01/95 to 06/30/00 07- 67- 157- 157-
07101/00 to present 07- 4.57-" 127- 157-
MThe tax rate IMposed on the net value of transfers from 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 the child is 0%.
The lineal clBss of heirs ineludes grandparents, parents, children, and lineal descendents. "Children" includes natural children
whether or not they have been adopted by others, adopted children and step children. "Linesl 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.
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 ad.inistration by a personal representative is insufficient
to pay the deductible items.
B. You actually paid the debts after death of the decadent and can furnish proof of payment.
C. Debts being clai.ed Must be itamized fully in PBrt 3. If additional space is needed, Use plain paper 8 1/2" x 11". Proof of
pay.ent 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 EX111-96J
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
SULLIVAN TAWNYA ANN
130 RElLlM STREET
CARLISLE, PA 17013
~_~nn_ fold
ESTATE INFORMATION: SSN: 186-32-7441
FILE NUMBER: 2105-0018
DECEDENT NAME: SWEENEY BARBARA ANN
DATE OF PAYMENT: 04/25/2005
POSTMARK DATE: 04/22/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 12/27/2004
NO. CD 005242
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
05114809 I $20.62
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 20.62
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$20.62
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 05-0018
ACN 05114808
DATE 04-08-2005
REV-154SExAFPCO'-DD>
-EST. OF BARBARA A SWEENEY
5.5. NO. 186-32-7441
DATE OF DEATH 12-27-2004
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
IX] CHECKING
D TRUST
D CERTIF.
TAWNYA A SULLIVAN
130 RELLIM ST
CARLISLE PA 17013
RE"IT PAY"ENT AND FOR"S TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MEMBERS 1ST Feu has provided the Departllent with the inforllation listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above dBcBdent~ you were a joint owner/beneficiary of
this account. If you feel this inforllation is incorrect~ please obtain written correction frail 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 Co..onwealth
of Pennsylvania. Questions .ay be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PA1MENT INSTRUCTIONS
Account No. 170625-11 Date 09-09-1997
Established
To insure proper credit to your account~ two
[Z) copies of this notice must acco.pany your
payment to the Register of Wills. Make check
payable to: "Register of Wills~ Agent".
Account Balance 646.89
Percent Taxable X 50.000
Allount Subject to Tax 323 . 45
Tax Rate X .045
Potential Tax Due 14.56
PART TAXPAYER RESPONSE
[!]i!i!iill~~.i!i!.ii!il:;:;:::;:::;:i;;:;:;:::;:;:::!i!il~~~iii!ilRll!i!ii~liii!.!i!i.I~II~!ii!!I.iij!lIIIgi!!!U.11!!.I:ii~~~!ii!!.I~.!jili
NOTE: If tax pay.ents are lIade within three
(3) .onths of the decedent.s date of deBth~
you .ay deduct a 5X discount of the tax due.
Any inheritance tax due will beco.e delinquent
nine (9) months after the date of death.
[CHECK ]
ONE
BLOCK
ONLY
A. The above infor.ation and t8X due is correct.
1. You may 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 may 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. c=J The above information is incorrect and/or debts and deductions were paid by you.
You .ust complete PART ~ and/or PART ~ below.
PART If you indicate a different tax rate, please state your
@] relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. De*e Established I
2. Account Balance 2
3. Percent Taxable 3 X
4. Allount Subject to Tax 4
5. Debts and Deductions 5
6. Amount Taxable 6
7. Tax Rate 7 X
8. Tax Due 8
PART
@]
DATE PAID
PAYEE
DESCRIPTION
AMOUNT PAID
I
$
I
TOTAL (Enter on Line 5 of Tax Computation)
Under penalties of perjury, I declere that the facts I
cOllplete to the best of IIY knowledge and belief.
CL s.. 0 f . 0~
URE
have reported above are tru81 correct and
HOME (I n) '2..I...\q -C}Lf ~ ~
WORK ( ~
TELEPHONE NUMBER
!:I12o/~
DATE '
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on infor""Uon
5ub.itted by the financial institution.
Z. Inheritance tax becomes delinquent nine months after the decedent's date of death.
3. A joint account is taxable even though ths 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 .ore than one year prior to death are 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 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 sub.it them with your check fOr the ~ount of
tax to the Register of Wills of the county indicated. The PA DepartMent of Revenue will issue an official assess.ent
(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 "8" of Part 1 of the "'Taxpayer Response" section. Sign one
COPy and return to the PA Departqent 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 clai.ed, check block "C" and co.plete Parts Z and 3
according to the instructions below. Sign two copies and sub.it the. with your check for the aqount of tax payable to the Register
of Wills of the county indicated. The PA Department of Revenue will issue an official assess.ent (Form REV-lS48 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 aeonBr Bxisting at date of death.
For a decedent dying after 12/12/82: Accounts which the decedent put in joint na.as within one (1) year of death are
taxable fully 8S 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 been deducted from the account balance as reported by the financial institution.
z. Enter the total balance of the account inCluding interest accrued to the data of death.
3. The percent of the account that is taxable for each survivor is deter.ined as follows:
A. The percent taxable for joint assets established more than one year p~ior to the decedent.s death:
I OIVIOEO BY TOTAL NUHBER OF
JOINT OWNERS
Example: A joint asset registered
DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE
SURVIVING JOINT OWNERS
in the na.a of the decedent and two other persons.
I OIVIOED BY 3 (JOINT OWNERS) OIVIOED 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):
I OIVIOEO BY TOTAL NUHBER OF SURVIVING JOINT
OWNERS OR TRUST BENEFICIARIES
X 100
PERCENT TAXABLE
I DIVIDED
Joint account registered
the decedent.
BY 2 (SURVIVORS) = .50
in the na.e of the decedent and two other persons and established within one year of death by
Example:
X 100
50X (TAXABLE FOR EACH SURVIVOR)
4. The amount subject to tax (line 4) is dete......ined by .ultiplying the account balance (line 2) by the percent taxable (line 3).
S. Enter the total of the debts and deductions listed in Part 3.
6. The amount taxable (line 6) is deter.ined by subtracting the debts and deductions (line 5) fro. the a.ount subject to tax (line 4).
7. Enter the appropriate tax rate (line 7) as deter.ined below.
Date of Deeth Spouse Lineal Sibling Collateral
01101/94 to 12/31/94 31. 61. 151. 151.
01/01/95 to 06/30/00 01. 61. 151. 151.
01101100 to present 01. 4.51." 121. 151.
_The tax rata ~~osed an the net value of transfers from a deceased chIld twenty-one years of age or y
DUnger at
death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is D~.
The lineal class of heirs includes grandparents~ parents, child~en, and lineal descendents. "Children" includes natural children
whether or not they have been adopted by others~ adopted children and step children. "lineal descendents" inoludes 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.
CLAIMED DEDUCTIONS - PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and deductions a~e determined as follows:
A. You legally are responsible for pay.ent~ or the estate SUbject ta ad.inistration 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 BUst be ite.ized fullY in Part 3. If additional space is needed~ use plain paper 8 1/2" x II". Proof of
payment .ay be requested by the PA Depa~t.ent of Revenue.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EXI11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
SULLIVAN TAWNYA ANN
130 RELLlM STREET
CARLISLE, PA 17013
__nnn lold
ESTATE INFORMATION: SSN: 186-32-7441
FILE NUMBER: 2105-0018
DECEDENT NAME: SWEENEY BARBARA ANN
DATE OF PAYMENT: 04/25/2005
POSTMARK DATE: 04/22/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 12/27/2004
NO. CD 005243
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
05114808 I $14.56
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$14.56
REMARKS:
CHECK# 4591
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS