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HomeMy WebLinkAbout05-09-05 - - \<) - --- - ~~ - - - < - - - - - " - ~ ,> i "",..- ~~ )1: ,,-~~~ '--~ ~ c:' .... ... <::> <) ,D <::> \ (J\ \11 o .... .i- \'1 .... o ,.... ... 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 Om 05113375 03-29-2005 REY-154!EX'FPCQ9.DOl -EST, Or:LA~UE E WERZINSKY S.S. NO. 179-30-8433 DATE OF DEATH 12-18-2004 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS IX] CHECKING o TRUST o CERTIF. MARY F BEST 47111 SOUTHAMPTON CT STERLING VA 20165 REHIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PSECU has provided the Departllent with the infor.ation listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent~ YOU were a joint owner/beneficiary of this account. If you feel this infor.ation is incorrect~ please obtain written correction 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. 0179308433-54 Oat. 05-31-1990 Established Account Balance 3/149.56 Percent Taxable X 16 . 667 Allount Subject to Tax 524.94 Tax Rata X .045 Potential Tax Due 23.62 PART TAXPAYER RESPONSE [!]!iii!i~~~~.iiii~li!i!llIRiliil~~~!!!!!II.~iii!i~~!!!!.!i!i.~~~~!!!j!~.!!!!i~."!j!i"ii!iH!!!!.~~!i!I.~.!i!I! To insure proper credit to your account~ two (2) copies of this notice .ust accollpany your payment to the Register of Wills. Make check payable to: "Register of Wills~ Agent... NOTE: If tax payments are .ade within three (3) .onths of the decedent.s date of death~ you may deduct a 5X discount of the tax due. Any inheritance tax due will bsco.e delinquent nine (9) months aftsr the date of death. [CHECK ] ONE BLOCK ONLY A. e abovs information and tax due is correct. 1. You .ay choose to rSllit paYllent to ths 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 noties to the Register of Wills and an official asssss.ent will bs issued by the PA Department of Revenue. B. D The above asset has bsen or will bs reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent.s repressntativs. C. c=J The above information is incorrect and/or debts and deductions wsre paid by you. You lIIust complete PART 0 and/or PART ~ below. TAX ON JOINT/TRUST ACCOUNTS PART @] TAX RETURN - COMPUTATION OF If you indicat. a different tax rate 1 please state your relationship to decedent: LINE 1. Da+.. Established 1 2. Account Balance 2 3. Percent Taxable 3 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Allount Taxable 6 7. Tax Rate 7 8. Tax Due 8 PART @J DATE PAID PAYEE X X DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID I TOTAL (Enter on line 5 of Tax COllputation) rjurYI I declare that the facts I have reported Y knowledge and belief. HOME ( ) WORK ( ) TELEPHONE U I $ GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicabls interest basad en infer.ation submitted by the financial institution. Z. Inheritance tax bsco.ss delinquent nins .onths after the decedent.s date of death. 3. A joint account is taxable evsn though the decedent's name was added as a matter of convenience. 4. Accounts (including those held batNsen husband and wife) which the decadent put in joint names within one year prior to death are fully taxable as transfers. 5. Accounts 8stablishad jointly between husband and wife mora than ona year prior to death ara not taxable. 6. Accounts held by a decedent nin 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 clai.ed, place an "X" in block "An of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them 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 asses~ent (ForM 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 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 Z8060l, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice inforllation is incorrect andlor deductions are being claimed, check block "cn and complete Parts Z and 3 according to the instructions below. Sign two copies and sub. it thell with your check for the amount of tax payable to the Register of Wills of the county indicated. The PA DepartMent of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return from the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter NOTE: the date the account originallY was established or titled in the lIanner existing at date of death. For a decedent dying after lZ/IZ/8Z: 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 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,DOO 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 date of death. 3. The percant of tha account that is taxable for each survivor is determined as follows: A. The percent taxable for joint assets establishad more than one year prior to the decedent.s death: DIVIDED BY TOTAL NUMBER OF JOINT OWNERS Example: A joint asset registered DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE SURVIVING JOINT OWNERS in the name of the decedent and two other persons. I DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 16.7r. (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of tha 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 10D PERCENT TAXABLE Example: Joint account registered in the name of the decedent and two other persons and establIshed within one year of death by the decedent. 1 DIVIDED BY Z (SURVIVORS) = .50 X 100 507. (TAXABLE FOR EACH SURVIVOR) 4. The amount SUbject to tax (line 4) is deter.ined by mUltiplying the account balance (line 2) by tha percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The amount taxable (IIna 6) is deterllined by SUbtracting the debts and deductions (line 5] frail the amount subject to tax (line 4]. 7. Enter the appropriate tax rate (line 7] as deter.inad below. death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is Dr.. The linesl 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 who have at least one parent in common 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 3% 6r. 157. 157. 01/01/95 to 06/30/00 Or. 6r. 15X 15X 07/01/00 to present OX 4.5%- 12X 15X MThe tax ra1:e l.lllposed on the n.' value 0' transfers frolll a deceased Chlld twenty-one years of age Dr y ounger at CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMEO Allowable debts and deductions are determined as follows: A. You legally ara responsible for pay.ent, or the estate subject to ad.inistration by a personal representative is insufficient to pay the deductible itellls. 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 itemized fully in Part 3. If additional space is needed, use plain paper 8 l/Z" x II". Proof of pay.ent lIay be requested by the PA Departlllent of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU Of' INDIVIDUAL TAXES DEPT. 280501 HARRISBURG, PA 17128.0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BEST MARY F 47111 SOUTHAMPTON CT STERLING, VA 20165 n______ fold ESTATE INFORMATION: SSN: 179-30-8433 FILE NUMBER: 2105-0423 DECEDENT NAME: WERZINSKY LARUE E DATE OF PAYMENT: 05/09/2005 POSTMARK DATE: 05/06/2005 COUNTY: CUMBERLAND DATE OF DEATH: 12/18/2004 NO. CD 005303 ACN ASSESSMENT CONTROL NUMBER AMOUNT 05113375 I $26.32 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK#1945 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $26.32 GLENDA FARNER STRASBAUGH REGISTER OF WILLS CO""ONWEALTH 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 0'5 I)'+d.-?- ~ 05113377 03-29-2005 REV-15UEMAFP (Q9-DOl c EST. 'oF LARUE E WERZINSKY S.S. NO. 179-30-8433 DATE OF DEATH 12-18-2004 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST IX] CERTIF . OFF, ! MARY F BEST 47111 SOUTHAMPTON STERLING CT VA 20165 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 PSECU has provided the Departrlent 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 form 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) 787-8321. COMPLETE PART 1 BELOW . . Account No. 0179308433-555 . SEE REVERSE SIDE FOR 07-20-2001 FILING AND PAYMENT INSTRUCTIONS o.t. Established Account Balance Percent Taxable AMount Subject to Tax Tax Rat. Potential Tax Due x 2,339.65 16.667 389.95 .045 17.55 To insure proper credit to your account~ two (2) copies of this notice Must accompany your pay.ent to the Register of Wills. Make check payable to: nRegister of Wills~ Agentn. x NOTE: If tax pay.ents are .ade within three (3) months of thB decedent's datB 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. PART m i!!!!ill~~III!illm!,:,: ,,,,,,,.,,,,,,,: iii'- ",,;;;,i,i!;! TAXPAYER RESPONSE ,:~~ii!i!I_~~!,i!~!m~I!,I!~g~I~~~!\i;:;!~~i\!\_!ii!_1!~I!\ii~I~I\III.i!;l~.11 [CHECK ] ONE BLOCK ONLY A. The abOVB information and tax due is correct. 1. You may ChOOSB to re.it paYMent to the RBgister of Wills with two copies of this notice to obtain a discount or avoid interest~ or you .ay check box RAn and return this notice to the Register of Wills and an official asses~ent will be issued by the PA DepBrt.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. 0 ThB above information is incorrect and/or debts and deductions were paid by you. You must co~lBte PART ~ and/or PART ~ below. PART ~ 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 lINf ]. Oat. E~tabli~hAd 1 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 CEnter on Line S of Tax Computation) perjury, I declare that the facts I my knowledge and belief. I $ GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable inteint based on information submitted by the financial institution. Z. Inheritance tax beee.as dslinquent nine .onths after the decedent's date of death. 3. A joint account is taxable even though the decedent's 08_8 was added as a .stte; 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 8S 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 infer.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 subMit them 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 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 representative~ place an "X" in block "B" 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 Z80601~ 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 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 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. Entlilr NOTE: the date the account originallY was established or titled in the manner existing at date of death. For a decedent dying after lZ/I2/82: 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 account or the number of accounts held. If a double asterisk (..) appears before your first name in the address portion of this notice~ the $3~000 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 date of death. 3. The percent of the account that is taxable for each survivor is determined as follows: A. The percent taxabllil for joint assets established more than one year prior to the decedent's death: I DIVIDED BY TOTAL NUMBER OF JOINT OWNERS Example: A joint assat ragistered DIVIDED BY TOTAL HUMBER OF X 100 PERCENT TAXABLE SURVIVING JOINT OWNERS in tha name of Ula decedent and two other persons. B. The percent taxable for assets creatad 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 3 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) - .167 X 100 16.77. (TAXABLE FOR EACH SURVIVOR) 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 Z (SURVIVORS) ;; .50 in the name of the decedent and two oUler persons and established within one year of death by X 100 507. (TAXABLE FOR EACH SURVIVOR) 4. The a.ount 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. death to or for Ule 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 wh.ther or not they have been adopted by others~ adopted children and step children. "Lineal descendents" includ.s all children of the natural parents and th.ir 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.llon 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 3% 67- 157. 15Y. 01/01/95 to 06/30/00 OY. 6Y. 15Y. 15Y. 07/01/00 to present OY. 4.57.- 12Y. 15Y. _The tax rate imposed on the net value .f transfers from a deceased chlld twenty-one years of age ., y ounger at CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible for payment~ or the estate 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 decedent end can furnish proof of payment. C. Debts being clai.ed .ust be itemized fully in Part 3. If additional space is needed~ use plain paper 8 I/Z" x 11". Proof of pay.ent lIay be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES OEPT 280601 HARRISBURG, PA 17128-0601 REV- 1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BEST MARY F 47111 SOUTHAMPTON CT STERLING, VA 20165 -- fold EST A TE INFORMATION: SSN: 179~30~8433 FILE NUMBER: 2105-0423 DECEDENT NAME: WERZINSKY lARUE E DATE OF PAYMENT: 05/09/2005 POSTMARK DATE: 05/06/2005 COUNTY: CUMBERLAND DATE OF DEATH: 12/18/2004 NO. CD 005304 ACN ASSESSMENT CONTROL NUMBER AMOUNT 05113377 I $17.55 I I I I I I I I TOTAL AMOUNT PAID: $17.55 REMARKS: CHECK#1946 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. 260601 HARRISBURG, PA 17126-0601 '* INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 ()5 C>Lj.:l6 ACN 05113373 DATE 03-29-2005 IEW-1545EXAFP{09_DDl E~T: of LARUE E WERZINSKY S.S. NO. 179-30-8433 DATE OF DEATH 12-18-2004 COVNTY CUMBERLAND TYPE OF ACCOUNT IXJ SAVINGS o CHECKING o TRUST o CERTIF. MARY F BEST 47111 SOUTHAMPTON CT STERLING VA 20165 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PSECU has provided the Deparhent 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 form 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 answered by calling (717) 767-6327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0179308433-57 Date 01-12-1999 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 709.58 16.667 118.27 .045 5.32 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice must acco.pany your paYMent to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax payments ara made within thrae (3) months of the decedent.s date of death, you Nay deduct a 5~ discount of tha tax due. Any inheritance tax due will beCOMe da1inquent nine (9) months after the date of daath. Tax PART [!] The above information and tax due is correct. 1. You .ay choose to relllit 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. [CHECK ] ONE BLOCK ONLY B. 0 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 @J below. If you indicate a different tax rate) please state your relationship to decedent: PART @] TAX RETURN - COMPUTATION 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 PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 4 5 6 7 8 x x PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ facts I have repor~~abov. HOME ('J'"tJ6) WORK ( ) T LE H NE NUMB 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 baeD.as delinquent nins _onths after the decedent's date of death. 3. A ioint account is taxable even though the decedent's na.e was added as a matter of convenience. 4. Accounts (including those held between husband and wife] which the decedent put in ioint nelles within one year prior to dsath are fully taxable as transfers. 5. Accounts establishad jointlY betwasn husband and wife lIore than one year prior to death are not taxable. 6. Accounts held by a dacedant "in trust for" another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 TAXPAVER RESPONSE 1. BLOCK A _ If the inforllation and co.putation in the notice are correct and deductions are not being clailled~ 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 asseSSMent (Forg 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 ahd return to the PA Departllent 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 claimed~ check block "C" and cOllplete Parts 2 and 3 according to the instructions below. Sign two copies and SUbMit thell with your check for the allount of tax payable to the Register of Wills of the county indicated. The PA DepartMent of Revenue will issue an official asseSSMent (Form REV-1548 EX) upon receipt of the return frOM the Register of Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter NOTE: the date the account originallY was established or titled in the Manner existing at date of death. For a decedent dying after 12/12/82: Accounts which the decedent put in joint 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 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 froll the account balance as reported by the financial institution. 2. Enter the total balance of the account inclUding interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is deter.ined 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 Ex~ple: 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. 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 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 16.7X (TAXABLE FOR EACH SURVIVOR) 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 nalle of the decedent and two other persons and established wi thin one year of death by 4. The allount subject to tax (11ne 4) is determined by lIultiplying the account balance (11ne 2) by the percent taxable (line 3l. 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. X 100 sox (TAXABLE FOR EACH SURVIVOR) death to or for the use of a natural parent~ an adoptiva 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 thay have been adopted by others~ adopted children and step children. "Lineal descendents" includas all children of tha natural parents and thair descendents~ whether or not thay have been adopted by others~ adopted descendents and their descendants and stap-descendants. "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 Collateral 07/01/94 to 12/31/94 37. 67. 15% 15Y. 01/01/95 to 06/30/00 07. 67. 157. 157. 07/01/00 to present 07. 4.5%- 127. 157. _The tax rate i.posed on the net value of transfers frOM a deceased ch Id twenty-one years of age 0' y ounger at CLAIMED DEDUCTIONS - PART :5 DEBTS AND DEDUCTIONS CLAIMED Allowabla dabts and deductions are deterllinad as follows: A. You legally are responsibla for pay.ent~ or the estate subject to administration by a parsonal representative is insufficient to pay the deductible iteMS. B. You actually paid the dabts after death of the decedent and can furnish proof of payment. C. Debts being claimed lIust be ita.ized fully in Part 3. If additional spaca is neaded~ use plain papar 8 1/2" x II'". Proof of payment may be requested by the PA DepartMent of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HIl.RRISBIJRG. PIl. "\ 71 28-0601 REV-l'62 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BEST MARY F 47111 SOUTHAMPTON CT STERLING, VA 20165 nuu__ told ESTATE INFORMATION: SSN: 179-30-8433 FILE NUMBER: 2105-0423 DECEDENT NAME: WERZINSKY lARUE E DATE OF PAYMENT: 05/09/2005 POSTMARK DATE: 05/06/2005 COUNTY: CUMBERLAND DATE OF DEATH: 12/18/2004 NO. CD 005305 ACN ASSESSMENT CONTROL NUMBER AMOUNT 05113373 I $5.32 I I I I I I I I TOTAL AMOUNT PAID: $5.32 REMARKS: CHECK#1944 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WilLS