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RECEIVED PROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 021085
RICE EDWIN L
24 W EPPLEY DRIVE
CARLISLE, PA 17015
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
---- ---
15141298 59.74
ESTATE WFORMATION: ssn�:
FILE NUMBER: 211 1 -0720 I
DECEDENT NAME: RICE NAOMI J I
DATEOFPAVMENT: 08/10/2015
POSTMARK DATE: OH/lO/ZO75 I
couN7v: CUMBERLAND I
DATEOFDEATH: 12/24/2010
TOTAL AMOUNT PAID: 59.74
REMARKS:
CHECK# 4819
INITIALS: CJ
sEA� RECENED BY: LISA M. GRAYSON, ESQ.
REGISTER OF WILLS
REGISTER OF WLLLS
°°"�^° °` '"o'°'°'"� '"xE� Penns Ivania lnheritance Tax k� !�'' penn5�/�Varlld
PO BO% 2006�1 � pEPPRTMENT OF RFVENUE
NARRISBVRG PR lll$B-0601 Information Notice �i�1�
,� A¢dT,�p�yerResponse Fi�ENo-zi—'�—D`72D
RECOR� �: � i ,.,, F ACN isiaizea
REG!�T "- �_ !"�,L_S oareoa-oa-zoie
�ois �u� io Pr� i yi
Type of Account
CLEI EstateofNAOMIJRICE Savings
ORPHt,'� , . x cne�k��9
Date of Death 12-24-20�0 Tms[
HEATHER J RICE CUMBEZ�� :. Coun[yCUMBERLAND Certi}iCate
24 W EPPLEY �R
CARLISLE PA 17015-4393
rNc BANK NR provided Ihe department with the information below indicating that at the death of the
above-named decedent you were a joint owner or beneficiary of the account identified.
Remit Payment antl Forms to:
AccountNo.5140190048
Date Establishetl 12-01-1966 REGISTER OF WILLS
Account Balance $ �,pgg,qp 1 COURTHOUSE SOUARE
Percent Taxable X 16.6fi7 CARLISLE PA 17013
Amount Subjec[to 7ax $216,47
Tax Rate X 0.150 NOTE': If tax paymen(s are made wi�hin�hree months of�he
Potential Tax Due $32.46 decedenfs date of death, deduct a 5 percent disroun[on ihe tax
With 5%Discount(Tax x 0.95) ${see NOTE') due. Any inheri[ance tax due will become delinquent nine months
aiter the tlate oi death.
PART StEP 1 : Please check the appropriate boxes below.
1
A �No tax is due. I am the spouse of the deceased or I am the parent of a decedent who was
21 years old or younger at date of death.
Proceed ro Step 2 on reverse. Do nof check any ofher 6oxes and disregard the amounf
shown atwve ss Polenlial Ta.Gue.
g �The information is The above information is correct, no tleductions are being taken, and payment will be sent
correcl. with my response.
Proceed to Step 2 on reverse. Do nof check any other boxes.
p The tax rate is incorrecL �4.5% I am a lineal beneficiary (paren�,child,grendchild,etc.) of ihe deceased.
elec�correc�tax ra�e at
right, and complete Part � �p� I am a sibling of[he tleceased.
3 on reverse.)
� 15% All o�her rela�ionships (including none).
p �Changes or deduc[ions The information above is incorrect and/or debts and deductions were paid.
lis�ed. Complete Part 2 and part 3 as appmpriate on the back oi this lorm.
E �Asset will be reportetl on The above-identified asset has been or will be reported and tax paid with�he PA Inheritance Tax
inheri�ance��form Retum filed by�he esta�e represen�ative.
REV-150D. PmceedfoStep2onreverse. Donofcheckanyother6oxes.
� Please sign and date the back of the form when finished.
PART Debts and Deductions
2
Allowable deb�s antl deduc�ions must meet bo�h of�he tollowinq criteria:
A. The decedent was legally responsi6le(or payment,and[he estate is insufficient to pay�he deductible i�ems.
6. You paid ihe debis af[er the death of the decedent and can fumish proof of payment if requested by the department.
(If additional space is required, you may attach 8 V2'x 1 P sheets of paper.)
Date Paitl Payee Description Amount Paid
To�al (Enter on Line 5 of Tax Calculation $
PART Tax Calculation
3 H you are making a correclion to the establishment date(Line 11 account balance(Line 2), or percenl taxable(Line 3).
please obtain a written corredion from the financial institu[ion and atlach it ro[his torm.
L Enter the date�he accoun�was established or titled as it exis�ed a�the da�e of death.
2 Enter the total balance of ihe account including any interest accmed at the date of dea�h.
3. Enter the percentage of the account iha�is taxable to you.
a First,determine the percenta9e owned by the decedent.
i. Accounts that are held"in�mst for"another or others were 100%owned by the decedent.
ii. For joint accounts established more than one year prior to lhe date of death,�he percen�age t�able is 100%divitletl
by ihe total number of owners including the decedenL (For example:2 owners=50%, 3 owners=3333%, 4 owners
=25%, atc.)
b. Next, divide the decedenfs percenta9e owned by the number of surviving owners or beneficiaries.
4. The amount subject to tax is determined by multipying the account balance by lhe percent taxable.
5. Enter ihe total of any debts and deduc[ions claimed from Part 2.
6. The amount�axable is determined by subtracting ihe tlebts and deductions Gom Ihe amount subject to tax.
7. Enter the appropriate tax rate from S�ep 1 based on your relationship�o�he decedent.
If indicating a different tax ra�e, please �ate Ofi'icial Use Qnly:{]aqF ,� .
your relationship�o�he decedent:��. �f{�yPy�(�p1 Of REV8f1UB �.
1. Oate Esta6lished 1 —� � ' . � '� % '
2 Accounl Balance 2 $ � PA�
3. Percent Taxable 3 X � (A��o�o, �
2
4. Amount Subject to Tax 4 $ c��(0 4 � 3
5. Debts and Deduc�ions 5 - `—'- 4 .
fi. Amount Taxable 6 $ ( 5 .
7. Tax Rate 7 X S� � ... .
8. Tax Due 8 $ � `� ,.
9. With5%Discount(Taxx .95) 9 X �
.StBF) 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the tront of this form,
along with a check for any payment you are making. Checks must be made payable to"Register of Wills, Agent" Do not send
payment directly ro ihe Department of Revenue.
Under penalry of perjury, I declare iha�Ihe facis I have repotled above are irue,correct and complete to the best of my knowledge and
belief.
Work 719-q31-GIDI
Iln�}{ivn �u�t N�e�tol,t_ Home 9i'1-22(y-4i�15 A�1I�5
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Taxpay r Signatur Telephone Number Date
IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE
DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR
TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKWG NEEDS ONLY: 1-800-447-3020