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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 51.5
05122738
06-01-2005
REV-1543EXAFPI09-00J
"-"
TYPE OF ACCOUNT
D SAVINGS
IX] CHECKING
D TRUST
D CERTIF.
EST. OF ElVA M THOMAS
5.5. NO. 161-12-3205
DATE OF DEATH 03-15-2005
COUNTY CUMBERLAND
HARRIET FINDLEY
216 MOUNTAIN VIEW RD
MT HDllY SPRGS PA 17065
REHIT PAYHENT AND FORHS TO:
REGISTER OF WIllS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
FULTON BK has provided the Department 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 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 form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of P8nnsyl~ar.ia. Quegtions ~e~ b9 answered ~, ~alljng (717) 787-8327.
Date
Established
REVERSE SIDE FOR
10-17-2000
FILING AND PAYMENT INSTRUCTIONS
COMPLETE PART 1 BELOW
Account No. 0100-65873
IE IE IE SEE
Account Balance 495 . 78
Percent Taxable X 50.000
Allount Subject to Tax 247.89
Tax Rate X .15
Potential Tax Due 37.18
PART TAXPAYER RESPONSE
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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".
NOTE: If tax payments are made within three
(3) months 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) months after the date of death.
[CHECK ]
ONE
BLOCK
ONLY
A. c=J The above infor~ation and tax due is correct.
1. You .ay choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount Dr avoid interest, or you ~ay check box "An 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. fi1 The above information is incorrect and/or debts and deductions were paid by you.
You .ust co~plete PART 0 and/or PART @] below.
x
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. Allount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF TAX ON JOINT/TRUST ACCOUNTS
1
2
3
4
S
6
7
8
x
PART
[!]
DATE PAID PAYEE
Y~~11:::;~1:: ~
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
Xnp_ I/:::i~;/~:~::~
TOTAL tEnter on Line 5 of Tax Computation)
AMOUNT PAID
1'~~2
$
Under penalties
~o~lete to th es
CbI/;"
TAXPAYER SIGNATURE
of perjury, I declare that the facts I
f~nO~ledg~ d belief.
-r-~
have reported
HOME (71
WORK (
TELEPHONE
and
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable intsrBst based on information
sub.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 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 joint na_as within one year prior to
death are fully taxable as transfers.
5. Accounts established jointly between husband and wife more than one year prior to death are not taxable.
6. Accounts held by a decedent "in trust fa,." 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 "X"
in black "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and submit the. with your check far the allount of
tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment
(Farm 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 ")(" in black "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 and/or deductions are being claimed, check black "C" and complete Parts 2 and 3
according to the instructions below. Sign two copies and submit the. with your check far the amount of tax payable to the Register
of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Far. REV-1548 E)(} 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.
Far a decedent dying after 12/12/82: Accounts which the decedent put in joint nalles within one (I} 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~ber of accounts held.
If a double asterisk (..} appears before your first nalle in the address portion of this notice, the $3,000 exclusion
already has been deducted fro~ 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 fallows:
A. The percent taxable for joint assets established mare than one year prior to the decedent's death:
1 DIVIDED BY TOTAL NUMBER OF
JOINT OWNERS
Example: A joint asset registered
DIVIDED BY TOTAL NUMBER OF )( 100 PERCENT TAXABLE
SURVIVING JOINT OWNERS
in the name of the decedent and two other persons.
1 DIVIOED BY 3 (JOINT OWNERS} DIVIDED BY 2 (SURVIVORS} = .167 X 100
16.7% (TA)(ABLE FOR EACH SURVIVOR}
B. The percent taxable far 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
)( 100
PERCENT TA)(ABLE
1 DIVIDED
Joint account registered
the decedent.
BY 2 (SURVIVORS} = .50
in the nalle of the decedent and two other persons and established within one year of death by
Exallple:
)( 100
50% (TA)(ABLE FOR EACH SURVIVOR}
4. The amount subject to tax (line 4} is deter.ined 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) froll the amount subject to tax (line 4}.
7. Enter the appropriate tax rate (line 7) as determined below.
_The tax rate l.posed on the net value of transfers frail a deceased Chlld twenty-one years of age or younger at
death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is oz.
The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children
whether or not they have been adopted by others~ adapted 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 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
07101/94 to 12/31/94 3X 6% 15X 15X
01/01/95 to 06/30/00 0% 6X 15X 15X
07101/00 to present OX 4.5%- 12X 15X
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 decedent and can furn\sh proof of payment.
C. Debts being claimed .ust be itemized fully in Part 3. If additional space is needed~ use plain paper 8 1/2" x II". Proof of
paYllent .ay be requested by the PA Department of Revenue.