HomeMy WebLinkAbout06-16-05
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
6UREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96j
RECEIVED FROM:
PENNSYLVANIA
INHERITANCI' AND ESTATE TAX
OFFICIAL RECEIPT
BARRETT WilLIAM F
504 N HUMER STREET
ENOlA, PA 17025
u____n fold
ESTATE INFORMATION: SSN: 133-22-5791
FILE NUMBER: 2105-0541
DECEDENT NAME: BARRETT ROMA J
DATE OF PAYMENT: 06/16/2005
POSTMARK DATE: 06/1 6/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 11/16/2004
NO. CD 005439
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $184.93
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: W F BARRETT
CHECK# 0979
SEAL
INITIALS: VZ
RECEIVED BY:
REGISTER OF WILLS
$184.93
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
REV.1500EX(&-OO)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA i712B-060i
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
....
z
w
o
w
()
w
o
w
,..,
",~II)
0"''''
w"O
",00
0"'-'
....
~
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
BA I{~!; T T, !CO/lf,f J.
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
/1_ /0 - 2.bo'f 0/- IJI'- /~2'1
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Ii! / If
[ZI1. Original Return
04. Limited Estate
o 6. OecedentOied Testate (~ttM:hrorJfofWill)
o 9. Litigation Proceeds Received
D 2. Supplemental Return
o 4a. Future Interest Compromise (dale 01 death after 12-12-82)
o 1. Decedent Maintained a L\v\r.g Trust l-"ttachcopy ofTrusl)
o 10. Spousal Poverty Credit (daleofdealhbelwe9n 12-31-91 and 1-1-95)
tV/l.t./A-,H ;=; ~A-,e,(E TT
FIRM NAME 1'_"')
COMPLETE MAILING ADDRESS
NAME
OFFICIAL USE ONLY
FILE NUMBER
1-1 05
JLQ~.iL
NUMBER
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
/33 - 22
579/
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (date of death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
o 8. To1.al Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (AttachSchO)
S7J ~ AJ. H U d( e7f' ST.
E/VoLJf-, J'7A /7oZS-
TELEPHONE NUMBER
7/7- 72.9- /'/:;6.
(1)
(2)
(3)
(4)
(5)
o
o
o
o
f (" .1.3/. SO
z
o
~
:::l
....
ii:
c(
()
W
~
1, Real Estate (Schedule AI
2, Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4, Mortgages & Noles Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6, Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8, Total Gross Asseta (total Unes 1-7)
9. Funeral Expenses & Administrative COSts (Schedule H)
10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule I)
11, Total lledu<:tions (total Lines9& 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
o
(6)
11 'if, 374.15"
(7)
(9)
(10)
f /0, 'f~r. ()f)
o
14. Net Value Subject to Tax (line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
z
o
!;;:
I-'
:::l
l1.
~
o
()
~
1"'<)
; ~::::,~
c_ _ CDFFICI
"n
",,'\
7
r-,
f',)
'-.w-
(8)
t/.i-f ~7.(,~
,
(11)
(12)
(131
!
/0, 'f'lT. O()
" ~, If) P. 'S-
O
(14)
!
4, /"9. tio!;
15. Amount of Line 14laxable at the spousal tax
rate, or transfers under Sec. 9116 (a}(1.2)
o
~ ~ to'!. 'S-
O
C
x.o~ (15) 0
, ,0 'fL (16) 't3'f,f(3
, ,12 (17) 0
x .15 (18) c:J
(19) '/.fY. f3
16. Amount of line 14 taxable at lineal rate
11. Amount of Line 14 taxable at sibling rate
18. Amount of line 14 taxable at collateral rate
19. Tax Due
20.0
CHEer< -lERE F 'SU l,RE QEr:lUEsr:NG ... REt:'tJND )F ....N ':VERPAY'\llEH~
Decedent's Complete Address:
STREET ADDRESS SOIfN. f!/(/JfGf' ST..
CITY clVOut I STATE /'A I ZIP 170 zS
Tax Payments and Credits:
1. Tax Due (Page 1 Line 1 g)
2. CreditsJPaymenls
A. Spousal Poverty Credil
B. Prior Paymenls
C. Discount
(1)
.,.
It'!. 93
o
o
l)
Total Credits (A+ B + C) (2)
o
3.
InteresUPenalty if applicable
D. Interest
E. Penalty
(3)
(4)
(5)
(SA)
o
o
4.
TotallnteresUPenalty ( 0 + E )
If Line 2 Is grealer than Line 1 + Line 3, enter the difference. This is Ihe OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5.
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is Ihe TAX DUE.
A. Enter the interest on the tax due.
B. Enter the totai of Line 5 + SA. This is the BAlANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
"
/~'tf3
o
. ~/,fl/-?$
o
, t8L/- '3
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS
1. Did decedent make a Iransfer and: Yes
a. retain the use or income of Ihe property transferred;.......................................................................................... 0
b. retain Ihe right to designate who shall use the property lransferred or ils income; ............................................ 0
c. retain a reversional'j interest; or.......................................................................................................................... 0
d. receive the promise for life of either paymenls, benefits or care? ...................................................................... 0
2. If death occurred after December 12, 1982, did decedenl transfer property within one year of death
withoul receiving adequate consideration? .............................................................................................................. 0
3. Did decedenl own an "in lrust for" or payable upon death bank account or security at his or her death? .............. 0
4. Did decedent own an individual Retirement Account, annUity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0
No
00
[jJ
I:8J
~
~
~
~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN,
Under penalties of pe~ury, I declare that [!lave. examined this retum. irdOOing accompanying schedules and statements, and to Ihe besl 01 my knowlEldge and belief, it is true, correct
and complete.
DeclaratiOn of preparer other than the personal representative is based on all infonnation of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE F R FILING RETU
lJ.J.,J. __ "I-
ADDRESS 1U1<"<..IA-M r. ~."
Sbf/' AI. Hllllfst. Sr.:, €h..~A, /" / 71) z.s
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE ~/I~/..S'"
ADDRESS
DATE
~.",,";&iil' ~~I~I'f~\t;~~;li.o!i1 1 mm... _.k't~~i!Ij
For dales of death on or after Juiy 1, 1994 and before Janual'j 1, 1995, Ihe tax rate imposed on Ihe nel value of transfers to or for Ihe use of the surviving spouse is 3%
[72 P.S. ~9116 (a) (1.1) (i)).
For dates of death on or after January 1, 1995, Ihe lax rate imposed on the nel value of transfers 10 or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)].
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements ior disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child 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 0% [72 P.S. ~9116(a)(I.2)].
The tax rate imposed on the nel value of transfers to or forthe use of the decedent's lineai beneticiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)].
The lax rate imposed on the net value of transfers to or for the use of Ihe decedenl's siblings is 12% [72 P.S. ~9116(a)(1.3)]. A sibling is detined, under Section 9102, as an
individual who has at least one parent in common wi\t1 the decedent, whether by blood or adoption.
"",..",."," '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDEN,
ESTATEOF B ~
1'fA-1t t: T' /
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
~A(A. .:r.
FILE NUMBER
Include the proceeds of litigation and ttJe date the proceeds were received by the eslate. All property jointly......ed with the right of survivorship must be disclosod on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
S/t6IP/ltI tf)kr"g~ /99/ Sfif.17'N t()A-6tMI
~t.l> 70 S77f /H'€". Au7&> ..r~LGS
VALUE AT DATE
OF DEATH
Jr
t:,Zl!!O.oo
2.
69-$ /A' tlI~L.G7
,)<
&;.c;c,
5.
~"R/J! CLpl!.k
~
/. S-O
I<- NolE: J)EtJEbl;Nr LlrEI) tlJ/771 HBf' di:tNS .A?Ae: MS7 tf'
YG!J.NS """l> HHl> G()77'J9,/ 1I?/.tJ e>r HE!(! ,oRt,JPAI-Hry ~T 7h#€
~ ~ #6e H;vSt!:.
TOTAL (Also enteron line 5, Recapitulation) $ " -131. SO
(If more space is needed, insert add~ional sheets of the same size)
"".'''EX'''~.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF B,4UET7; ~d-l
SCHEDULE F
JOINTL Y.OWNED PROPERTY
.::r.
ff an asset was mad. joint within on. yea' ofth. decedent's date of doalh, M must be roported on Sc:hedule G.
FILE NUMBER
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. tu/U.;,I//11;:; L!J/1/t1tETT
SJ:> 'I AI.
€/V~, 1'7/9
fi~"'B'( s,T
~7"'2S
B.
c.
~I'I
JOINTLY.OWNED PROPERTY:
"E"
NUMBER
LETTER OATE
FOR JOINT MADE
TENANT JOINT
DESCRIPTION OF PROPERTY
Include name of finalCial jnstitullOn SId balk account number or similll' identifying number. Attach
deed forjointly-held real estate.
pseCll AeeT: /Va. ()J 33 zZ579/
~
/JIlt.AAJI!E 9, ~ S"' ./ R
A-evi. ~Nr. ,1.1'1
" 1,357.01
{~IFE;" t:E77l:7l A-/"77f(!#cD ~ (!f)1'Y 0":
_r,CE' ~A! 7JJ5'77-" "'r A!E1'-)
1.
A. /'lfS
.1.
I3AIJI< /MCr. Ab.
~s, /l53.7:{
'fbPtJ/O.,2 7.:;.
A.
,,"rep.
"qS'
WM PO/NT
8~llf-"'C"
3.
~;ru
",S
(i)/f.'IPottJT &-IVK If-Mr. M:>. 01 {)O g:z /001'
talk,.A;$ <fa.,3.H.S-V
(SE/i L.~77c::7{ A-7fIf-CJl~ hill rJoI'y of
Nut/e!iS /7(01fI fJBJr. /)1' !l€Y-)
.4.
DATE OF DEATH
VAlUE OF ASSET
f>
'1, "3S1.U7
~
S; /)S3. 7"]..
l'
:z.,~39.SO
%OF
DECO'S
INTCRE$l
SZ'h
~,.i,
~h.
DATE OF DEATH
VAlUE OF
OECEOENrs INTEREST
F
~ 679.5'1
,
:l,S2'.3r..
11 '. I" 1. 75
TOTAL (Also enter on line 6, RecapMulation) $ 3, ])7&.. IS
(If more space is needed, Insert additional sheets of the same ~ze)
PSE(~
the financial fink ill
February 15,2005
Account # 0133225791
WILLIAM BARRETT
504 N RUMER ST
ENOLA, PA 17025
Dear MR BARRETT:
The following is the status ofROMA L BARRETT's account with PSECU as of the date of death.
Joint Owner's Name
Date of Death
Date of Birth
WILLIAM BARRETT, ADDED 07.16.1985 AS JOINT TENANT W/ROS
11.16.2004
01.08.1924
Share
SOl
S04
Description
Regolar Shares
MoneyHandler
Open date
02.15.1974
Balance
$9,356.18
0.00
Accrued Dividend
$2.89
0.00
The dividend earned from January 1, 2004 through the date of death was $50.90. The decedent had no loans with us.
We do not have safe deposit boxes for our members.
The check for the proceeds will be sent under separate cover. If you have any questions, please call 234-8484 in
Harrisburg or our toll-free number, (800) 237-7328. At the menu prompt, enter 6 and then extension 2227.
Sincerely,
Lf~~/
Meacie Fairfa{j (
Member Service Representative
Finance Support Unit
PENNSYLVANIA STATE EMPLOYEES CREDIT UNION
Main Address: 1 Credit Union Place, Harrisburg, PA 17110-2990. (717) 234~8484 . (800) 237-7328
Mailing Address: P.O. Box 67013, Harrisburg, PA 17106-7013. (717) 777-2100 (TOO) . (BOO) 472-1967 (TOO)
Web Address: www.psecu.com
Saving_ fedn"Uy Insurea up to $100,000 by the Natlontll Credit Union Administration.
COMMONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21
05117735
05-31-2005
REY-1S4SEX AflI (19-111>
EST. OF ROMA L BARRETT
S.S. NO. 133-22-5791
DATE OF DEATH 11-16-2004
COUNTY CUMBERLAND
TYPE OF ACCOUNT
!Xl SAVINGS
o CHECKING
o TRUST
o CERTIF.
PA 17025-2226
REHIT PAYHENT AND FORHS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
WILLIAM F
504 N HUMER
ENOLA
BARRETT
ST
PSECU hilS provided thll DlIpartlllilnt tlith thll inforllBtion listed balON which has bean uslld in
calculating the potllntial tax dull. Thtlir records indicate that at thll death of th8 abOVtI dacectan:t, !IOU IWre a joint OMnar/bwlef-iciary of
this account. If yoU flllll this infa~tion is incorrect, plllsse obtain written corrllction frail thlil financial institution, attach a copy
to this fa,.. and return it to the above address. This account is taxable in accordance with the Inheriti!ll1lC8 Tax Laws of the COIllKJl"MoIealth
of Panns::ilvania. Quastions: nn:ty be anSllarsd by e.-alling l:717) 187-83l7.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Acco...t No. 0133225791 Data 07-16-1985
Esblblishecl
x
9,359.07
50.000
4,679.54
.045
210.58
To insure proper cradi t to !lour acc:aunt, tNo
(2) copies of this notice MUst acco~y your
pBYllmt to the Register of Wills. Make check
payable to: ""Register of WillS, Ag..,t"".
Account Balance
Perc..,t lax.ble
Aftount Subject to
Tax Rate
Potential Tax Due
x
NOTE: If tax paYIIlll1ts arll lIBde within thr_
(3) lIanths of thll decedent"s date of death,
yo... IIl!IY daduct II 5% discount of the tax due.
Any inheritancll nue due will hecOll. deUnqu.nt
nine (9) lIonths aftar the dab of ct..th.
Tax
PART TAXPAYER RESPONSE
[!] I nr_
'm~. . ..;,~;,,"'~ .__~;~,: ~) ... """ ..,~"". '. .. ~,..=. ..: "'.~'''''''!:" ,~!i:". 'r... :~~-"""~'" __;",.f~;~~".,,,._;J;. -'~=' ,.,.~,,;; oi:. ",...,,,,,.,. -_.=,~.. "..'"._ ~:~~,
~, _'" -~'.- !l!", _...,~~_, ""."~Eim"';J; . . ~ !ffiE'-~~'
on'" ''''''~_._.,...._ ,_,~"'","'..._. . "'''''ro. ..' "''''. _. ._ on'" ... . .",,, ... .. "'''''''_......~.'''~'.-.-........ ._~. "'~""'" , _"'. ...~.,.. ...... . .-.....- .~'.'" -
"'.... ~"'"....... .~.'....- .~. ... .. .. ~
[CHECK ]
ONE
BLOCK
ONLY
A. 0 The above infar_t.ion and tax dWl is carr8c:t.
1. You.BY choose to rHit payHnt to the Register of Wills with bto copies of this notic. to obtain
a discount or avoid interest, or you IIBY chtIc::k box "An and natum this natic. to the RlIgister of
Mills and an official assllsnent will be issued by thll PA O.par'btent of Revilflue.
B. /VI The abOVe asset has beBn or will be rBported and tax pElid with the PennS!llvenia lriwrit1mca To n~turn
~ to be filad by the decedent"s representative.
C. 0 Tha abOve infarlRltion is incarr8Gt and/or debts ;wu:i deductions Wllre p8id by YOU.
You .ust CDJlPlete PART 0 and/or PART @] belOlt.
TAX ON JOINT/TRUST ACCOUNTS
PART
~
TAX RETURN - COMPUTATION OF
If you indicat. a different tax rate, please state your
relationship to decedent:
LINE 1. get. Established 1
2. Account Balance 2
3, Percent Taxable '3 X
4. """...t Subj..,t to Tax 4
S. Debts and D~ctions 5
6. AlIOUOt Texable 6
7, Tax Rate 7 X
8. lax Due 8
PART
~
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
$
I
TOTAL IEn_ on Lu.. 5 of Till< ~1..1l
Under penalti_ of- perjUry, I d8cl.,.. th.t- the- fects
caoop;l.t. to _ _ of ~ _..... _. baU..
~ ~ {::j~JJ
T S GNATURE
I MV. r .orted. abaft a.... tn., correct and
HOME On) 7.a.8-/7''-r...
WORK ( )
~1J::p.LlnlllJ;; UIIMIEI[I::D .....-r-r-
Y-lWay~qi!'Kt
January 31,2005
To Whom It May Concern:
This letter is to inform you that Roma J Barrett had two accounts with Waypoint Bank.
Her savings account number is 960010272 and had a balance of$5,053.72 at the time of
her death, November 16, 2004. Ms. Barrett's checking account number is 0100821008
and had a balance of $2,339.50 on November 16,2004. If you have any further
questions, you may contact me at the number below.
-
Sincerely,
/ --:> -c- ~
Danielle Henry ............. _________
Customer Service Rep.
Waypoint Bank, Summerdale
401 N Enola Road
Enola, PA 17025
717-732-3637
P.O. Box 1711. HARRISBURG. PeNNSYllIANIA 17105-1711
Toll Free I-B66-WAYPOINT (1-866-929-7646) . IN YORK AAEA 717/B15-45oo . www.waypointbank.com
COMMONWEALTH OF PENNSYLVANIA
DEPARTtENT OF REVENUE
IUREAU OF INDIVIDUAL TAXES
DEPT. Z806Dl
HARRISBURG~ PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21
ACN 05118147
DATE 05-31-2005
REW-lSUEX AFP U,..UI
WILLIAM F BARRETT
504 N HUMMER ST
ENOLA PA 17025
TYPE OF ACCOUNT
EST. OF ROMA BARRETT [X] SAVINGS
s. S. NO. 133-22-5791 0 CHECKING
DATE OF DEATH 11-16-2004 0 TRUST
COUNTY CUMBERLAND 0 CERTIF.
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
WAYPOINT BANK has provided the Oepartllent with the infonHItion listed below which halS b&en uS8cl in
calculatIng the potential tax due. Their rllCords indicate that at the dllath of 'thll abovlII decedllrlt~ you were III joInt owner/beneficIIIIrY of
this account. If YOU f1Iel <this infcn".'tian is incorrllCt~ please obtain writtllrl correction frOll the financillll inlSti tution~ attlllch ill copy
to this fa... and return it to the above address. This account is taxable in acc;ardance with the Inh.r! tanCB Tax LillNs of the COIIlIDntfeBI th
of Pennsyl~~nia. OuBstlans may b8 answBred b~ calling (711) 781-8327.
COMPLETE PART 1 BELOW
Account No. 960010272
. . . SEE REVERSE SIDE FOR
IlIot. 04-24-2000
Establish.d
FILING AND PAYMENT INSTRUCTIONS
Account Balance
P....c.nt Taxable
Anount Subject to Tax
Tax R.t.
Potential Tax Du.
5,053.41
X 50.000
2,526.71
X .15
379.01
To Insur. proper c....dit to your account, two
(2) caples of this notice ....st accOllplllny your
paymBnt to the Register of Wills. Make ChBCk
payable to: -RegIster of Wills, Ag~tn.
NOTE: If blx pay.ents are .&de within three
(3) IIOnths of thll decedl!nt"s date of death,
YOU bY deduc't a SX discount of the ux due.
Any inheritancB tax due wIll beca.ll delInquent
nine (9] liIonths after the data of d8ath.
PART TAXPAYER RESPONSE
m_.!~[.R__1
""':...... ...'~'.~"'.._....._._' _ .._~.'" ...",,_,;?, _,_.", ."~. .....,.,.'" ":0" -""i,,:o!iF""'- ._,~...:o_ _._...,._ .,......,.,... ",......iE.~. ,,_..__. ~".....,. . .,'''' _..,...;>,;,
"".".,......r~'" . _. .'~="_""~ .... .=" "_.."..,,. __,.".. "...:0:"" ..."
_._. _=_ _... ... ..' _ ..~r. _. .' ......._ ... _ . .n ".,.. __ . . ..,~ _. ~. ....... __m._.. .......... _. ... ...~ ._'" "_ '" .... ... ........ _., ._..... .~~.:O:...n .. ~"'.n..
""" ._ "''' ..... _. "'.... .~ ...,.....
[CHECK ]
ONE
BLOCK
ONLY
A. 0 The above inforation and tax dUll is correct.
1. You ny chaaH to .....it pay...,t to the Register of Wills with two capies of this notice to obbin
a discoLU1t or avoid Interlilst, or you IIBY check balC nAn and ratum thIs noticliI to the RegIster of
Wills and an official asses,..snt will be issued by the PA o.par~t of RavBOUIiI.
B. ~ The abaVB asset has been or will be reported and tax paid with the Pennsylvania InheritBncliI Tax return
~ to ba filad by tha decedent" s r&prBSIInbltive.
C. 0 Tha abOVB infor....tion is incorrBCt and/or debts and cklductions were P8id by you.
You lIust cOllpl.t. PARr 0 and/a... PART @J b.lo....
PART
~
TAX RETURN - COMpUTATION OF TAX
LINE 1. O.te Established 1
2. Account Sal~c. 2
3. P.r-cent Taxable 3 X
4. AlIOunt Subject to Tax 4
5. Debts and Deductions 5
6. AIIount Taxable 6
7. Tax R.te 7 X
8. TII>( Due 8
ON JOINT/TRUST ACCOUNTS
If you indiCllt. a diff....ent tax rat., pl__ state your
M11.t1onship to .......t...t:
PART
l!l
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
$
I
TOTAL IEn_ on Line 5 o~ TII>( ~onJ
Unde... ~lti.. o~ ~jury, I dec18.... that the ~acts
CCIOlPlet. to _ _t of-~, ~ _ ali.f-.
W~~R 1. p~
TAX SIGNATURE
I t.ve MIpOrt.d: IIbov. .... true-, eal"l'"eCt
HOME (7/7) -,.-8' If,r'''
WORK ( )
TELEPHONE NUMBER
.....
nATJ;
COMMONWEALTH OF PE~SYLVANIA
DEPARTMENT OF REYEHUE
BUREAU OF IMDI"IDUAl TAXES
DEPT. 280601
HARRISBURG~ PA 17128-0601
*'
XNFORMATXON NOTXCE
AND
TAXPAYER RESPONSE
FILE NO. 21
ACN 05118148
DATE 05-31-2005
REY-1S'45EX ~p ",-on
PA 17025
TYPE OF ACCOUNT
EST. OF ROMA BARRETT 0 SAVINGS
S. S. NO. 133-22-5791 IX] CHECKING
DATE OF DEATH 11-16-2004 0 TRUST
COUNTY CUMBERLAND 0 CERTIF.
REMIT PAYMENT AND FORNS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
WILLIAM F
504 N HUMER
ENOLA
BARRETT
ST
WAYPOINT BANK hss provided the Dspartaent Nith the infortlation listed below which has been uSlld in
calculating the pOUntial tax due. Their records indicate that at the Math of the abOve decBdant~ YOU were a joint oWntlr/a.neflcu.ry of
this account. If YOU feel this infor..tion is Incorr8Gt~ please obtain written correction fro. the financial institution~ attach a COpy
to this forll and return it to tha above address. This account is taxable in acc:ordanca with the InharitanCfl Tax taNS of tha CCIII.onwaalth
of Pennsylvania. Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW
Account No. 100821008
l( l(
l( SEE REVERSE SIDE FOR
D.ts 05-18-2004
Established
FILING AND PAYMENT INSTRUCTIONS
Account Balance 2,339.50
Percent Tex....l. X 50.000
AIlount Subject to Tex 1,169.75
Tex Rate X . 15
Potential Tex aue 175.46
PART TAXPAYER RESPONSE
[!]Dlli"'_~"'_"""__
To insura proper credit to your acoount~ two
(Z) copies of this notice .ust acc~pany your
pa)'llent to the R8IIIIstlllr of Wills. Make chllCk
payabllil to: "Register of "ills~ Agllnt"".
NOTE: Jf ux pa~ts ara .ad. within three
(3) .ontns of tha declllChlnt"s datlil of de.th~
YOU By d8duct. a SX discount of thlil tax dUliI.
Any inhlilritance tax due will bec~ dlillinquent
niM (9) .onths aftar the dIIt11 of death.
[CHECK ]
ONE
BLOCK
ONLY
A. 0 Tha abava infor..tion and tax due is correct.
1. You .ay chooSll to ra.1t paYIIlll1t to thlil Register of Wills with two copilils of this notice to obuin
a discount or avoid interast~ or you _y check box RAR and r.turn this notic. to the R.gister of
Wills and an official aSSlils~ent wilL be issuad by the PA Departalll1t of RliIvliIOUliI.
B. Jdi The above asset has bB4iln or will be reported and tax paid with the PBmsylvania Inheritance Tax return
lbJ tG ba filed by the m.c8dent~s rapresantative.
C. D The abovliI inforlll8tian is incorrlilct and/or dlilbts and deductions WlIr& paid by you.
You .ust cOlIPlettl PART 0 and/or PART I!J balON.
If you indicat. a different tax rat., pl.-sa state your
relationship to ~cedent:
PART
@]
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Dat. Establi!:had 1
2. Account Ba1&1"1(:. 2
3. Percent Taxable 3 X
4. Anount Subject to Tax 4
5. Debts and lleductions 5
6. AItount Taxab1. 6
7. Tex Ret. 7 X
8. Tax Du. 8
PART
[!J
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Lin. 5 of- Tex '-tetien)
~r penal ti.. 0" .... jury JII I dec18re that the facts I
.......loot. to - _t of :;::;7 -, beU.f.
~~~c SIGN~URE B
I
$
h.,. reported above. are true.J11
<TI1) 7J.'Y
( )
HOME
WORK
correct .nd
t q s-?
Tl=Ii=-ploInNJ; UUIIMI.Z:D
......,.........
REV.1511 EX+ (12+99) .
*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
8hUET7J ~""" .:r.
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. t0r!1/,l-JW.5C111 '7
/-1IA1ae.H. JiM/iF _ /'IIt!. Dr I!!7vP UI .s; 3'2. DD
~. FtMIG1VH. /H/:/fL ",
7'.tJO
3. Ft-DINE]( .J/2.tUY ~
:rS.I!JD
4. t; tf!,(.J'ill11P.~G7f! , "Ui/C7Z -r. I(o;(p I ,;om. DI= Dt.<.I&c;/S 7'1
. SOO.DO
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name 01 Personal Aepresentative(s) IVIU/,,/III r. ~Err tuAIVltD_
Social Security Number(s)fEIN Number 01 Personal Representative{s)
Street Address
City State _ Zip
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address Is not the same as claimant's, aUach explanation)
Claimant tv/U/AIII .c: ,tU/UErT
Street Address S7)(f .If. HIlAt~ ~T
State flA Zip 17DJ.$" "
City ~tX.A ~ no.ao
Relationship of Claimant to Decedent SDN
4. Probate Fees
5. Accountant's Fees
6. Tax Return Pre parer's Fees
7. FILING FEE 70 ;(1:(;15 re;t. oF tuIUS. ,..
IS: 00
TOTAL (Also enter on line 9, Recapitulation) $ /O,<f'ff'. 00
(If more space is needed, insert additional sheets of the same size)
REV.""",.".."W
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
8.#RI'fE77; ~/J//f ..r
FILE NUMBER
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
RELATIONSHiP TO DECEDENT
Do Nol List Truslee(s)
AMOUNT OR SHARE
OF ESTATE
Solli
'lz
1. tv/~U"'Af,t:: iiB~;(tf!c TT
.sr>fI #. Ii t( AlI3? 5. t;
e:N()t.I1-,,:1~ 17025"
~. J"oSfi:P1I ~ ,tB,,4,€.I(?ETT
/(,s<l /-IDLTZ- If!..t).
/ENIJt.IF,;9.4 1 7 "ZS
c5c>N
1/2
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON liNES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRiBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARiTABLE AND GOVERNMENTAL DtSTRIBUTIONS
1.
TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON liNE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)