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COMMONWEALTH OF PENNSYLVANIA '*
DEPARTMENT OF REVENUE INFORMATION NOTICE FILE NO. 21 05- O~ lJ
BUREAU OF INDIVIDUAL TAXES AND
DEPT. 280601 ACN 05125390
HARRISBURG, PA 17128-0601 TAXPAYER RESPONSE
DATE 06-03-2005
REY-154! EX AFP 10'-001
TYPE OF ACCOUNT
~, r. EST. OF MIRIAM B KLEIN o SAVINGS
I.) i l.;.~ i U:J
S.S. NO. 171-50-5304 !Xl CHECKING
DATE OF DEATH 03-03-2005 o TRUST
COUNTY CUMBERLAND o CERTIF.
REMIT PAYMENT AND FORMS TO:
EDMUND KLEIN REGISTER OF WILLS
5435 BONNYRIGG CT CUMBERLAND CO COURT HOUSE
MECHANICSBURG PA 17055 CARLISLE, PA 17013
PSECU has provided the Department 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. 'ue~ti~ns may be answared b~ calling (717) 787-8327.
COMPLETE PART 1 BELOW )( )( )( SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0171505304 Date 1l-04-1992 To insure proper credit to your account, two
Established (2) copies of this notice must accompany your
Account Balance 1,484.42 payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Percent Taxable X 50.000
Amount Subject to Tax 742.21 NOTE: If tax payments are made within three
(3) months of the decedent's date of death,
Tax Rate X .045 you may deduct a 5% discount of the tex due.
Potential Tax Due 33.40 Any inheritance tax due will become delinquent
nine (9) months after the date of death.
PART TAXPAYER RESPONSE
[!] iil!i!li~~III!li~I!lill.llliiill~~lii!i!II.~!i!ii~li!i!~1!i!il.~li~.!I!i!~iliiii~~.~I..iiiill~lliiiiMiiii~I~!!i!i.i~lliiiii!
A. ~ The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
CHECK a discount or avoid interest, or you may check box "An and return this notice to the Register of
[ ONE ] Wills and an official assessment will be issued by the PA Department of Revenue.
BLOCK B. c=J The above asset has been or will be reported and tax paid with the PennSYlvania Inheritance Tax return
ONLY 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 ~ and/or PART ~ below.
PART If you indicate a different tax rate, please state your iiillllliil.i":iiiiiiiii,i!!II,illllllllllllllll~llliill/IIII!:
~ relationship to decedent:
.................................................................................................................................-....................................,-,
......................-.......-...........................-.-.......................................-....................................................................
TAX RETURN - COMPUTATION OF TAX ON ,JOINT/TRUST ACCOUNTS 11!!~~I!I!I!I!I!!i!I!!!I!I!I!I!J!!!!;:!1!l!1!!!!!!!!!1!!!!!1!1!1!1!1!J!I!I!I!:!:!I!!!!!!!I!I!;!1!1!1!1!1!1!!!:!1!!!!!!!!!1!!!1!1!1!1!!!!!I!I!I!!!I!I!I!I!I!I!
LINE 1. D..te Established :a. il;lm!111111!1!!11~!j!i!!;!!I!!!1!!!!!1!!!;;!!!!!!!!!!i!:!l!!!!!!!l!!!:!::!!!!!!1!!!!!!:1!!!1!!!!!!!;;;!!!!!!!;!!;;:;;l!!!!!!!!;;;;;!!!!!!!!;!m!!!!!l!!!!!I!!!!!!!
2. Account Balance 2 ijlli'lllifl~lrllj
3. Percent Taxable 3 X
4. Amount Subject to Tax 4
5. Debts and Deductions 5 - iii!iiiiiiiii!iJiii~i!ii!!!!!!!!!!!I!!!!!!!!:!!!:1:1:i!!:!:;:J!I!!!!!!!:!!!!!!!!:!:!!!:!!!:!!J!!:!!!:;!!!!!!!!!!!!!!!!:!!!!J:!!!:;!!!J!!!!!!:!:!!!!!!l!!m!!1!!:!:J:
6. Amount Taxable 6 !iii::i"li!iiiiii:I!III!I!I'I:j:!!/!/!l:i!!,!:!!I!!il:I,I!I!I!I!1iiil,I,I'I!I!/:!:I,I:l!!!lllii:II/:I!I!!!I;I:i,I,lll!1iiii:I:/:I!i!I!I'lil,!!!!!!l'i'li!,I!I!I!I;li
7. Tax Rate 7 X
8. Tax Due 8 i!iiiii!i!i!iJiiiii~!iii!!!!!!!!!!!!!!!:!!!!!!!!!I!!:!!!!!!J!!!!!!!!!!!!!!!!!!!!:!!!:::;!J!!!l:!!J!;!;!!!!!!!i!!!:!!!!:I!J:l!::;!!!!!!!!!!!;!;!!!!!!!!!!!J:!!I:I!l!!:
PART DEBTS AND DEDUCTIONS CLAIMED
[!]
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
I I I
TOTAL (Enter on Line 5 of Tax Computation) $
perjury, I declare that the facts I have reported above are true, correct and
.~ f?~ aJld belief. HOME (7/1 ) ?'3j,..CJ~~
- " I "--."~ J'. , WORK ( )
TElEPHONE NUMBER DATE
GENERAL INFORMATION
1- FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information
submitted by the financial institution.
2. Inheritance tax becomes delinquent nine months after the decedent.s date of death.
- 3. A joint account is taxable 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 names 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 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 claimed, 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 Oepartment 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 nx" in block nB" of Part 1 of the nTaxpayer Response" section. Sign one
COpy and return to the PA Department of Revenue, Bureau of Individual Taxes, Oept 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 block "C" and complete Parts 2 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. Enter the date the account originally was established or titled in the manner existing at date of death.
NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in joint names 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 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.
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 determined 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 OIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE
JOINT OWNERS SURVIVING JOINT OWNERS
Example: A joint asset registered in the name 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 owned by the decedent but held
in trust for another individual(s) (trust beneficiaries):
I DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE
OWNERS OR TRUST BENEFICIARIES
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 2 (SURVIVORS) = .50 X 100 = 50% (TAXABLE FOR EACH SURVIVOR)
4. The amount 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.
Date of Death Spouse Lineal Sibling Collateral
07/01/94 to l2/3l/94 3%' 6%' l5%' 15%'
Ol/01/95 to 06/30/00 O%' 6%' 15%' 15%'
07/01/00 to present O%' 4.5%'. l2%' l5%'
MThe 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%.
The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Childrenn includes natural children
whether or not they have been adopted by others, adopted children and step children. "Lineal descendentsn 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. nSiblings" 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.
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 items.
B. You actually paid the debts after death of the decedent and can furnish proof of payment.
C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 1/2" xli". Proof of
payment may be requested by the PA Oepartment of Revenue.
P1llkdDEPiART:MENT:"",o.f,LdtEVENUE"",D!1)ST:RICT:"",o.FE:,ICE"",OR,An;Atitl)"",r,rHE"",IUREAttJilf:j""""""""",",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,',,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"',',""',"""""""
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT,2B0601
HARRISBURG, PA 1712B-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 005465
KLEIN EDMUND
5435 BONNYRIGG CT
MECHANICSBURG, PA 17055
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
_Unn_ fold ---------- --------
05125390 I $33.40
ESTATE INFORMATION: SSN: 171-50-5304 I
FILE NUMBER: 2105-0566 I
DECEDENT NAME: KLEIN MIRIAM B I
DA TE OF PAYMENT: 06/21/2005 I
POSTMARK DATE: 06/20/2005 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 03/03/2005 I
I
TOTAL AMOUNT PAID: $33.40
REMARKS:
CHECK#1900
INITIALS: JA
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA '*
DEPARTMENT OF REVENUE INFORMATION NOTICE FILE NO. 21 uS- - Of,1.tJlp
BUREAU OF INDIVIOUAL TAXES . AND
DEPT. 280601 TAXP-AYER RESPONSE ACN 05125391
HARRISBURG, PA 17128-0601
DATE 06-03-2005
REY-154! EX AFP [09-001
TYPE OF ACCOUNT
! ~r_ 0 MIRIAM B KLEIN !Xl SAVINGS
'- i I EST.,.:J OF
S.S. NO. 171-50-5304 o CHECKING
DATE OF DEATH 03-03-2005 o TRUST
COUNTY CUMBERLAND o CERTIF.
REMIT PAYMENT AND FORMS TO:
EDMUND KLEIN REGISTER OF WILLS
5435 BONNYRIGG CT CUMBERLAND CO COURT HOUSE
MECHANICSBURG PA 17055 CARLISLE, PA 17013
PSECU has provided the Department 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 Com.onwealth
of Pennsylvanh.. Questions may bg answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW )( )( )( SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0171505304 Date 1l-04-1992 To insure proper credit to your account, two
Established (2) copies of this notice must accompany your
50,801.41 pay.ent to the Register of Wills. Make check
Account Balance payable to: nRegister of Wills, Agent".
Percent Taxable X 50.000
Amount Subject to Tax 25,400.71 NOTE: If tax payments are .ade within three
(3) .onths of the decedent's date of death,
Tax Rate X .045 you may deduct a 5% discount of the tax due.
Potential Tax Due 1,143.03 Any inheritance tax due will become delinquent
nine (9) months after the date of death.
PART TAXPAYER RESPONSE
[!]li!i!i!II~~~.iii!~I!i!i."III!i!ilj~llii!j!.II~!i!i!~liiii.iiii.~li~~liiii!!ili!i!~~.~"!i!ill~.iiiilljiii~I~!ii!i.i~111
A. W The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
CHECK a discount or avoid interest, or you may check box "An and return this notice to the Register of
[ ONE ] Wills and an official assessment will be issued by the PA Department of Revenue.
BLOCK B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
ONLY 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.
PART If you indicate a different tax rate, please state your i!i!i!i!iiiijijijiiij!j!i!i!iiiijii!i!jijii!I~~~~~~i~jii!i~lli!i!il~~~!ililiii!lIiljll~i!1
~ relationship to decedent: mmmijij:j:j:jij:jiHm~AiiiH:OEl~ARI~EJilli:mOlffiij:jiREIElJilIllEiHjij:jii:jimiHi
...-...................................................................................................-.....................................-...........................
....-.........................................................................................................................................-..........................
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS !!l!~II!!!!!!m!I!I!I;I!I!I!I!I!;!!!!!I!I!I!I!I!:!;!l!l!I!J!I!l!1!:!1!1!1!1!1!1!1!1!1!1!1!1!!!1!1!1!:;:!I!I!J!I!I!I!I!I!I!1!1!1!1!1!:!:!:!:!I!I!;!I!I!I!I!I!
LINE 1. Dat. E.stablished 1 m!~!!!ll!!l!lljlll!ll!!!!!!!~!;:!!!!;:~!~;;1!!:!~:!!~!!;~::;!!:;!1::!:!;!;~~~:!~!:!1!!~!!!!!!!!~;::::;!;:!!1!!!!!~!~!~!;!l~!!j!j!!!l!;!;!!!;!!!!!i!;!;:;!!!l!l!l!l~
2. Account Balance 2 l!m!lm!!!m!!!~!ll!!l!l!I!I!I!l!l!I!1!1!1!1!1!1!1!1!1!1!1!1!1!;!1!1!1!1!1!1!1!1!1!1!1!1!1!1!f!l!l!I!;!I!I!I!I!I!I!I!:!I!1!1!f!l!l!l!l!I!I!l!I!I!l!l!I!I!I!I!I!I!
3. Percent Taxable 3 X lij!111!lililililil~I!li!!!i!I!I!I!I!i!!!!!!!!!i!i!i!!!i!!!!!!!!!!!1!1!1!1!!!!;;!;!i!l!i!I!I!I!!!!!i!I!!!!!I!!!!!i!i!!!i!l!l!l!1!!!I!i!!!I!!!!!;!!!i!!!i!!!i!l!!!!!i!
4. Amount Subject to Tax 4 1!!!l!!!l!mmm!jjj!!j!l!i!!!!!!!i!I!!!!~!~!~!~!!!~!~!~!~j!!!j!i!!!i!i!j!!!!:!!!!;!i~!!j~!!!!j:i!j!l!i!!!!!!!j~!!!:i!i!!!;~!!!~j!!!i:j!!!!~!!!!!!i!!!i!i!i~i!!:i!
5. Debts and Deductions 5 - lilljilijiliiiillil~lil!!!;!;i!!!!!l!i!!!J;l!;!l!i!i!I!!!;!!!l!!!!!i!!!!!!!i!!!i!!!!!i!!!i!!!I!I!!!!!;!i!i!I!I!!!!!i!!!;!i!i!!!1!mm;!;!i!i!i!i!!!i!!!!!i!i!i!ill!
6. Amount Taxable 6 !1!1!!!!!!!!!!l!!JJlllmm;!;!;!;!;!;!;!;I;m;!;!;!;;;!;!;!;:;::!;!;!;!;!;!;!:!;!;!;!;!;!;!;J;!::;!;!;!;!;!;!;!::;!;!;!;!;!;!;!;!;!;:;!;!;!;!;!;!;!;;:!;!;!;!;!;!;
7. Tax Rate 7 X IJI1J!!Jmlll!!!I!I!!!!;!;!;!;!;!;!;!;!;::!;!;!;!;!;!;!;!:!;!:!;!;!;!;!;!;!;J;!;!;J;!;!;!;!;!;!;!;!;!;!;!;!;J;!:!;!;!;!;!;!;!;!;!;!:!;!;!;!;;;!;!;!;!;!;!;!;!l::!;!;
8. Tax Due 8 !!!!!m!!lj!J!!!JI~!!!J;!;!;j;!;!;m:m;m;!;!;:;;;:;!;:;!;!;!;!;!l::!;!:!;!;!;!:;:;::;:;!:!;!;!;!;!:::::!;!;!;!;!;!;!::;:;!;I;!;!;:;!;!;::::!;!:!;!;!;;;!;;;;;!;
PART DEBTS AND DEDUCTIONS CLAIMED
~
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
I I I
TOTAL CEnter on Line 5 of Tax Computation) $
declare that the facts I have reported above are true, correct and
and belief. HOME (2'/7) ?3/.-~~
\ WORK ( )
TELEPHONE NUMBER DATE
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information
submitted by the financial institution.
2. Inheritance tax becomes delinquent nine months after the decedent's date of death.
3. A joint account is taxable 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 names 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 forn 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 "Xn
in block "An of Part 1 of the "Taxpayer Responsen 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 I of the nTaxpayer 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 block "C" and complete Parts 2 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. Enter the date the account originally was established or titled in the manner existing at date of death.
NOTE: 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 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 taxable for each survivor is determined as follows:
A. The percent taxable for joint assets established more than one year prior to the decedent.s death:
1 DIVIDEO BY TOTAL NUMBER OF DIVIDEO BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE
JOINT OWNERS SURVIVING JOINT OWNERS
Example: A joint asset registered in the name of the decedent and two other persons.
1 DIVIDED BY 3 (JOINT OWNERS) DIVIDEO 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 owned by the decedent but held
in trust for another individual(s) (trust beneficiaries):
1 DIVIDEO BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE
OWNERS OR TRUST BENEFICIARIES
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 2 (SURVIVORS) = .50 X 100 = 50% (TAXABLE FOR EACH SURVIVOR)
4. The amount 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.
Date of Death Spouse Lineal Sibling Collateral
07/0l/94 to l2/3l/94 3X 6X 15X l5X
Ol/Ol/95 to 06/30/00 OX 6X 15X l5X
07/01/00 to present OX 4.5X- l2X l5X
MThe 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%.
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, adopted children and step children. "Lineal descendentsn 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.
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 items.
B. You actually paid the debts after death of the decedent and can furnish proof of payment.
C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 1/2" xli". Proof of
payment may be requested by the PA Department of Revenue.
PA",,,nEeARIMEN:r,,,,,o.fL"'~EVEl!nJE,,,,'DlS:r:R,IC:r:,,,,,o.EE:lCE"",QR;,Ail:A,ljtl;;;;"THE,'"">>UREAltA)F1',;"""",;;;,;,,,',',',','",',',',',',',;,;,;;;,;",;,;,,,,,',,,',',',,,,,'",,,;,;;;,;;;,;,,,,,;,,,,,,,,,,,',',,
1J~~j~!ifjlJ~~~:~!:!ml1~~J;!j~j~j!!j!:~~~~~~e.~ii:!j~N~UjlR~jj:jj~JjI.~~j!i!j~N:m:~~~R~~J!ll~Gj:j:j~j11imij~j~~~j~jm:jtl,!~:l~~~~~:!~:mimm~~~~~~~~mmmmmjj
~~!jmj~~!~~~~~~jmi~j~~~mjj~~~~~~~jjm~~~!j~~~jmj~~!mj!~~~~~~~~ij:!j~~~!~jjf;jjjjjij~j~!j~j~~~~~~~j~~!mm~j~~!mj~~~~j~m~jmmmmmmjmjjm
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-961
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT,280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 005466
KLEIN EDMUND
5435 BONNYRIGG CT
MECHANICSBURG, PA 17055
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
_nnn_ fold ---------- --------
05125391 I $1/143.03
ESTATE INFORMATION: SSN: 171-50-5304 I
FILE NUMBER: 2105-0566 I
DECEDENT NAME: KLEIN MIRIAM B I
DATE OF PAYMENT: 06/21/2005 I
POSTMARK DATE: 06/20/2005 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 03/03/2005 I
I
TOTAL AMOUNT PAID: $1/143.03
REMARKS:
CHECK# 1901
INITIALS: JA
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS