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HomeMy WebLinkAbout06-21-05 .'-' .,. ~>, -;, ..-:- ~j J J\ ,. '0 I' I Ct-} '. '= '- 1_. i \ "\ 'I ''-' ~~_ J / '- '- '- "-"\".- ;' :=-- .....'/ '- '- '- '- '- '- '. '- '- '- '- '- ril Ul ::> o ::r: E-i Ul~ M P::..:lO .-l ril..:lCJ()lO ~~8:~ ~~ Ul~ OQ::>1ll ~P::~~ril Zril..:lE-i..:l rilE-iP::P::Ul ..:lUlrilDH (9HP=!O..:l Ul?E~CJ~ ~P::CJ.-lCJ <:Ii .~ ;> >-. ~ 0 @ (I) ~ ~ ",~E-< I p:;~~ ~ 4-;;>~ - O(l)"Cl r--- ~ ~ .;; - - ..... 4-; .- 0 ...... ~O~\O;;'< (1).........0..... ~~;:OOOJ) l:<soN:3 08t::8~iS <:Ii W CO .- 8o..~ol:: o (I) ~ <:Ii UClCOA...:I: ... :) o ~ c: o ... o ... ... CD c: .- CD :) c: CD ~ ~ '0 C ~ 1:- o 0. CD o CD -!: ~ ,.t1 -0 CD > "i ~ ... CD ... CD .;. ~ CD -Os :&-0 ~ 8 "ij;2, -;;'0. c- CDi E ... a 0 o c: -00'.4, O~C "ij; ~ ~ -s;... ~ '" 0 .... CD'd~ .s:. 0 ~~~ ., .' ~ ~ ....... .!!!. -0 CD ,... '" -::: c: '" CD Jj. ~o ~ ~ ~ .= ~ 'i ~ CD 00 '" ~.... :),.t1 ~ CD ':;(~ _ 0 ~ ~~ ....~ ill ~ 0 __ ~ 4. '0, -0 E % ~ zo. CD CD _ '", o'g ~ '8~ ~s: 1 "'-UCD~O o ~ c:.s:. _ u O~.... ... ~ 0. 0. o 1;; :) E ~ ill o -u c: CD ill ~ CD -0 ~ c: o o - -0 CD -0 o ~ CD 0. o ""i ~ CD c: o III c;; 0: ~ on on ~ o c: o .;;; ~'.~ ~o.... u ~~ ,.:..... ~ ..s:o. CD ...... "'co ' ... c: ""- ~ :) o'~ ""i ~:c" 'i c: 1 .... ~ -t c: t::. (i; ---""-- :) o ~ ~ o .s:. .... r.::> - - - - - - - - - - - - - - - - - - J> i ;:, ... S' ::! :;:! o 8 1-, ~ ni ,~} ~ ,~ ! rr' ;:;: , to m x W ~ I- ::;) z 0 w :E >- ~ llIi: 0.: Z c( ::> < CJ 0 :I: z >- ... 52 LL c( -~ :E ~ti: w a: c( g~ ::l 0 UJ - - > >[0 !!: Z~ w Wu CL. (/)0 0 -....I .... J:ca w 1-:: > WO z w (/)UJ rn ::>~ ~ ~n3 w ZJ: rn 00 ::l 5 z 0 Q ~<;,~ ~~i COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE AND. TAX PAVER RESPONSE FILE ACN DATE NO. 21 0':> - 05toS 05116496 05-27-2005 REY-1545 EX AFP lD9-DDl I \.,J' ESTJ aFi~~~Y M LEREW S.S. NO. 195-07-6386 IlATEOF DEATH 01-20-2005 COVNTY";T CUMBERLAND . -, . J TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST !Xl CERTIF . REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 WILLIAM K COWDEN 331 EVERGREEN ST NEW CUMBERLAND PA 17070 WAY POINT BANK has provided the Departllent 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 froll the financial institution, attach a COpy to this forll and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Comllonwealth 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. 7100090107 Date 04-11-2003 Established x 21. 035.53 16.667 3.505.99 .15 525.90 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice must accompany your paYllent to the Register of Wills. Make check payable to: "'Register of Wills, Agent". Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x NOTE: If tax payments are made within three (3) months of the decedent's date of death, you .ay deduct a 57. discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. ~ The above information and tax due is correct. 1. You may choose to rellit 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. 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=J The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ 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 E~tablished 2. Account Balance 3. Percent Taxable 4. Amount 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 5 6 7 8 x PART [!J DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ Under P;~;lties of perjury. I declare that the mat.: t. b~edge and belief. TAXPAYER SIGNATURE facts I have r~p~~ted above are true. correct and HOME\('V77 G) 7 9 L :1-- ~ WORK (,/1) 11(P - J-t.( I J... ~ TELEPHONE NUMBER DATEb - 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 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 Department of Revenue will issue an official assessment (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 280601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C - If the notice information is incorrect andlor 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 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 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 DIVIDED 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 l6.7~ (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 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 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 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. MThe tax rate lmposed on the net value of transfers from 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 O~. 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 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. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12131/94 37. 67. 157. 157. 01/01/95 to 06/30/00 07. 67. 157. 157. 07/01/00 to present 07. 4.57.. 127. 157. 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" x 11". Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128.0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT COWDEN WilLIAM K 331 EVERGREENST NEW CUMBERLAND, PA 17070 _nn___ fold ESTATE INFORMATION: SSN: 195-07-6386 FILE NUMBER: 2105-0565 DECEDENT NAME: lEREW HARRY M DATE OF PAYMENT: 06/21/2005 POSTMARK DATE: 06/21/2000 COUNTY: CUMBERLAND DATE OF DEATH: 01/20/2005 REMARKS: CHECK# 5584 SEAL REV-1162 EX( 11.96) NO. CD 005467 ACN ASSESSMENT CONTROL NUMBER 05116496 TOTAL AMOUNT PAID: INITIALS: JA RECEIVED BY: REGISTER OF WILLS I I I I I I I I I AMOUNT $525.90 $525.90 GLENDA FARNER STRASBAUGH REGISTER OF WillS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z8060l HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE ANO- TAXPAYER: RESPONSE FILE ACN DATE NO. 21 05 - OSlP~ 05116498 05-27-2005 REY-1545 EX AFP [09-001 I ~st~: dp ~kRRY M LEREW S.S. NO. 195-07-6386 . nAtE OF DEATH 01-20-2005 i:;:OlfN1NT CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST !Xl CERTlF. REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 WILLIAM K COWDEN 331 EVERGREEN ST NEW CUMBERLAND PA 17070 WAYPOINT BANK 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. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 9600013811 Date 06-24-2003 Established x 52,182.62 16.667 8,697.28 .15 1,304.59 TAXPAYER RESPONSE 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... Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x NOTE: If tax payments are made within three (3) months of the decedent.s date of death, you may deduct a 5Z discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. ~ 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 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. [] 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. [] The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. x If you indicate a different tax rate, please state your relationship to decedent: PART [!I TAX RETURN - COMPUTATION OF LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 8. Tax Due 8 TAX ON JOINT/TRUST ACCOUNTS x PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ Under pen~}:jes ;fj:~r~~t~~_~n~eclare that the lA:f~he,( .st~~ and belief. TAXPAYER SIGNATURE facts I have reported above are true, HOME '7f7-f7G) '7 7'"L:l- WORK (,'1) 17~-; TELEPHONE NUMBER correct and 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 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 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 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 andlor 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 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 jointAnames 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 DIVIDED BY TOTAL NUMBER OF DIVIDED 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): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 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 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. 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 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. Date of Death Spouse lineal Sibling Collateral 07/01/9ct to 12/31/9ct 3Y. 6Y. 15/; l5Y. 01/01/95 to 06/30/00 OX 6X l5X l5X 07/01/00 to present OX 4.5XlE l2X l5X - 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"' 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 HARRISBURG, PA 17128.0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT COWDEN WILLIAM K 331 EVERGREENST NEW CUMBERLAND, PA 17070 ACN ASSESSMENT CONTROL NUMBER ____un fold 05116498 ESTATE INFORMATION: SSN: 195-07-6386 FILE NUMBER: 2105-0565 DECEDENT NAME: LEREW HARRY M DA TE OF PAYMENT: 06/21/2005 POSTMARK DATE: 06/21/2005 COUNTY: CUMBERLAND DATE OF DEATH: 01/20/2005 TOTAL AMOUNT PAID: REMARKS: CHECK# 5583 SEAL INITIALS: JA RECEIVED BY: REV.1162 EX(11-96) NO. CD 005469 AMOUNT I I I I I I I I I $1,304.59 $1,304.59 GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS 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 0 5 5LP 5 05117914 05-31-2005 REV-1545 EX AFP (09-001 . ;)~STr. j iO~: ~rRY M LEREW S.S. NO. 195-07-6386 r~:D.A1f OF DEATH 01-20-2005 . . (:.bUN:1';Y.,. CUMBERLAND TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST !Xl CERTIF. REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 WILLIAM K COWDEN 331 EVERGREEN ST NEW CUMBERLAND PA 17070 WAYPOINT BANK 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. QUQst!o~s ~ay be answered by cal1i~g (717) 787-8~~7~ COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 768237422 Date 03-01-1993 Established x 100,204.58 16.667 16,701.10 .15 2,505.17 TAXPAYER RESPONSE 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... Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 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. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. ~ 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 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. [] 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. [] The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. OF TAX ON JOINT/TRUST ACCOUNTS PART ~ TAX RETURN - COMPUTATION If you indicate a different tax rate, please state your relationship to decedent: LINE 1_ Oats Established 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 PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ Under pe~~ies of perjury, I declare that the li:r~tt< .es~dge and belief. TAXPAYER SIGNATU~E facts I have reported above are true, correct HOME ( 7/7) 77(..~ '/ 9 L 7-- WORK (In ) 17&'" ~tfJ) TELEPHONE NUMBER and ~lllllpS- 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 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 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 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. LINE 1. Enter NOTE: TAX RETURN PART 2 - TAX COMPUTATION 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 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 DIVIDED 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): 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 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 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. 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 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. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12/31/94 3% 6X 15X 15X 01/01195 to 06/30/00 OX 6% 15X 15X 07/01/DO to present 0% 4.5%lE 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 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" x 11"'. Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128.0601 REV-1162 EX(11.96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT COWDEN WILLIAM K 331 EVERGREENST NEW CUMBERLAND, PA 17070 ______n fold ESTATE INFORMATION: SSN: 195-07-6386 FILE NUMBER: 2105-0565 DECEDENT NAME: LEREW HARRY M DA TE OF PAYMENT: 06/21/2005 POSTMARK DATE: 06/21/2005 COUNTY: CUMBERLAND DATE OF DEATH: 01/20/2005 NO. CD 005470 ACN ASSESSMENT CONTROL NUMBER AMOUNT 05117914 I $2,505.17 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 5582 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $2,505.17 GLENDA FARNER STRASBAUGH REGISTER OF WILLS