Loading...
HomeMy WebLinkAbout02-0683 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 '~'6fj 02131837 07-12-2002 REV-15U EX iFP (09~OOI TYPE OF ACCOUNT IX] SAVINGS D CHECKING D TRUST D CERTIF. TO: DONNA BRASHEARS 458 BROOK CIR MECHANICSBURG PA 17050 EST. OF MARGARET DONALDSON 5.5. NO. 511-22-4287 DATE OF DEATH 03-14-2002 COUNTY CUMBERLAND REHIT PAYHENT AND REGISTER OF WILLS CUMBERLAND CO COURT CARLISLE, PA 17013 FORHS HOUSE WAYPOINT BANK has provided the Deparbent 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, ~ou were a joint owner/beneficiary of this account. If ~ou feel this infor.ation is incorrect, please obtain written correction froll the financial institution, attach a cop~ 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 .ay be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW Account No. 3060000561 )( )( )( SEE Date Established REVERSE SIDE FOR 01-31-2000 FILING AND PAYMENT INSTRUCTIONS PART [!] 852.50 50.000 426.25 .15 63.94 TAXPAYER RESPONSE iiiiii!i'~~~~ii!i~iii!~~.~li!ii~i~~~ii!i!~~.~iii!ii~lii!i~~iii!.I~~i~.i!!i!~~~iiii~II~_iiii~!~~liii!miii!~~~!iiii.~~!:Ii!iW Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x To insure proper credit to your account, two (2) copies of this notice must acco.pany ~our payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax payments are .ade within three (3) /lonths of the decedent's date of death, you /lay deduct a 5~ discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. Tax [CHECK ] ONE BLOCK ONLY A. e above infor.ation and tax due is correct. 1. You /lay 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 Oepartment of Revenue. B. 0 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. c=J The above information is incorrect and/or debts and deductions were paid by you. You .ust co.plete PART 0 and/or PART @] below. PART @] TAX RETURN - COMPUTATION If you indicate a different tax rate, please state your relationship to decedent: PART @] DATE PAID :wv,'o--I DEBTS AND DEDUCTIONS CLAIMED LINE 1. Date Establ1shed 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 X 4 5 6 7 X 8 PAYEE DESCRIPTION AMOUNT PAID I {tJ-?, ~ '-:-/ $ I TOTAL (Enter on Line 5 of Tax Computation) Under penalties of perjury, I declare that the facts I complete to the best of my knowledge and belief. D (/Yl/1ll '- 611- J J.. ./ M / TAXPAYER SIGNATURE have reported above are true, correct and HOME (7/7) q-Z;.- -/..:L "'>Y WORK () ~ [, //}y TELEPHONE NUMBER ATE' GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHENT with applicabllEl interest based on information submitted by the financial institution. Z. Inheritance tax beeo.as delinquent nine months after the decedent's date of death. 3. A joint account is taxable Bven 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 names within one year prior to death lire fully taxable as transfers. 5. Accounts established jointly betwBsn husband and wife lIore than one year prior to death are nat 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 infcillaUon and computation in the notice are correct and deductions are not being clalDled~ place an nx" in block "An of Part 1 of the "Taxpayer Response" section. Sign two copies and submit the. 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 (Forll 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 Z80601~ 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 "cn and complete Parts 2 and 3 according to the instructions below. Sign two copies and sub.it them with your check for the allount of tax payable to the Register of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt of the return frail 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 12/12182: 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 nu.ber of accounts held. If a double asterisk (MM) appears before your first na.e 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. Z. 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 lIore than one year prior to the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF JOINT OWNERS Example: A joint asset registered DIVIDED BV TOTAL NUMBER OF X 100 PERCENT TAXABLE SURVIVING JOINT OWNERS in the name of the decedent and two other persons. 1 DIVIDED BV 3 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 16.770 (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 Exallple: Joint account registered the decedent. 1 DIVIDED BV 2 (SURVIVORS) = .50 in the na.e of the decedent and two other persons and established within one year of death by X 100 5070 (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is determined by multiplying the account balance (line Z) 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 deter.ined 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. 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~ 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% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present OX 4.5%. 12% 15% MThe tax rate Imposed on - the not value of transfers from a deceased chIld 'twenty-one years of age Dr y ounger at 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 ite.s. B. You actually paid the debts after death of the decedent and can furnish proof of pay.ent. C. Debts being claimed must be ite.ized fully in Part 3. If additional space is needed~ use plain paper 8 1/Z" x 11". Proof of payment may be requested by the PA Depart.ent of Revenue. . . "__...___".".".".__.~"~.._."~_.~.,_._."_"_,,..,",,..u, .~ 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-~~~~ 02131838 07-12-2002 REV-154S EX lFP {09-00l EST. OF MARGARET DONALDSON S.S. NO. 511-22-4287 DATE OF DEATH 03-14-2002 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS IX] CHECKING o TRUST o CERTIF. DONNA BRASHEARS 458 BROOK CIR MECHANICS BURG PA 17050 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 WAYPOINT BANK has provided the Department with the information listed below which has bean 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 infor_etion is incorrect, please obtain written correction fram 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. 3000011517 Oat. 01-03-2000 Established PART [!] 968.59 50.000 484.30 .15 72.65 TAXPAYER RESPONSE !,','i~~!~~.I'!'!~I!!!!~III!!Ii!!i~i~~~,iiii..~ii,ii!~1i!ii.iiii~i~~i~.ii!ii~~liiii~II!!I~.!ii!i~~~~iii!~,!ii.~~iiii.~~~li,i'ii Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x To insure proper credit to your account, two (2) copies of this notice .ust acco.pany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax pay~ents are made within three (3) months of the decedent's date of deathl you .ay deduct a 5Z discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. Tax [CHECK ] ONE BLOCK ONLY A. e above information 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 or avoid interestl 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. 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. 0 The above information is incorrect and/or debts and deductions were paid by you. You must complete PART 0 and/or PART @] below. PART @] DATE PAID 7Q~,0~ I DEBTS AND DEDUCTIONS CLAIMED 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. 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 K PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) Under penalties of perjury) I declare that the facts I compl.te to the best of my knowledge and belief. 1cJ. .& ~ , $ have reported above are true) correct and (/1'7 ) q7~- /2. '5''1 WORK ( ) TELEPHONE N MBER 7 R"'(i)d-- ATE c/ rY/.A-- '-- TAXPAYER SIGNATURE HOME GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information sub.itted by the financial institution. Z. Inheritance tax becomes delinquent nine .onths after the decedent's date of death. 3. A joint account is taxable Byen though the decedent's name was added as a matter of convenience. 4. Accounts (including those held between husband and wife) which tha decedent put in joint na~BS 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 infor.ation and computation in the notice are correct and deductions are not being clai.ed~ 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 a.ount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assess.ent (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 Dr 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 inforNation is incorrect and/or deductions are being claimed~ check block "C" and complete Parts Z and 3 according to the instructions below. Sign two copies and submit theN 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 assessNent (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 lZ/I2/8Z: 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 nu.ber of accounts held. If a double asterisk (MM) appears before your first naNe 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. Z. 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 .ore 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 DF X 100 PERCENT TAXABLE SURVIVING JOINT OWNERS in the name of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY Z (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 BV TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE Example: Joint account registered the decedent. 1 DIVIDED BV Z (SURVIVORS) m .50 in the name of the decedent and two other persons and established within ona year of death by X 100 507. (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is determined by multiplying the account balance (line Zl by the percent taxabla (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 deter.ined below. Date of Death Spouse lineal Sibling Collateral 07101/94 to 12/31/94 3X 6X 15X 15X 01/01/95 to 06/30/00 OX 6% 15X 15X 07101/00 to present OX 4.5%- 12% 15X MThe tax rate Imposed on the not value 0' transfers from a deceased chIld twenty-one years of age or Y ounger 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 "Collateralft 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 ad~inistration by a personal representative is insufficient to pay the deductible ite.s. B. You actually paid the debts after death of the decedent and can furnish proof of paYNent. C. Debts being claimed must be iteNized fully in Part 3. If additional space is needed. use plain paper 8 l/Z" x 11". Proof of payment .ay be requested by the PA DepartNent of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT_ 280601 HARRISBURG, PA 17128-0601 REV-l 162 EX{1 1-96} RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BRASHEARS DONA 458 BROOK CIRCLE MECHANICSBURG, PA 17050 -------- fold ESTATE INFORMATION: SSN: 511-22-4287 FILE NUMBER: 2102-0683 DECEDENT NAME: DONALDSON MARGARET DATE OF PAYMENT: 07/30/2002 POSTMARK DATE: 07/29/2002 COUNTY: CUMBERLAND DATE OF DEATH: 03/14/2002 NO. CD 001460 ACN ASSESSMENT CONTROL NUMBER AMOUNT 02131838 I $72.65 I I I I I I I I TOTAL AMOUNT PAID: $72.65 REMARKS: CHECK#109 SEAL INITIALS: AC RECEIVED BY: TAXPAYER MARY C. LEWIS REGISTER OF WILLS 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 BRASHEARS DONA 458 BROOK CIRCLE MECHANICSBURG, PA 17050 __~nn_ fold ESTATE INFORMATION: SSN: 511-22-4287 FILE NUMBER: 2102-0683 DECEDENT NAME: DONALDSON MARGARET DATE OF PAYMENT: 07/30/2002 POSTMARK DATE: 07/29/2002 COUNTY: CUMBERLAND DATE OF DEATH: 03/14/2002 NO. CD 001461 ACN ASSESSMENT CONTROL NUMBER AMOUNT 02131837 I $63.94 I I I I I I I I TOTAL AMOUNT PAID: $63.94 REMARKS: CHECK# 110 SEAL INITIALS: AC RECEIVED BY: REGISTER OF WillS MARY C. LEWIS REGISTER OF WILLS .....-.-., a~ \110;> :( ,_J C"-' '." ~.'; 0 a: CL. ,,_, fi:; ~... '~'! l\~}. <J .(\ '\ 0 . ,;j r:- :?-~ ~ "" C, <:y is "- -:f, . ~ .' "'''''- ~"l~ ~~"O ci'~~ ~ ~ l~~ ~ ",~ \'" . ........ "/ ,,~ ~~~ -~~~ '-> ~ - ~~~ ~~~ sA~ .- - .- .- .,..J () f') {.) ". 't', I. -,..1 () j"" '/"0) , '0. 1?-?t?-9 \; BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE *' NOTICE OF INHERITANCE TAX APPRAISEBENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTION~, AND ASSESSBENT OF TAX ON JOINTLY HELD OR TRUST ASSETS Rn-15~S EX AFP (OI-OZl DONNA BRASHEARS 458 BROOK eIR MECHANICSBURG PA 17050 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN 09-16-2002 DONALDSON 03-14-2002 21 02-0683 CUMBERLAND 511-22-4287 02131837 Allouni Remitted MARGARET "' MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ RE-Y=is4-i-iX--AFii-foi-=ozi------------------------------------------------------------------------------------ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 09-16-2002 ESTATE OF DONALDSON MARGARET DATE OF DEATH 03-14-2002 COUNTY CUMBERLAND FILE NO. 21 02-0683 TAX RETURN WAS: S.S/D.C. NO. 511-22-4287 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION ACN 02131837 FINANCIAL INSTITUTION: WAYPOINT BANK ACCOUNT NO. 3060000561 TYPE OF ACCOUNT: DATE ESTABLISHED (lO SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE 01-31-2000 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due x 852.50 0.500 426.25 .00 426.25 .15 63.94 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." x TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 07-29-2002 CDOO1461 .00 63.94 TOTAL TAX CREDIT 63.94 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. . I IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRl.. YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORB FOR INSTRUCTIONS. ) \/-?-~,f'-9 \, BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 260601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE *' NOTICE OF INHERITANCE TAX APPRAISENENT, ALLOWANCE OR DISALLOWANCE OF OEOUCTION~, AND ASSESSNENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REY-l!i~B EK IF' (01-02> DONNA BRASHEARS i 458 BROOK CIR MECHANICS BURG PA 17050 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN 09-16-2002 DONALDSON 03-14-2002 21 02-0683 CUMBERLAND 511-22-4287 02131838 Allount Re.1i tted MARGARET ',', MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ Rifv=is4-i-Eif-AFFi-[oi-=ozi------------------------------------------------------------------------------------ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 09-16-2002 ESTATE OF DONALDSON MARGARET OATE OF DEATH 03-14-2002 COUNTY CUMBERLAND FILE NO. 21 02-0683 TAX RETURN WAS: S.S/D.C. NO. 511-22-4287 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION ACN 02131838 FINANCIAL INSTITUTION: WAYPOINT BANK ACCOUNT NO. 3000011517 TYPE OF ACCOUNT: () SAVINGS (Xl CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 01-03-2000 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due x 968.59 0.500 484.30 .00 484.30 .15 72.65 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." X TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 07-29 2002 CDOO1460 .00 72.65 TOTAL TAX CREDIT 72.65 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. . ( IF TOTAL DUE IS LESS THAN $1, NO PAVNENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIP' ( CRJ1 YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )