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CoMMoMWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG, PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 05-0129
ACN 05120507
DATE 05-31-2005
REV-1Sli5 EX AFP (09-00)
EST. OF SYBILLA E GROVE
5.5. NO. 187-50-0084
DATE OF DEATH 02-03-2005
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
D CHECKING
D TRUST
[Xl CERTIF.
** AQUILLA R LICK
BOX 104
911 GRANTHAM RD
GRANTHAM PA 17027
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PNC BK has provided the Departllsnt with the information listed below which has been used in
calculating the potential tax dUe. Their records indicate that at the death af the above decedent~ you were a joint owner/beneficiary of
this account. If you feel this infor.ation 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 P...i-.o.;i::,.lvEilii6. Qu:;;::;t.icn~ c:ay bG ~r;Gworod =:.: c;;;:;lli~S (717) 787-83?:7_
Date
Established
REVERSE SIDE FOR
12-15-2004
FILING AND PAYMENT INSTRUCTIONS
COMPLETE PART 1 BELOW .
Account No. 31000250166
. . SEE
x
7,034.42
100.00
7,034.42
.045
316.55
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
Tax Rate
Potentiel Tax Due
x
NOTE: If tax payments are made within three
(3) months of the decedent.s date of death~
you may deduct a 57. discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) .onths after the date of death.
PART TAXPAYER RESPONSE
IT] 1!!i:::ltiOO~.~:ml:!i!!l:II~_i!!!:li~!!!!i!i.e~iiii!~li:!:!!!:ii.~OO~!OO~:!:i:~~I!ii!~~~.mIM.!i!'i~liili.~~i:i!!.OOm!:!::1
[CHECK ]
ONE
BLOCK
ONLY
A. [] The above information and tax due is correct.
1. You ..y 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.
B. ~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 must complete PART ~ and/or PART ~ below.
TAX ON JOINT/TRUST ACCOUNTS
PART
~
TAX RETURN - COMPUTATION
If you indicete a different tax rate, please state your
relationship to decedent:
LINE
1. Cats ~stablis~ed
2. Account Balance
3. Percent Taxable
~. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
OF
1
2
3
~
5
6
7
8
x
x
PART
~
DATE PAID
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tex Computation)
I
$
Under penalties of
complete to the best of
perjury, I declare that the
my, k'}Ywledge ancl.. belief.
'K ~ <-.8.-
facts I
have reported above are true, correct
HOME ( 7 t7) "9 7 - ~ r !3 $/
WORK ( ) --
TElEPHONE NUMBER
and
C.r-aS
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. InhsritancB 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 ioint 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 a~e not being claimed" place an "X"
in block nAn of Part 1 of the nTaxpaye~ 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-l548 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 '.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 ths
envelope provided.
3. BLOCK e - If the notice info~.ation is incorrect andlor deductIons are beIng claImed, check block "e" and complete Parts 2 and 3
according to the instructions below. Sign two copies and submit them with you~ 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 afte~ 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
ths account or the number of accounts hsld.
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 tha 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:
OIVIDED BY TOTAL NUMBER OF DIVIOEO BY TOTAL NUMBER OF X 100 PERCENT TAXABLE
JOINT OWNERS SURVIVING JOINT OWNERS
Example: A joint asset ~egistered in the name of the decedent and two other persons.
1 OIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (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 OIVIOEO 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 OIVIDED BY 2 (SURVIVORS) = .50 X 100 SOX (TAXABLE FOR EACH SURVIVOR)
4. The amount subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taKable (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 ~at. Imposed on the net value of transfers from a decsased child twenty-one years of age Dr younger at
death to or.for the use of a natural parent, an adoptive parent, or a stepparent of the child is 07..
The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children
whethgr or not they have been adopted by others" adopted children and step children. "Lineal descendents'. includes aU 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 et leest one parent in common wIth the decedent, whether by blood
or adoption. The "Collateral" class of heirs includes all othe~ beneficiarIes.
Date of Daath Spousa Lineal Sibling Collateral
07/01/94" to 12/31/94 3X 6X 15X 15X
01/01/95 to 06/30/00 Ox 6X 15X 15X
07101/00" to present OX 4.5Xlf 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 de~th of the decedent and can furnish proof of payment.
C. Debts bein~ claimed gust be itemized fully in Part 3. If additional space is needed" use plain paper 8 1/20 x II". Proof of
payment may be requested by the PA Department of Revenue.