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HomeMy WebLinkAbout07-26-05 I~ 19, J ~ ~ ~ ~~ ~ .~ ~ ~ = ~ r - " ~ ~ en o ::8 Ql a, '" ~ E~f.2 C.)m:( ~ta.. Q) m ~ CO 0 ~ ' :g1R5{ ~ ~ "} , 11J 9..., 1r' :' \"." . . I . .~ - - - - - N ... f! f') , f} .. o l'" .. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 '*' ~~,~A~P;!A~C~OTICE I TA)(P:AY;ER"~E$PONSE FILE ACN DATE NO. 21 05-0084 05117912 05-31-2005 REY-15ti3EJCAFPU'-DD> zoo: ,-' !,: 04 ~ .~, r I; EST. OF MALCOLM G HARRO ,S-,-S",~NO. 188-09-5937 'DATEOFd~EATH 12-11-2004 COUNT~ CUMBERLAND TYPE OF ACCOUNT IX] SAVINGS o CHECKING o TRUST o CERTIF. ( CU REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 BETSY 560 CARTREF ETTERS CROUSE RD PA 17319-8808 PSECU has provided the Department with the information listed below which has been used in calculating the potential tax due. Th8ir records indicate that at the death of the above decedent I you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain wrItten correction from the financial institution, attach a copy to thIs form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Penns~1~9nid. gue~~!o~~ ~3Y be ons~grgd ~y calling (717) 75?-8327. COMPLETE PART 1 BELOW . Account No. 118240794251 . . SEE REVERSE SIDE FOR Date 01-18-1989 Established FILING AND PAYMENT INSTRUCTIONS Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due x 312.73 16.667 52.12 .045 2.35 To insure proper credit to your account~ two (2l copies of this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of Wills~ Agent". x NOTE: If tax payments are made within three (3l months of the decedent's date of death~ you may deduct a 5Z discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE ill ImmI;Aj~~Uii[[[[!liii[[iiiP._i[[il:tti[[[!ii~R~'[![!~~[[::'iiH~~~~~~~i~[f::r~~]'[I\is~,.~~[,[![~~~~![![~M'mT.K!ij$",'_!ijC~""'1 ,.,.,.,.,.,.,.,.,.".,.,.,.".,.".",.""""""",.-.-.-.-.-.-.-.-.-...-.-...-.-...-.-,-...-..-.,..-.....................................-.-...-.-...-.-...-.-...-.-...-.-...-.-.....-.-.....-...-.-.....-.-.-.-...-.-...-.-.....-,-.-.-........-...-...-..................-...................................................................................... .. .. . .. . .. . . .. . . . . .. . . . . . . .. . . . . . . . . .-...-.-...-...-.-...-.-...-.-...-.-. .-.-..-..... ........................ .............................................................................................................................................. ...................................................................................................... ..... ..... . . .. . .. ,.,.......,.,.................................................................,...........................,,'"""'T"""""""""""""""""""""""",.,.,.,...,.,.,.,.,...,.,.. "'.,',.,.,.,.,...,.,,' ',." ,.."',.,.,.,...,.,...,.,.,.",.,..,,.,.,.,.,.,...,.,.,.,.,.,.,.....,.....,...,.,.....,.....,.,.,.,.,...,.,...,.,.,.,.,.,.,.,.,...,.,.,.,.,.,...,.,...,.,...,.,..".,..',.,.,',',',',',',', [CHECK ] ONE BLOCK ONLY 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 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. [] 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 indicate a different tax rate, please state your relationship to decedent: 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 1 2 3 4 5 6 7 8 x x PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I $ I TOTAL (Enter on Line 5 of Tax Computation) Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME ( WORK ( TELEPHONE ) ) NUMBER DATE TAXPAYER SIGNATURE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable Interest based on information submitted by the financial institution. z. 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 af 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 natice are correct and deductions are not being c18imed~ place an "K" in block nA" 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 decedenes representative" place an '"X'" in block "B" of Part 1 of the ""Taxpayer Response'" section. Sign onB 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 end 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 lMM) appears before your first name in the address portion of this notice, the $3~OOO 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 OIVIDED BY TOTAL NUNBER OF JOINT OWNERS Example: A joint asset registered OIVIOEO BY TOTAL NUMBER OF X 100 PERCENT TAXABLE SURVIVING JOINT OWNERS in the name of the decedent and two other persons. 1 DIVIOEO BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 16.77. (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 100 507. (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 determined by subtracting the debts and deductions (line 5) fro. the amount subject to tax [line 4). 7. Enter the appropriate tax rate (lina 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 dBscendents" 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 Co11atere1 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 0% 4.5%11 12% 15% 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 items. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed must be itsmized fullY in Part 3. If additional space is needed, use plain paper 8 1/2" x Il"". Proof of payment may be requested by the PA Dspartment of Revenue. COMMONWEALTH OF PENNSYLVANIA OEPARTNENT OF REVENUE BUREAU OF INOIVIOUAL TAXES DEPT. ZB0601 HARRISBURG, PA 171Z8-0601 *' INFORMATION NOTICE R TAXPAiet~~PONSE ~', ~ ""! ,~, II '1 FILE NO. 21 05-0084 ACN 05117913 DATE 05-31-2005 REV-1543EICAFPlD9-DD) Z005 .. EiT. FBI? ~A~~OLM G HARRO S.S. NO. 188-09-5937 .'DA"l$:-(jF DEATH 12-11-2004 COUNTY" - CUMBERLAND TYPE OF ACCOUNT [X] SAVINGS o CHECKING D TRUST D CERTIF. o CUll, REHIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 GEORGE E 560 CARTREF ETTERS CROUSE RD PA 17319-8808 PSECU has provided the Depart.ent with the information listed below which has been used in calculating the potential tax dUB. Their records indicate that at the death of the above deC9dent~ you wera 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 for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth o~ Pennsylvania. Q~asti~fi~ ~d~ be anDwerad ~y ~~lli~; ~7l7~ 187-B3Z7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 118240794251 Date Established 01-18-1989 To insure proper credit to your account~ two (Z) copies of this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of Wills~ Agentn. Account Balance 312.73 Percent Taxable X 16.667 Anount Subject to Tax 52.12 Tax Rate X .045 Potential Tax Due 2.35 PART TAXPAYER RESPONSE [!] I'W::FA'!i!LJUIII"",g"".PM""i!i!LJIiHWmmJr.!":,'!I!i!,,,!fij,,:,O~!i!C,!i!IIiHWTAX:W'iS_iM:Elirm',BA.D',m_W:.!i!S,W:NO'!i!CI:WWI ";;;;"';;;;";;;;;;";;;;";;;;";;;;";;"';;;;,;;"';;;;"';;;,;,~;,;,;";;;;",;,;m;mmmm,mm;,,,,m;i;;;;';;;;'''';;;;;;;;;;;;;;'';;;;;;;;;;''';;;;';;;;',;;,;;",;;;;",;;;;,;;""";;"",;;;;";;",;,;;,;;;,,;,,,,;,,,,;",;;;,;;"""",;"";,;;",;;;,;;"",;,,,;;;;;,;;;,;;;;,,;;;;;,;;;;;;;"";",;;;;"",;",;;,;;"";"";;;,;;;;;;;",,,,,;,,",,;;;,;;,,;;,;;;;;;, 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. [CHECK ] ONE BLOCK ONLY 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 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. [] 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 l3J relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS lINE l. Dete Established 1 2. Account Balance 2 3. Percent Taxable 3 X 4. Anount Subject to Tax 4 S. Debts and Deductions S 6. Anount Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 PART ~ DATE PAID PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on line S of Tax Conputation) I $ Under penalties of perjury, I declare that the facts I haye reported aboye are true, correct and conplete to the best of ny knowledge and belief. ( WORK ( TELEPHONE HOME ) ) NUMBER DATE TAXPAYER SIGNATURE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest besed on informotion submitted by the financial institution. z. 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 na.as 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 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 amount of tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REY-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 liB" 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 [For. REY-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/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 (~~) 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 Z (SURVIVORS) = .167 X 100 16.77. (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 Z (SURVIVORS) = .50 X 100 507. (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 Cline 7) as determined below. -The tax rete Imposed on the net value of transfers fram a deceased chIld twenty-one years of age or younger at death to or for the use of a natural parent, an adaptIve perent, or a stepparent of the child is 07.. The linoel 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 havs at least one parent in common with the decedent, whethsr by blood or adoption. The .'Collateral" class of heirs includes all other beneficiaries. Data of Death Spouse Lineal Sibling Collateral 07101/94 to 12/31/94 370 670 1570 1570 01/01/95 to 06/30/00 OX 670 1570 1570 07101/00 to present OX 4.570" 1270 1570 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 l/Z" x II". Proof of paYMent may be requested by the PA Department of Revenue. l"! COMMONWEALTH OF PENNSVLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIOUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE nr,-'"<r"cn rA~O:: (-c~ ITAxeaveti', )t'E$PONSE i""'''-''"' " :'; ~. '., i-' : ' FILE ACN DATE NO. 21 05-0084 05120847 05-31-2005 REV-1545EXAFP (119-00) c TYPE OF ACCOUNT o SAVINGS IX] CHECKING o TRUST o CERTIF . 2[U:, JLl E~~. b~ A1Sb~LM G HARRO S.S. NO. 188-09-5937 'DATE (oF D,f:ATH 12-11-2004 COUNTY CUMBERLAND PA 17319-8808 REHIT PAYHENT AND FDRHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 BETSY 560 CARTREF ETTERS CROUSE RD 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 incorrectl please obtain written correction from the financial institutionl attach a coPY to this for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Com.onwealth of PQnnsylvania_ Questions may be answer-Ad by ealJjng (717) 7~7-83Z7. COMPLETE PART 1 BELOW Account No. 1182407942 · . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Date 01-18-1989 Established Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due x 12,051. 44 16.667 2,008.61 .045 90.39 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". x NOTE: If tax Payments are made within three (3) months of the decedent"s date of death, you may deduct a SZ discount of the tax due. Any inheritance tax due will become delinquent nins (9) months after the date of death. PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. [J The above infor_ation 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 int.rest~ 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. [J The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. If you indicate a different tax rate, please state your relationship to decedent: PART I!J DATE PAID PART ~ TAX RETURN - COMPUTATION LINE 1. D2~g Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rat. 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 4 5 6 7 8 x x PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME ( WORK ( TELEPHONE ) ) NUMBER DATE TAXPAYER SIGNATURE GENERAL INFORMATION 1. FAILURE TO RESPOND ifILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest basad on information submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after the decedent's date of death. 3. A joint account is taxable even though the dscedent's name was added as a matter of convBnience. 4. Accounts (including those held between husband and wife) which the decadent put in joint names within ane year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife ma~e 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 clai.ed, place an "X., in block "A" of Part I 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 (Fo~m 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 representativejl place an .IX" in block liB" of Part I of the '"Taxpayer Response'. section. Sign one copy and return to the PA Department of Revenuejl Bureau of Individual Taxesjl Dept Z8060ljl Harrisburgjl PA 17128-0601 in the envQlope provided. 3. BLOCK C - If the notice information is incorrect and/or deductions are being claimedjl check block "e" and complete Parts Z and 3 accQrding 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 o~ 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/IZ/8Z: Accounts which the decedent put in joint names within one (1) year of death are taxable fUlly as t~ansfers. Howeverjl thsre is an exclusion not to excQed $3j1000 per transferee regardless of the value of the aecount or the number of aceounts held. If a double asterisk (~.) appeB~s before you~ first name In the address portion of this noticejl the $3j1000 exelusion already has been deducted from the account balance as reported by the financial institution. z. Enter the total balance of the account including interest accrusd 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: I DIVIDED BY TOTAL NUNBER OF JOINT OWNERS Example: A joint asset registered DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE SURVIVING JOINT OWNERS in the name of the decedent and tWD 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 DR 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. I DIVIDED BY 2 (SURVIVORS) = .50 X 100 50% (TAXABLE FOR EACH SURVIVOR) ~, The amount subject to tax (line 4) is determined by multiplying the account balance (line 21 by the pereent 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 subtr8eting 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 12/31/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07101/00 to present 0% 4.5%" 12% 15% _The tax rate imposed on the net valuQ of transfers from a deceased child twenty-one years of age or y ounger at death to or for the use of a natural parentjl an adoptive parentjl or a stepparent of the child is OX. The lineal class of heirs Includes grandparentsjI parentsjI childrenjl and lineal descendents. "Children" includes natu~al children whether or not they have been adopted by othersjl adopted children and step children. "Lineal descendents.. includes all chIldren of the natural parents and thsir dsscendentsjI whether or not they have been adopted by othersjI adopted descendents and thei~ descendants and step-deseendants. "Siblings" are defined as individuals who have at least one parent in common with the decedent# whether by blood or adoption. The "Collateral" class oT heirs includes alJ other beneficiaries. CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legally are responsible for paymentjl or the estate SUbject to administration by a personal representative is insufficient to pay the deductible items. 8. 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 neededjl 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 IMDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 * INFORMATION NOTICE F~!TAiiiA QEa~~5PONSE REV-15U EX AFP (09-00) FILE NO. 21 05-0084 ACN 05120848 DATE 05-31-2005 200" , ~:EST(~;O~:r-fA~COLM G HARRO S.S. NO. 188-09-5937 -u~... OF DEATH 12-11-2004 COUNTY' CUMBERLAND TYPE OF ACCOUNT o SAVINGS [Xl CHECKING o TRUST o CERTIF. (' .--. CL REHIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 GEORGE E 560 CARTREF ETTERS CROUSE RD PA 17319 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 af this account. If you fael this information Is incorrect, please obtain written correction fro. the financial institution, attach B copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance rax Laws of the Commonwealth Df P~rn~Sylv.nia. QUG5ticns ~m~ be a~~~e~ed h, ~a!!!ng ~7l7) 787-8321. Date Established REVERSE SIDE FOR 01-18-1989 FILING AND PAYMENT INSTRUCTIONS COMPLETE PART 1 BELOW Account No. 1182407942 I( I( I( SEE x 12,051.44 16.667 2,008.61 .045 90.39 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 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. 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. 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. Ca~a 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 TAX ON JOINT/TRUST ACCOUNTS OF I 2 3 4 5 6 7 8 x PART ~ DATE PAID PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME ( WORK ( TElEPHONE ) ) NUMBER DATE TAXPAYER SIGNATURE GENERAL INFORMATION 1. FAILURE TO RESPOND WIll RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on informetion submitted by the financial institution. z. Inheritance tax becomes delinquent nine months after the decedent's date of death. 3. A joint account is taxable evsn 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 betw..n 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 co.putation in the notice are correct and deductions are not being claimed~ place an "X" in block .'A" of Part I 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 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 '.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 a.ount 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 IZ/IZ/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~DDO 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. 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 more than one year prior to the decedent.s death: OIV10EO BY TOTAL NUMBER OF OIVIOEO BY TOTAL NUMBER OF X 100 PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT ONNERS Example: A joint asset registered in the name of the decedent and two other persons. 1 OIVIOEO BY 3 (JOINT ONNERS) 01VIOEO BY 2 (SURVIVORS) = .167 X 100 16.77. (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 ather persons and established within one year of death by the decedent. 1 01V10EO BY 2 (SURVIVORS) = .50 X 100 507. (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 determined by subtracting the debts and deductions (line 5) fro. the amount subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as determined below. -The tax rate 1.posed 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 07.. 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 dBscendents" includBs 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 07101/94 to 12131/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07101100 to present 0% 4.5%" 12% 15% 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 a~d can furnish proof of payment. C. Debts being claimed .ust be ite.ized fully in Part 3. If additional space is needed~ use plain paper 8 l/Z" 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 171Z8-0601 - INFORMATION NOTICE ,T.AXPA.;:e~m~~ONSE '.,1 1(.... , - FILE NO. 21 05-0084 ACN 05117968 DATE 05-31-2005 RE\I-1545EK AFP <09-DDJ ( REMIT PAYMENT AND REGISTER OF WILLS CUMBERLAND CO COURT CARLISLE, PA 17013 TYPE OF ACCOUNT D SAVINGS !Xl CHECKING D TRUST D CERTIF. FORMS TO: 21 JU~~~ &i 1 Mhl.gbtM G HARRO 8.8. NO. 188-09-5937 ~~~<ot DEATH 12-11-2004 COUNTY 'J CUMBERLAND BETSY L 560 CARTREF ETTERS CROUSE RD HOUSE PA 17319 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 abovo address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth aT Pennsylvania. lOIue:>>"tlons !Day be answElred b:;i callinjj C"17) 787'--63Z7. Account No. 018809593754 Date Established REVERSE SIDE FOR 01-22-1993 FILING AND PAYMENT INSTRUCTIONS COMPLETE PART 1 BELOW . . . SEE x 846.20 25.000 211 .55 .045 9.52 To insure proper credit to your account, two (2) copies OT this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent... Account Balance P...cent Taxable Amount Subject to Tax 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. PART TAXPAYER RESPONSE [!]lijiiii~;t~~~!liiiit~iii!i._mil~~~iiiii~_~i!j:i~li:i!~!!iji.~~i~.:i!j!~~!iiiil~.~.flmi~~~l!iii:i~~i!i!~I~~iiii.~~jljjii~ [CHECK ] ONE BLOCK ONLY A. c=J The above information and tax due is correct. 1. You may choose to remit paymgnt 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. 8. c=J The above asset has been or will be reported and tax paid with the PennsYlvania Inheritance Tax return to b. filed by the decedent"s representative. c. c=J The above information is incorrect and/or debts and deductions were paid by you. You dUSt complete PART ~ and/or PART ~ below. PART ~ TAX RETURN - COMPUTATION LINE 1. Date Est~lishad 2. Account Balance 3. Pe..cent 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 If you indicate a diffe..ent tax ..ate, please state you.. relationship to decedent: x PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ Unde.. penalties of pe..ju..y, I declare that the facts I have ..epo..ted above a..e t..ue, co....ect and complete to the best of my knowledge and belief. HOME WORK ( TELEPHONE ( ) ) NUMBER DATE TAXPAYER SIGNATURE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicabla intarast based on infor.ation submitted by the financial institution. Z. Inheritance tax becomes delinquent nine months after ths decedent.s date of d..th. 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 betwesn husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent "'in trust for'" another Dr others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. BLOCK A - If the informstion and computation in the noticH era correct and deductions arliil 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 an 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 "8" 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 WiIJ$. 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 (MMJ 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. 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 more than one year prior to the decedent.s death: OIVIOEO BY TOTAL NUMBER OF OIVIOEO 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 OIVIOEO BY 3 (JOINT OWNERS) 01VI0EO 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 individualCs) (trust beneficiaries); 1 OIVIDEO 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 OIVIOEO 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 ZJ by the percent taxable (line 3J. 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 5J from the amount subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as determIned below. -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%. 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 dsscendents, whether or not thsy havs 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 07101/94 to 12131/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07101/00 to present 0% 4.5%" 12% 15% 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 OEPARTMENT OF REVENUE BUREAU OF INOIVIOUAL TAXES OEPT. Z8D6Dl HARRISBURG, PA 171ZB-D6Dl * INFORMATION NOTICE T~~~~Y~;~~ESe6NSE FILE NO. 21 05-0084 ACN 05117969 DATE 05-31-2005 REV_1545EXAFPC09-DDJ ZDL Est~ ~~;~ALa~LM G HARRO S.S. NO. 188-09-5937 bATE (OF DEATH 12-11-2004 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS IX] CHECKING o TRUST o CERTIF . 0, CUM REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 GEORGE E 560 CARTREF ETTERS CROUSE RD PA 17319 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 dBcedBnt~ you were a joint owner/beneficiary of this account. If you feel this infer.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 o~ PBnr.~ylvan!e. Que3~i~ns m~y be an~wered by c~l!ing (717) 787-8327. Date Established REVERSE SIDE FOR 01-22-1993 FILING AND PAYMENT INSTRUCTIONS COMPLETE PART 1 BELOW . Account No. 018809593754 . . SEE x 846.20 25.000 211.55 .045 9.52 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 Pe..cent Taxable Amount Subject to Tax 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. PART [TI 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. 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. [] Tha above information is incorrect and/or debts and deductions ware paid by you. You must complete PART ~ and/or PART ~ below. LINE 1. Dat. Established 2. Account Balance 3. Pe..cent Taxable 4. Anount Subject to Tax 5. Debts and Deductions 6. Amount Texable 7. Tax Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 PART ~ TAX RETURN - COMPUTATION If you indicate a diffa..ent tax ..ate, please state you.. ..elationship to decedent: PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I TOTAL IEnte.. on Line 5 of Tax Computation) I $ Unde.. penalties of pe..ju..y, I decla..e that the facts I have ..epo..ted above a..e t..ue, co....ect and conplet. to the best of ny knowledge and belief. HOME WORK ( TELEPHONE ( ) ) NUMBER DATE TAXPAYER SIGNATURE 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 taM becomes delinqusnt nine Months after the decedent"s date of dsath. 3. A joint account is taxable even though the decedent"s name was addad 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 85 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 ilK" in block "A" of Pa~t 1 of the "Taxpayer Response" section. Sign two copies and submit them with you~ check for the alllount 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 8 - 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 rep~esentative.. place an "X" in block "'8" 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 a~e being claimed.. check block "C" and complete Pa~ts 2 and 3 according to the inst~uctions 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 Departmsnt of Revenue will issue an official asssssmsnt (Form REV-1548 EX) upon receipt of the ~.turn fro. the Register of Wills. LINE 1. Enter NOTE: TAX RETURN - PART 2 - TAX COMPUTATION the date the account originally was establishsd 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 transfsree rega~dless of the value of the account or the number of accounts held. If a double asterisk (MM] appears befo~e you~ fi~st name in the address portion of this notice.. the $3..000 exclusion al~eadY has been deducted from the account balance as reported by the financial institution. 2. Enter the total balance of the account including intsrest 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 taxabls fo~ joint assets established more than one ysar prior to the decedent"s death: 1 OIVIOEO BY TOTAL NUMBER OF JOINT OWNERS Example: A joint asset rBgistsred OIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE SURVIVING JOINT OWNERS in the name of the decedent and two other persons. I DIVIOEO BY 3 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 16.7X [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 OIVIOEO BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE Example: Joint account registe~ed in the name of the decedent and two other persons and established within one year of dsath by the decedent. I DIVIOEO BY Z [SURVIVORS) = .50 X 100 50X [TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is determined by multiplying the account balance (line Z) by ths percent taxable (line 3). 5. Ente~ the total of the debts and deductions listed in Part 3. 6. Ths amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subjsct to tax (line 4). 7. Enter the appropriate tax ~ate Cline 7) as determined below. -The tax rate Imposed on the net value of transfers f~om a deceased ChIld twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent.. o~ a stepparent of the child is oz. The lineal class of heirs includes grandparents.. parents.. children.. and linsal descendents. "Children" includes natural children whether or not they have been adopted by others.. adopted children and stsp childrsn. "lineal descendents" includes all children of the natural parents and their descsndents, whether or not they have been adopted by othsrs.. adopted descendents and their descendants and step-descendants. ..Siblings" are defined as individuals who have at least one parent in com~on with the decedent.. whsther by blood o~ 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% 07/01100 to present 0% 4.5%" 12% 15% 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 dsductiblB itBms. B. You actually paid ths debts afte~ death of the decedert and can furnish proof of payment. C. Debts being claillsd 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 Depa~t.ent of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF fNDfVIOUAl TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 REV.1 162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 005613 CROUSE GEORGE E 560 CARTREF RD ETTERS, PA 17319 ACN ASSESSMENT AMOUNT CONTROL NUMBER ----~--- fold ---------- ----~--- 05117912 I $18.35 ESTATE INFORMATION: SSN: 188-09-5937 05117913 I $2.35 FILE NUMBER: 2105-0084 05120847 I $90.39 DECEDENT NAME: HARRO MALCOLM G 05120848 I $90.39 DATE OF PAYMENT: 07/26/2005 05117968 I $9.52 POSTMARK DATE: 07/26/2005 05117969 I $9.52 COUNTY: CUMBERLAND I DATE OF DEATH: 12/11/2004 I I TOT AL AMOUNT PAID: $220.52 REMARKS: CHECK# 502 INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS