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COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
*F 0-.... .-INFORMATION NOTICE
- '" AND
P . TAXPAYER RESPONSE
FILE NO. 21 oS lPllo
ACN 05131351
DATE 07-05-2005
REV-1S43 EX AFP U9-00>
CL-.
EST. OF RALPH E GRIMES
S.S. NO. 182-22-9313
DATE OF DEATH 04-03-2005
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
[Xl CHECKING
o TRUST
o CERTIF.
?nn5 "'i
LUloi '- -,,--
PA 17240
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
KIMBERLY
320 ZION
NEWBURG
A SNYDER
RD
PNC 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, pleBse obtain written correction from the financial institution, attach a COpy
to this form and rBturn it to the above address. This account is taxable In accordance with the Inheritance Tax Laws of the Co.monwealth
of Pennsylvania. Questions .ay be answered by cblling (717) 787-83Z7.
Date
Established
REVERSE SIDE FOR
03-26-1990
FILING AND PAYMENT INSTRUCTIONS
COMPLETE PART 1 BELOW
Account No. 5140433927
)( )( )( SEE
x
8,380.16
16.667
1,396.72
.15
209.51
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 wii.~n three
(3) months of the def'1ent-s date .of"l death,
you .ay deduct a 5% dis~nt of the tax due.
Any inheritance tax due~JIl beco~ delinquent
nine (9) months after tne;~~~e of a.,th.
PART
[!]
~ The above infor.ation and tax due is correct.
~ 1. You .ay choose to remit payment to the Register of Wills with two copies oft~is nDtice~ tD obtain
a discount or avoid interest, or you may check box "A" and return this notice~o the Re~\~ter Qf
Wills and an official assessment will be issued by the PA Department of Rev,nue.
[CHECK ]
ONE
BLOCK
ONLY
C'J
B. c=J The above asset has been or will bs reported and tax paid with the Pennsylvania Inheritance~x
to be filed by the decedent-s representative.
return
c. c=J The above information is incorrect and/or debts and deductions were paid bY you.
You gust complete PART ~ and/or PART ~ below.
PART If you indicata a diffe..ent t.
~ ..elationship to decedent:
~ t<~-r ....
TAX RETURN - COMPUTATION OF TA
LINE 1. Date Estsblished 1
2. Account Balance 2
3. Pe..cent Taxable 3 X
4. Amount Subject to Tax 4
5. Dabts and Deductions 5
6. Amount Taxable 6
7. Tax Rate 7 X
8. Tax Due 8
PART
[!]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAVEE
DESCRIPTION
AMOUNT PAID
I
TOTAL IEnte.. on Line 5 of Tax Computation)
I
$
decla..e that the facts I have ..epo..ted above a..e t..ue, co....ect and
and belief. HOME (111) lf2.3-0001
W~~~EP~ONE N~MBE 1iT~O~
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based an 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 _atter 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. AccQunts 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
I. 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 I aT 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. OLOCK 0 - 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 decBdent"s representative, place an "X" in block "0" of Part 1 of the IITaxpayer Response" saction. 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 Ravenue will issue an official assessment (Form REY-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 decadent put in joint names within one (1) year of death are
taxable fUlly as transfers. Howaver, there is an exclusion not to exceed $3,000 per transferee regardless of the value af
the account or the number of accounts held.
If a double 8sterisk (..) appears before your first na.e in the addrass portion of this notice, the $3,DOO 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 daath.
3. The percsnt of the account that is taxable for each survivor is determined as follows:
A. The percent taxable for joint assets established mora 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 OF 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 2 (SURVIVORS) = .167 X 100
16.7% (TAXABLE FOR EACH SURVIVOR)
B. The percent taxable for assets created within ane year of the decedent's death or accounts owned by the decedent but hald
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 datermined by mUltiplying the account balance (line 2) by the percent taxable (line 3).
5. Enter the total of the debts and daductions listed in Part 3.
6. Tha amount taxable Cline 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 I_posed 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 OZ.
The lineal class of heirs includes grandparents, parents, children, and linsal descendents. "Chlldren" 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.
Data of Daath Spousa Linaal Sibling Collataral
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 prasant 0% 4.5%11 12% 15%
CLAIMED DEDUCTIONS - PART
3
DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and deductions are determined as follows:
A. Vou legallY are responsible for payment, or the estate subject to administration by a personal representative is insufficient
to pay the deductible items.
B. Vou 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.