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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
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INFORMATION NOTICE
0-' AND
l }" TAXPAYER RESPONSE
FILE NO.
ACN
DATE
21 05 - O(3~
05136430
08-05-2005
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EST. OF WINNIE F STONER
S.S. NO. 182-22-7086
DATE OF DEATH 05-13-2005
COUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
[X] CHECKING
D TRUST
D CERTIF .
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, t' I S P :j 1: ! 0
KATHLEEN J KILMER
200 YALE RD
DUBOIS PA 15801
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MEMBERS 1ST FCU has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of PennS'~l"ania. QUQstj"n~ may he answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 153029-11 Date 07-25-1995
Established
x
348.80
8.333
29.07
.045
1. 31
TAXPAYER RESPONSE
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
NOTE: If tax payments are made within three
(3) months of the decedent's date of death,
you may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
Tax
PART
[!J
A.
[ CHECK ]
ONE
BLOCK B.
ONLY
c.
[] The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
[] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
~ The above information is incorrect and/or debts and deductions were paid by you.
~ You must complete PART ~ and/or PART ~ below.
PART
[!J
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
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ACCOUNTS
If you indicate a different tax rate, please state your
relationship to decedent:
3
4
5
6
7
8
PART
~
DATE PAID PAYEE
7-IB-=IJY\ '/ rr..:i ,c,," <rAt J/aon t.1
TOTAL (Enter on Line 5 of Tax Computation)
DEBTS AND DEDUCTIONS CLAIMED
DESCRIPTION
I- l...i J1 u-A' e... 'L -fJl:nCL
AMOUNT PAID
1.3.;l7.DO
$
Under penalties of perjury, I declare that the facts I
complete to the best of my knowledge and belief.
have reported above are true, correct and
HOME (aI4) 0 7i - 17S....l
WORK ( )
TELEPHONE NUMBER
~-IS-cS
DATE
GENERAL INFORMATION
1. FAILURE TO RESPOND WIll RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information
submitted by the financial institution.
2. Inheritance tax becomes delinquent nine months after the decedent's date of death.
3. A joint account is taxable even though the decedent's name was added as a matter of convenience.
4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to
death are fully taxable as transfers.
5. AccDunts established jDintly between husband and wife more than Dne year priDr tD death are nDt taxable.
6. AccDunts held by a decedent "in trust fDr" anDther Dr Dthers are taxable fuUy.
REPORTING INSTRUCTIONS
PART
1
TAXPAYER RESPONSE
1. BLOCK A - If the infDrmatiDn and cDmputatiDn in the nDtice are cDrrect and deductiDns are nDt being claimed, place an "X"
in block nAn of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of
tax tD the Register Df Wills of the cDunty indicated. The PA Department Df Revenue will issue an official assessment
(FDrm REV-1548 EX) upDn receipt of the return frDm the Register of Wills.
2. BLOCK B - If the asset specified Dn this nDtice 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 I'ITaxpayer Response" section. Sign one
CDPY and return to the PA Oepartment Df Revenue, Bureau Df Individual Taxes, Oept 280601, Harrisburg, PA 17128-0601 in the
envelope provided.
3. BLOCK C - If the nDtice infDrmatiDn is incDrrect and/Dr deductiDns are being claimed, check blDCk "C" and cDmplete Parts 2 and 3
accDrding tD the instructiDns belDW. Sign tWD cDpies and submit them with YDur check for the amDunt Df tax payable tD the Register
Df Wills Df the county indicated. The PA Department Df Revenue will issue an Dfficial assessment (FDrm REV-1548 EX) upon receipt
Df the return frDm the Register Df Wills.
TAX RETURN
PART
2
TAX COMPUTATION
LINE
1. Enter
NOTE:
the date the accDunt Driginally was established Dr titled in the manner existing at date of death.
FDr a decedent dying after 12/12/82: AccDunts which the decedent put in jDint names within Dne (1) year Df death are
taxable fully as transfers. However, there is an exclusiDn not tD exceed $3,000 per transferee regardless of the value Df
the accDunt Dr the number of accDunts held.
If a dDuble asterisk (--) appears befDre YDur first name in the address pDrtiDn Df this notice, the $3,000 exclusiDn
already has been deducted frDm the aCCDunt balance as repDrted by the financial institution.
2. Enter the tDtal balance Df the aCCDunt including interest accrued tD the date Df death.
3. The percent of the accDunt that is taxable fDr each survivor is determined as fDIIDws:
A. The percent taxable fDr jDint assets established mDre than Dne year prior tD the decedent's death:
1 OIVIOED BY TOTAL NUMBER OF DIVIOED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE
JOINT OWNERS SURVIVING JOINT OWNERS
Example: A jDint asset registered in the name Df the decedent and tWD other persons.
1 OIVIOEO BY 3 (JOINT OWNERS) OIVIDEO BY 2 (SURVIVORS) = .167 X 100
16.7% (TAXABLE FOR EACH SURVIVOR)
B. The percent taxable fDr assets created within Dne year Df the decedent's death Dr accDunts Dwned by the decedent but held
in trust fDr anDther individual{s) (trust beneficiaries):
1 OIVIOEO BY TOTAL NUMBER OF SURVIVING JOINT
OWNERS OR TRUST BENEFICIARIES
X 100
PERCENT TAXABLE
Example: JDint accDunt registered in the name Df the decedent and two Dther persDns and established within one year Df death by
the decedent.
1 DIVIOED BY 2 (SURVIVORS) = .50 X 100 50% (TAXABLE FOR EACH SURVIVOR)
4. The amDunt subject tD tax (line 4) is determined by multiplying the aCCDunt balance (line 2) by the percent taxable (line 3).
5. Enter the tDtal of the debts and deductiDns listed in Part 3.
6. The amDunt taxable (line 6) is determined by subtracting the debts and deductiDns (line 5) frDm the amount subject tD tax (line 4).
7. Enter the apprDpriate tax rate (line 7) as determined belDw.
-The tax rate ImpDsed Dn the net value of transfers frDm a deceased ChIld twenty-one years Df age Dr younger at
death tD or fDr the use of a natural parent, an adDptive parent, Dr a stepparent of the child is 0%.
The lineal class Df heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children
whether Dr nDt they have been adDpted by Dthers, adDpted children and step children. "Lineal descendents" includes aU children Df the
natural parents and their descendents, whether Dr nDt they have been adopted by Dthers, adDpted descendents and their descendants
and step-descendants. "Siblings" are defined as individuals whD have at least Dne parent in CDmmDn with the decedent, whether by blDDd
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% 1.57- 1.5%
01/01/95 to 06/30/00 0% 6% 15% 15%
07/01/00 to present 0% 4.5%1E 12% 15%
CLAIMED DEDUCTIONS
PART
3
DEBTS AND DEDUCTIONS CLAIMED
AIIDwable debts and deductiDns are determined as fDIIDws:
A. You legally are responsible for payment, Dr the estate subject to administration by a personal representative is insufficient
tD pay the deductible items.
B. YDU actually paid the debts after death of the decedent and can furnish prDDf Df payment.
C. Debts being claimed must be itemized fuUy in Part 3. If additiDnal space is needed, use plain paper 8 112" xU". PrDDf Df
payment may be requested by the PA Oepartment Df Revenue.