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HomeMy WebLinkAbout12-12-05 REV-1S00 EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z W C W o w c w .... lI:: ~Ul oO:::lI:: wg;o :J:o:::g O~lJI <C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAl) Charles D. Gordon DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) OFFICIAL USE ONLY FILE NUMBER 2 1 -05 042 4 ""CoUNTYCci'iiE ---YEA~ - - NOOER-- SOCIAL SECURITY NUMBER 1 69- 0 5 - 1 453 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Retum (date of death prior to 12-13-82) o 5. Federal Estate Tax Retum Required _ 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) z o j:: =:s ::>> l- ii: <( o w 0:: z o j:: <( I- ::>> 0. :i o o >< <( I- 04/14/2005 05/19/1915 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ~ 1. Original Return o 4. Limited Estate ~ 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy ofTrusQ o 10. Spousal Poverty Credit (dale of death between 12-31-91 and 1-1-95) COMPLETE MAILING ADDRESS 2000 Linglestown Road, Suite 202 PA 17110 OFFIC~USE ol-fl.Y' .::.<:-:"".') C~ I=-~~ I I 130,250.811 I 29.881 4,704.461 12, 199.42L. u_ _ fT'..) NAME Marielle F. Hazen FIRM NAME (If Applicable) Law Office of Marielle F. Hazen TELEPHONE NUMBER 717-540-4332 Harrisbur --..... ", ~~~ .;0"') r11 (1) (2) (3) (4) (5) 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) (6) (7) (9) (10) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 0.00 X _ (15) 118,001.63 X .045 (16) 0.00 X .12 (17) 0.00 X .15 (18) (19) ...) r....) ,..... - c=~ 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT (8) 147,184.57 19,173.50 10,009.44 (11) (12) (13) 29,182.94 118,001.63 (14) 118,001.63 ece en s omDlete ress: STREET ADDRESS 1260 Hillside Drive CITY I STATE I ZIP Mechanicsburg PA 17055 o d t' C Add Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 5.000.00 263.15 Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( 0 + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check to: REGISTER OF WILLS, AGENT 5,310.07 5,263.15 0.00 0.00 46.92 46.92 PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred; ........................................................................... 0 b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 c. retain a reversionary interest; or ...................................................................................................... 0 d. receive the promise for life of either payments, benefits or care? ............................................................. 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................. 0 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which t. be f" d' t'? l)(1 con ams a ne IClary eSlgna Ion. ....................................................................................................... ~ No 00 00 00 00 00 00 o IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ADDRESS For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 99116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: 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% [72 P.S. 99116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)]. The tax rate imposed on the net value of transfers to orfor the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Charles D. Gordon FILE NUMBER 21 05 All property jointly-owned with right of survivorship must be disclosed on Schedule F. 0424 ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 90,005.86 2. Citizens Investment Acct#L7C054518 Dreyfus Premier Balanced Fund 4739.645 shares @ $18.99 Citizens Investment Acct#L7C054518 Oppenheimer Strategic Class A Fund 9491.734 shares @ $4.24 40,244.95 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 130250.81 REV-1508 EX + (6-98) '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Charles D. Gordon FILE NUMBER 21 05 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. 0424 DESCRIPTION ITEM NUMBER 1. Citizens Bank 5-1-05 Deposit of Patriot News Refund VALUE AT DATE OF DEATH 29.88 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 29.88 REV-1509 EX + (6-98) '* SCHEDULE F JOINTLY-OWNED PROPERTY COWIMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Charles D. Gordon FILE NUMBER 21 05 0424 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Paula Smith 1260 Hillside Drive Mechanicsburg, PA 17055 Daughter B Mary Soster 109 Main Street Ambridge, PA 15003 Daughter c JOINTL Y.OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY '10 OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'SINTERES 1. A. & B. 6/02 Citizens Bank 11,413.52 33.3333 3,804.50 Checking#61 0057-905-0 2. A. &B. 6/02 Citizens Bank 2,699.87 33.3333 899.96 Money Market Acct#610119-193-5 TOTAL (Also enter on line 6, Recapitulation) $ 4.704.46 T (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (6-9B) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Charles D. Gordon SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBA TE PROPERTY FILE NUMBER 21 05 0424 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER ATTACH ACOPV OF THE DEED FOR REAl ESTATE VALUE OF ASSET INTEREST (IF APPliCABLE) VALUE 1. Conseco 12,199.42 100. 12,199.42 IRA Annuity#00124896 Estate Beneficiary TOTAL (Also enter on line 7 Recapitulation) $ 12 199.42 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (12-99) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Charles D Gordon ITEM NUMBER A. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. B. 1. 2. 3. 4. 5. 6. 7. 8. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21 05 Debts of decedent must be reported on Schedule I. DESCRIPTION FUNERAL EXPENSES: Timothy Berkebile Funeral Home Funeral Flowers Funeral Reception Memorial Service Luncheon Cemetery Foundation Pianist Pastor Grace Evangelist Lutheran St. Augustine's Cemetery Headstone/Gravemarker (Estimate) ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Paula Smith Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 1260 Hillside Drive City MechanicsburQ State PA Zip 17055 Yea~s} Commission Paid: 2005/2006 Attomey Fees Marielle F. Hazen Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip Probate Fees Register of Wills - Open Probate Accountanfs Fees 2004 income taxes Tax Retum Preparer's Fees Cumberland Law Journal The Sentinel TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0424 AMOUNT 3,237.40 164.30 821.93 281.54 250.00 50.00 50.00 100.00 800.00 800.00 7,080.34 5,00u.00 310.00 45.00 75.00 107.99 19173.50 REV-1512 EX + (6-98) '* SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Charles D. Gordon FILE NUMBER 21 05 0424 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1 . Manor Care Nursing Home Bill VALUE AT DATE OF DEATH 719.00 2. AXA Pension Reclaimed 7.18 3. West Short EMS Medical Bill 610.20 4. Citizens Bank Check No. 666 (Amy Smith-Dental Expense) cleared 4/22/05 79.00 5. Citizens Bank Check No. 667 (Internal Revenue Service) cleared 4/25/05 1,000.00 6. Internist of Central PA Medical Bill 8.54 7. Citizens Bank Check No. 664 (Met Med Services) cleared 4/19/05 50.00 8. Camp Hill Fire Company 659.00 9. IRS 2004 Interest & Penalties 258.47 10. IRS Additional 2004 income taxes 6,408.00 12. Holy Spirit Hospital Medical Bill 150.00 13. Metro Med Service Medical Bill 50.00 14. Moffit Heart and Vascular Medical Bill 10.05 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 10.009.44 ,,,,.,,,, "', ".. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER Charles D. Gordon ?1 n~ 0424 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OFEST A TE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Paula Smith Lineal 1260 Hillside Drive 33.33% Residuary Mechanicsburg, PA 17055 2. Mary Soster Lineal 109 Main Street 33.33% Residuary Ambridge, PA 15003 3. Barbara Shadier Lineal 11299 Crofton Circle 33.33% Residuary Waynesboro, PA 17248 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAl OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedent's date of death: 5,000.00 Discount: _2-63. t~ Interest Table --- -- - -- --1----- --- - - r--- -- --- ~ y : Days Delinquent I Balance Due ear 1 this tim~ peri~d J __ _tI1isyear___ ~:;;re 1981 _-=~=~-~-- -----~~-r __~=-- ] 1983 . __ __~ ____ i1JJ84 I 1 !!8!) _ --- t--------- 1986 I 1987 I 19lJ8 th!9lJ9.J11~~1_J__ 1992 ~_._._--_.. ---1"'-- I 1993 ~l1r9U9.I1_1~~~_ ,-- I . t9!:J~~hr()ujJJ11998 1999 , 2000 l~OOL_ 12002 1-- i 200~ 2004 Interest this period TOTALS Penalty Calculation If the decedent's date of death was on or before March 31, 1993, insert the applicable amount: Total Balance Due on January 17, 1996: Penalty:_ _____ 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 05-0424 05141199 08-29-2005 REV-1543 EX AFP 109-00> EST. OF CHARLES D GORDON S.S. NO. 169-05-1453 DATE OF DEATH 04-14-2005 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS [Xl CHECKING o TRUST o CERTIF . MARY G SOSTER 1260 HILLSIDE DR MECHANICSBURG PA 17055-9712 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CITIZENS BANK OF PA 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 Pennsylvania. Questions may be answered by calling (7171 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 6100579050 Date 05-01-1995 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 2,699.87 16.667 449.99 .15 67.50 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice must accompany your peyment 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 5Z discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. Tax 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 "An 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 [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PART @] TAX RETURN - COMPUTATION If you indicate a different tax rate, please state your relationship to decedent: OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established I 2. Account Balance 2 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ declare that the facts I and belief. have reported above are true, correct and HOME (7~ r ) ~ Ce~ <5q l?9 WORK ( ) TELEPHONE NUMBER 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. 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 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 fuUy. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE 1. 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 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 Oepartment of Revenue will issue an official assessment (Form 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, Oept Z8060l, Harrisburg, PA l7lZ8-060l in the envelope provided. 3. BLOCK C - If the notice information is incorrect andlor deductions are being claimed, check block "C" and complete Parts Z 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 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/lZ/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 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: 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 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) from the amount subject to tax (line 4). 7. Enter the appropriate tax rate (line 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 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 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 12131/94 3% 6% 15% 15% 01/01/95 to 06/30/00 0% 6% 15% 15% 07/01/00 to present 0% 4,5%lE 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 fuUy in Part 3. If additional space is needed, use plain paper 8 1/Z" x U". 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 17128-0601 '* INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 05- 0424 05141212 08-29-2005 REV-154S EX AFP lD9-00> EST. OF CHARLES D GORDON S.S. NO. 169-05-1453 DATE OF DEATH 04-14-2005 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS [XJ CHECKING o TRUST o CERTIF. MARY G SOSTER 1260 HILLSIDE DR MECHANICSBURG PA 17055-9712 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CITIZENS BANK OF PA 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 Pennsylvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 6101191935 Date 03-18-2002 Established Account Balance Percent Taxable Anount Subject to Tax Rate Potential Tax Due x 11,413.52 16.667 1,902.29 .15 285.34 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 5X discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. [J 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. [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. PART ~ DATE PAID 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. Anount Subject to Tax 5. Debts and Deductions 6. Anount Taxable 7. Tax Rate 8. Tax Due OF 1 2 3 4 5 6 7 8 x TAX ON JOINT/TRUST ACCOUNTS x PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax ConputationJ I $ perjury, I declare that the y ~~Wledge and belief. .~ facts I have reported above are true, correct and HOME (7,-)l () 61 ~t;, -50( J? C; WORK ( ') TELEPHONE NUMBER DATE GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHENT 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. Accounts established jointly between husband and wife more than one year prior to death are not taxable. 6. Accounts held by a decedent nin trust forn 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 claimed, place an "xn in block "An 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 Oepartment 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 nx" in block nB" 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 "cn 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 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 (**) 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 OIVIOED 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 DIVIOED BY 3 (JOINT OWNERS) OIVIDED 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 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 l (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 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 (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. "Childrenn includes natural children whether or not they have been adopted by others, adopted children and step children. nLineal 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. nSiblingsn are defined as individuals who have at least one parent in common with the decedent, whether by blood or adoption. The "Collateraln class of heirs includes all other beneficiaries. 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 6X 15X 15X 07101/00 to present OX 4.5X. 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 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/ln x Iln. 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 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 21 05-0424 05141198 08-29-2005 REY-1545 EX AFP 'D9-0D) EST. OF CHARLES D GORDON S.S. NO. 169-05-1453 DATE OF DEATH 04-14-2005 COUNTY CUMBERLAND TYPE OF ACCOUNT D SAVINGS [XJ CHECKING D TRUST D CERTIF. PAULA G SMITH 1260 HILLSIDE DR MECHANICSBURG PA 17055-9712 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CITIZENS BANK OF PA 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 Pennsylvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 6100579050 Date 05-01-1995 Established Account Balance Percent Taxable Anount Subject to Tax Rate Potential Tax Due x 2,699.87 16.667 449.99 .15 67.50 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 5% discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. Tax 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. [] The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. PART @J DATE PAID DEBTS AND DEDUCTIONS CLAIMED If you indicate a different tax rate, please state your relationship to decedent: PART [3J TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Anount Subject to Tax 5. Debts and Deductions 6. Anount Taxable 7. Tax Rate 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 ConputationJ I $ perjury, I declare that the facts I have reported above are true, correct and ny knowledge and belief. HOME ~ /~. ATE' )" 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. 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 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 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 Oepartment of Revenue, Bureau of Individual Taxes, Oept 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 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 (NN) 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 OIVIDED 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 OIVIOED 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 DIVIDEO 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 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 (line 7) as determined below. Date of Death Spouse Lineal Sibling Collateral 07/01/94 to 12131/94 3/. 6/. IS/. IS/. 01/01/9S to 06/30/00 O/. 6/. IS/. IS/. 07/01/00 to present O/. 4.S/.. 12/. IS/. NThe 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 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. 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. Oebts 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 Oepartment of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z8060l HARRISBURG, PA l71Z8-060l *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 05-0424 ACN 05141211 DATE 08-29-2005 , . REV-15~5 EX AFP 109-00l EST. OF CHARLES D GORDON S.S. NO. 169-05-1453 DATE OF DEATH 04-14-2005 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS IX] CHECKING o TRUST o CERTIF. PAULA G SMITH 1260 HILLSIDE DR MECHANICSBURG PA 17055-9712 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CITIZENS BANK OF PA has provided the Department with the information listsd below which has bssn used in calculating the potential tax due. Thsir records indicate that at ths death of the abovs dscedsnt, you wsrs 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 abovs address. This account is taxable in accordance with the Inhsritance Tax Laws of the Commonwealth of P9nnsylvania~ Questions ~a~ be answered b~ calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 6101191935 Date 03-18-2002 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 11,413.52 16.667 1,902.29 .15 285.34 TAXPAYER RESPONSE To insure proper credit to your account, two (Zl copies of this notice must accompany your payment to the Registsr of Wills. Make check payable to: "Registsr of Wills, Agent". x NOTE: If tax payments are made within three (3l months of the dscedent's date of death, you may deduct a 57. discount of ths tax dus. Any inheritance tax due will become delinquent nine (9l months after the date of death. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. [] The above information and tax due is correct. 1. You may choose to remit paymsnt to ths Registsr of Wills with two copiss of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Rsgister of Wills and an official assssSllent will be issued by the PA Departmsnt of Rsvenue. [] The above assst has bssn or will be reported and tax paid with the Pennsylvania Inheritancs Tax rsturn to be filed by the decsdent's representative. [] The above information is incorrsct and/or debts and deductions wsre paid by you. You must complste PART ~ and/or PART ~ below. PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED If you indicate a different tax rate, please state your relationship to decedent: PART [!] TAX RETURN - COMPUTATION OF tINF. 1. Date Established I 2. Account Balance 2 3. Percent Taxable 3 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 8. Tax Due 8 TAX ON JOINT/TRUST ACCOUNTS x x PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) perjury, I declare that the facts I my knowledge and belief. HOME I $ are true, correct and o -116- "'""D AT E GENERAL INFORMATION 1. FAILURE TO RESPOND WIll RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on inforllation 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. 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 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 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 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 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 (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. 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: 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 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 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 (line 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 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 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 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 8 112" x 11". Proof of payment may be requested by the PA Department of Revenue. COMMONWOALTh Of PENNSYLVANIA D~~ARrM~Nl O~ Rf.v~"llJS al..'~EAU 'OF INDIVIDIJAL .,. AXES DePT. 260601 IoIAPP.ISllIJRG, PA n12~-oec, REV-l1S2 EXI1 HIS) REcEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SMiTH PAULA G 1260 HILLSIDE DRIVE MECHANICSBURG, PA 17055 ------- ~I" ESTAn INFDRMATION: SSN: 169-05-1453 FILE NUMBER: 2105-0424 DECEDENT NAME: CORDON CHARLES D DATE OF PAYMENT: 06/17/2005 POSTMARK DATE: 06/17/2005 COUNTY: CUMBERLAND DATE OF DEATH: 04/14/2005 NO. CD 005447 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $5,000.00 I I ! , , I , I i I I I TOTAL AMOUNT PAID: REMARKS: CHECI<# 518 SEAL INITIALS: CCP RECEIVED BY; REOISTER OF WILLS $5,000.00 ~LENDA FARNER STRASBAUGH REGISTER OF WILLS