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HomeMy WebLinkAbout04-28-06 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT FONES ELIZABETH C 32 ROYAL PALM DR MECHANICSBURG, PA 17055 nn__n fold ESTATE INFORMATION: SSN: 168-24-4922 FILE NUMBER: 2106-0375 DECEDENT NAME: AIELLO MARY A DATE OF PAYMENT: 04/28/2006 POSTMARK DATE: 04/27/2006 COUNTY: CUMBERLAND DATE OF DEATH: 02/12/2006 NO. CD 006624 ACN ASSESSMENT CONTROL NUMBER AMOUNT 06117805 I $36.59 06117806 I $23.32 I I I I I I I TOTAL AMOUNT PAID: $59.91 REMARKS: CHECK# 2094/2095 SEAL INITIALS: MG RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS ~~~~r:~~:;~~~;~~~:~\~::'A 00.r<<0, ('~f\C~ HARRISBURG, PA 17128-060G:>,\ '\',-..'.>' ""'~, "~ \. \,.J "-,,.. \' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 b& 037~ ACN 06117806 DATE 04-14-2006 REV-1543 EX M'P <09-00> ,., ,'"' ( ~ 1\:'~--) : '-t I EST. OF MARY A AIELLO S.S. NO. 168-24-4922 DATE OF DEATH 02-12-2006 COUNTY CUMBERLAND TYPE OF ACCOUNT [i] SAVINGS D CHECKING D TRUST D CERTIF. (-\, REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ELIZABETH C FONES 32 ROYAL PALM DR MECHANICSBURG PA 17055 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 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. 0168244922 Date Established 03-02-2004 x 327.38 50.000 163.69 .15 24.55 To insure proper credit to your account, two (2) copies of this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". Account Balance Percent Taxable Amount Subject to Tax Tax Rate 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 [!]m~l~Fi~IIJiURE!!@tQ!ll11REipoND1~li!wlIIJiLil~l~RESULT111l11INl11!1AN!1l1lQFF!lclliL~!1!1ltiiil~liAisEsiiENT11!1!iAiEDll1!loNmmtilli~~!!iNQT!ICE1!~!1! ;;;~~:;:;:;:;;;:;:;:;:;:::;::~;;:;:::;:;:!:;:!:!:::::;:::::;:::::;::::::::;;;:::;~::;;;:::::;:;:;:;;:;:;;;:;:;:;:;:;:;:;:;:;:;:::::::;:::;:;:;:;:::;:;:::;:::::::;:::::::::::::::::::::;:::::;:::;::;;:;:::;~;~;:;~;:;:;:;;;;;:;;;:;:;:;:;:;:;:;:;:;:;:;:;;;;:;;;;:;;;;:;;~;;;;;~::~;;;:;;;;:::::;:~:::;:::::;:;:::;;::;:;:::;;;::;;;;::;:;;:;;~::;:;~;:;:;;;;;:;;;:;:;~;:;:;:;:::::;:;:::;:;:::;:;:;;;;::::;:;;:;;;;:;~:;::;;:;;;:;: [CHECK ] ONE BLOCK ONLY A. The above information and tax due is correct. 1. You may choose to re.it pay.ent 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. 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. C. [] The above information is incorrect and/or debts and deductions were paid by you. You must co.plete PART ~ and/or PART ~ below. x .-...... ..-...................-.. .-.. -. .. -.--.-. - ... -... . .............-.......-...-.-...-.-.-.-.-...-....................-...-.-...-.-.-.......................-.-.-.-............................. 1imm~~~i~i~m~1~1m1mijimmmmDFF~I1C1..;1;...;..;;;;;............:.ijm~QNL1~H\~;~;~; ; .............-...-.-.....-.-.-...................-.....-.........-... .........-.-..................... . ...........-.........-.-.-.-...-...-................................ -.......-.............-.-...-.-.-.-... ..-...-...-...-.-.... m111m1l:mmmmm~liiml1DEPAR "';'''';~mr''';''''~'';''''''~'';''''~'''''';mmmmnmH~ .-.-.......-.-...-.......-.-.-...-................................... -.-.-.-.-...-.-...-.-.-...........-...-...-.-...-.-.-.-.-.-.-.-...... mlPAD1!111~1!~H~~H~~~~~~~~~~~~~j~~~~~~~~~~~~~~~~~~L....... ... ....... .. '... . .....-.............-.....-.....-.....-.-.........-.....-.....-...-...-.........-.-...-.-...-.-...-...................................-...........-.......-...........-... ..............................................-.........-.-.-...-.-.-.......-.........-...........-.....................-...-...........-.-.-.....-.-...-.....-.-........ l~!i!mm~m~1~!ii1m;~nHH;j;~;Hj~HHj;;;~;;~j;jF1H~;~;!;~:j;gj;jH;WH;;HW;H~;j;;;j;;;E~;;~Ej;~;~\~~Enm;m;~;HHHHHHnHHnH~; ...-.-.-...-.....-. . ......-...-.-.....- ..-.-.....-....--. -.... ........-...-. -. ... . ... ...- . . .. ...-.-.-.........-.....................................................-.......-...-.-...............-.........-.....-.......-...............-.....-.......-............. -.-...-.........-.-.-.....-.............-........................-.-.-.-.-.....-.........................................................-...-.....-.-.-...-.....-...-.-.. .................................................-.-.........-.....-.-...-.-.......-...-.-.........-...-.......-...........-.-.-.-...-................................... ~i~1~~~~~1~1~iH~~~3~1~~~i~l~l~l~l~l~i~l~l~l~l~l~l~~~i~l~i~~~~~~~~~~~l~~~~~l~~~H~~~iji~:~~~~~I~i~i~~~~~i~;~i~l:~~i~l~I~I~i~i~i~i~H~~~ljl~~~~j:j~~l~i~i~l~i~l~i~l; .-...-.-.....-.......-...-...-.-.-...-.................-.....-.-...-...-.....-.-.-.-.-.......-.........................................................-.-.-.-.-......... -.....-...........................................-.........-...-.-.........-...-.....-.............-...........-.....-...........-.......-.............................. .........-...-...................................-.-.-.-...-...-...-...-.-.....................................................-.-...-.-...-.-.-.........-.............-. ~~m1~~~~~1~i~~~i~~m~~;~~~~~~~;~~~;:;~;~;~;~;F~;g~;g~;~;~;F~;~;:;~;g~;~;gF~;~;~;~;:;~;~;~;~;~;~;~;~;~;~;~;~;~;~;~i~;~i~;~;~~~;~;~;~;~;~;~;~;~;~i~;~;~ig~ij ...-.-.-...............-................. ..................-.......-...-.........- .-.-...-...........-..................... ""'.'.'"''''.'''5.....''''''''''''''''' ...........-.....- .-...-............ ................... .................. ~~~~~~~m~~~~H~~~~:~:~mi~~~~~~~;~:~:~;:~:~:;:;:;:;:;:!:;:;:!:;:;:;;::::::::::;:;~::;:;~;!~!~g;~!~;~~~:;;~;;:;;~;;;;;;;~i:!~;::~i;~:i;;;;:::;::::;!;!;i;:;:;!;i;;;;:~ !1!!!i',!il~,II!i,:,ii!~ii~,ii!i~!;~!!ii:~iif~~i,~,!~~i:,!il~!,~~!iii;li!!~~i!,~~~~,!!i;~~!!;i:!,i~i!,!;!:i~~'i,i: mmmmmml~lll!:!::j:;!:i;:;;:i;i:i~i:i:l:l:ijl;lji;i:i:i:ljl;!:i:l;l;i;l;i;m;i;;;i~:li;i;:~:;mjl::;:ji:mj!:!:!i::!:!j::!::ml:!:!:!:l:!:!:m:l::m PART ~ TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS If you indicate a different tax rate, please state your relationship to decedent: LINE l. Date Established 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 -...........-...........-........... ................................... -.-.......-...-.............-.-..... . . . . . . . . . . . . . . . - . . x PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) $ facts have reported above are true, correct and HOME ( ) WORK ("/ll) S1J0 6fo8' TELEPHONE NUMBER 11-1-9--00 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 Cincluding 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 CForm 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 CForm REV-1548 EX) upon receipt of the return from the Register of Wills. TAX RETURN PART 2 TAX COMPUTATION LINE 1. Enter the date the account originally was established or titled in the manner existing at date of death. NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one Cl) 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 C..) 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 CJOINT OWNERS) DIVIDED BY 2 CSURVIVORS) = .167 X 100 16.77. CTAXABLE 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) Ctrust 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 CSURVIVORS) = .50 X 100 507. CTAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax Cline 4) is determined by multiplying the account balance Cline 2) by the percent taxable Cline 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 Cline 5) from the amount subject to tax Cline 4). 7. Enter the appropriate tax rate Cline 7) as determined below. .The tax rate 1mposed on the net value of transfers from a deceased ch1ld 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 1/2" x II". Proof of payment may be requested by the PA Department of Revenue. . -, -. '." '. '0 '. '. '0 -. -, -. -. -. -, -. -. -. -'"0 '0"."0"."0"0. '0".. . "0' "0 -. ...."0 '0_' -. -, -. -. -. . '0"0 '. -, -." -. -, -. -.". -."0"0 -."0"0"0 ...."0"0"0"0 '0 '0' . .' . .. "0"0"0"0"0"0"."0 _._. _, _, _. _. '.". '. '."."0 _'"0 _. _ _. _. _0". _. _.. _.".".".". ....".".".".".""."0 '0'0.0 .". ."0"."0 '0""0 _, _. '0 _, _. '0 _. '0 '. '. '. '. '. . '0". '. '." _. '. '. _. _. _. _. '0 '. _. _, _. '."0 _. '.". _. .... _. .~_~ _~.~"~ _~"~"~ _."."~"."~".".".". '!"."!".". 'r.'E!:'''''~AJ:['''''N. e'E!:ft""'F'J:[I!t~f:}E!:I!t''''''r.'N. It"Dl!tu'.'~'r.'D.N""'AD:""':.Ii:~lC":'r.'lC":T.':.Ii:Nr.-:It""''''''''r.-:AN. T.':.Ii:P.'~"''':.Ii:N~'''''D:e'r.-:'r.'lC'iT.'E!:I!t'''''AE!:'''''W' 'r.'):o't,:.lC":""""""""""""",',""',',','.', ". !IIJlillliil[illi~lli~IIII~IIII~i~~li~ll~illillll~llili~l~iJ:~1IJ;~i~li,~~i~ill~ool~II,1ill'liilil'l !~~~jllll~~~~~~~~~mll~l~j~~ljljj~~~j~j~j~~jjmj~~~~l~j~~jljjj~~~jjjjj~~~j~~ll~l~~jlmm~j~~~jffijjjjllj~jjfflj~~~jffll~~j~ljfflj~~~~jmm~l~~jjjll~~~~~jjffiljjjjjljjjjjjlmjmmm COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 .' .-.r--......-\r-...; \ ,--,1..,-r\, '1 , ':.-'. . ," . . , I;., : . I ';,l1~-'.,"I.)\'._"':~ "j :....,._~~ '. : : . , INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 0& 03 -J:; ACN 06117805 DATE 04-14-2006 itEV-1543 EX AFP (09-00) . t,,8. .. --:{ TYPE OF ACCOUNT D SAVINGS liJ CHECK I NG D TRUST D CERTIF. EST. S.S. DATE OF COUNTY OF MARY A AIELLO NO. 168-24-4922 DEATH 02-12-2006 CUMBERLAND ELIZABETH C FONES 32 ROYAL PALM DR MECHANICSBURG PA 17055 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 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 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. 0168244922 Date Established 03-02-2004 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 ~ ~~ &SZ"1 PART TAXPAYER RESPONSE [!]lmm~~!~~ij~~~!i!~~gl~!1!~~$~g~ijl!I!!I!~~J.ll.!!!!!R~lijjjUJ.1I!I!I!~~!I!!!~~I!!!!g~~!~~I~~J.ll.!I!I!~~1!11!!i$I~I$"~~Jj!~!!!i~$~ij!j!j!g~~lj!~~HI~$!1!~I~l.lJj!~~~!!1!1!1 ''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''"""""""""""""""""""""""""""'"''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''"""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,.,,""'''''''''''''''". A. ~he LA I. Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due [CHECK ONE BLOCK ONLY ] 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. x 513.59 50.000 256.80 .15 38.52 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. above information and tax due is correct. 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. [] The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. PART ~ TAX RETURN If you indicate a different tax rate, please state your relationship to decedent: -....--....-...--....-.-.-.-.--.--.-..-.--..-.. .... ~mmmmmmmmmmmmmlmDFFi1I!1fr1111i"',";';';';,", .-.-.-...-.-.-.....-.......-..~............................................ -.-.-.-.-.-.-.-.-.-...-.-.......-...-.....-.-...-.-.....-...-.-...-.-...... .-.-.-.-.-.-.....-.-...-.-...-.-........................................... """"'''''''''''''''''''''P....'A...'''''''o....'e.....p....'A'...'R....'.l1..... ..........................-.. - -...-. ... ...........-.......-...-.-.-. ....... . - - -.- J!!!~I~I!!!II!!!!i!I!!!i!!!i!I!I!i!!!1!!!I!ll!li!l!i!;!I:I!ill!!;!;!;!j;;!:!j;;!:m:m;!;!;;j!;!;!:!;l:m:!:!;!;;;m;':l;m:!;l:l::mm;l;l;!;m::;;: ljll!!!!!!llil!l;i!i~::m;m;ffi;f:J!fli;:;;::;;:;:;:;;;i~:;:;:;;l:;:l;:;!:!;!:::l:::::l::;::l::;:;:::::;!;!::;:;:::::::;:;:::;::m:::::j:::;;::j:::::::l:l:l;I:I:I: !j!i!l!j!!!l!l!lj!!~!m:;~;~;m:::m;j:jmmm:i;l;!;i:i:!:l:l:!:i;l;!;!:!;l;l;i;l;l:i;l;l;l;!;!;l;l;l:i;l;l:l;l;l:l;!;l:l:l;!:;:l;l:ij:;i:i:i;:m::!;l;!:!;!j l'I',llIi'I'III'i'II'!!i,li~I'ilil~I,!li!11ill!i!i,llii;~lli!iil!lllli'ilj~!'!!1111!1'111~!ilil'II'lil .-...-.-...-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-...-.-.......................................................-.-.-.....-.......-.-.-.-...-.-.-.-.-...-...-...-.-.-.-...-.-.-. -.-.-.-.-.-.-.-.-.-...-.-.-...-.-.-.................-...-.-.-.....-.-...-.-.-.-.-...-.-.....-...............-...........................-.........-.-.....-.-.-.-.-.-...-.- .-...-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-...-.....-.......-.-............................................................................-...-.....-.....-.-.-.....-.-.....-...-. ..-.....-.-.-.-.-.....-.....-.-.....................................-.-...-.....-.-...-.-...-.......................................................-_..-.-...-.....-.....-. m:~~mmm~m~~~~n;j'j;jij'iijijijijij;ntj;j':;:;j;ji:'jij;j;j'j'j'j;j'jij':i:':i:'j'jij':i:;:ij'C:'j'j'ji:'j':ij;j'j'j'j;i'j':'j'i'jijij:jij'jijiEji .-...........................-.....-.............-.......-.-...-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.....-.-.........-..................................................... ................................................................-.......-.-...-.-...-.-...-..-....................................-.....-.....-...-.-...-.-.-.-...-.-..... .-...-...-.......-...........-.....-.....-.-.......................................-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.....-...........-....... -.-.......-.......................................................................-......-.....-.-.-.-.......-.-.....-...-.-...........................-................... !l!lll!lil!~i!!li~I~!m;;;m:;:;:;;;m;;;:;;;;!:!;;;!:!:!;!:!;!:l:!;l;!:!;':!;!;';l;l;!;!;!;!;!:!;!;!;!;!;!;,;!;!;!;l:!:!;!;!;,;!:!;';1;!;!;!;!;!;,;,;!;1;!:!;,;!: LINE l. Dat9 ~stablishe~ 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 PART ~ DATE PAID PAYEE DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) $ Under penalties of perjury, I declare that the facts complete to the best of my knowledge and belief. have reported above are true, correct and HOME ~ (j[S 1-/4--0& DATE GENERAL INFORMATION 1. FAI LURE TO RESPOND WI LL RESULT I N AN OFF I C IAL 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 '~" 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 the date the account originally was established or titled in the manner existing at date of death. NOTE: 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: 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 16.7% (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. I 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 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% ~The tax rate 1mposed on the net value of transfers from a deceased ch1ld 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 cOllmon 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. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 1/2" x II". 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