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Home My WebLink About06-05-06 W f- lIl:: :$(1) uO::lIl:: w Q.u :r 00 " O::.,.J ~ Q.r:a Q. <( REV-1500 EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 . REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 2 1 -0 6 0 0 3 4 9 C5UNTvCODE -vEAA- - - NOMiER-- SOCIAL SECURITY NUMBER DATE OF BIRTH (MM-DD-Year) 1 95- 1 6 - 4 5 8 7 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WIllS SOCIAL SECURITY NUMBER 00 2. Supplemental Retum o 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy OITruS!) o 10. Spousal Poverty Credit (dateofdealh between 12-31-91 and 1-1-95) o 3. Remainder Retum (dateofdeathpriort012_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) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS SUSAN H. CONFA/R 2331 MARKET STREET FIRM NAME (If Applicable) REAGER & ADLER P.C. TELEPHONE NUMBER 717-763-1383 CAMP Hill PA 17011 04/07/2006 08/02/1923 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) t- Z W C W () W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) 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) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 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) z o j::: <( ...J :J t- e:: <( () W lr ORRIS MARION 8. DATE OF DEATH (MM-DD-Year) o 1. Original Return o 4. Limited Estate o 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received f- Z w c z o Q. (I) W 0:: 0:: o U (1) OFFICIAL, ~SE ONLY -, (2) (3) (4) -, (5) (6) 28,579.84 . , ,'_.~ i ~-J 11 (7) 28,579.84 350.00 28,229.84 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 19. Tax Due (19) 20. 0 - --..- . "" """'onc" ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH z o i= ~ :J a. :E o () >< ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 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 28,229.84 0.00 X _(15) 28,229.84 X ~(16) 0.00 X .12 (17) 0.00 X .15 (18) << Decedent's Complete Address: STREET ADDftESS 4821 E. TRINDLE ROAD CITY I STATE I ZIP MECHANICSBURG PA 17050 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) 1,270.34 63.52 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + 8 + C) (2) 63.52 Total Interest/Penalty ( D + 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) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 0.00 1,206.82 1,206.82 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ........................................................................... 0 lKJ b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 lKJ c. retain a reversionary interest; or ...................................................................................................... 0 lKJ d. receive the promise for life of either payments, benefits or care? ............................................................. 0 lKJ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideratiOn?.............................................................................................. 0 lKJ 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 lKJ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... 0 lKJ 8507 Quaint Lane Vienna VA 22182 SIGNATURE O~~~THER THAN REPRESENTATIVE ADDRESS ~77<71 ,It; ( / (J iliA,,) , 71 h1- 1'7.01 DATE 6t ;;J {)b 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. ~9116 (a) (1.1) (i)]. F", dates of d"lh 00 0"1t,, Jan"", " 1995, ~e fax cate Imposed 00 Ihe oel ""'"' of 'ao_ 10 oc foe ~""se of Ihes"~Mog spo"se Is 0% ~2 P.S. ,9116 (a) (1.1) OiJJ 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 I'" eale Imposed on ~e oet ,at", of lea"f", from a deoeesed chl~ -fy-ooe y"" of age oc youogec al deafu to oc I", Ihe "se of a oofueal pacem, ao adop'" pamol, or a stepparent of the child is 0% [72 P.S. ~9116(a){1.2)]. The I'" cale Imposed "" .e 001 ,,'"' of lea,,"" 10 '" f", Ihe "se ofthe dee_" IIoea' beoeficla'" I, 4.5%, "cept as ooled 10 72 P.S. ,9116(1.2) ~2 P.S. ,9116(a)(1 IJ The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(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-1509 EX + (6-98) . SCHEDULE F JOINTL Y-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ORRIS. MARION B. FILE NUMBER If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. 21 06 00349 SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. SUSAN L. ORRIS 8507 QUAINT LANE VIENNA, VA 22182 DAUGHTER B c JOINTL Y.OWNED PROPERTY: lETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DE CD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 1996 Member's 1st FCU account no. 21649-11 300.00 50. 150.00 2. A. 1996 Member's 1 st FCU account no. 158655-05 1,810.53 50. 905.27 3. A. 1996 Member's 1 st FCU account no. 158655-00 1,475.84 50. 737.92 4. A 1983 Member's 1st FCU account no. 21650-11 2,865.53 50. 1,432.77 5. A 1983 Member's 1st FCU account no. 21650-00 2,876.18 50. 1,438.09 6. A 1983 Member's 1st FCU account no. 21650-09 47,831.57 50. 23,915.79 TOTAL (Also enter on line 6, Recapitulation) $ 28579.84 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (12-99) . COMMONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ORRIS MARION B. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21 06 00349 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attomey Fees Reager & Adler, P.C. 150.00 3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4, Probate Fees 5. Accountanfs Fees 6. Tax Retum Preparer's Fees 7. Chicago Title - Quit Claim Deed preparation - Hawaii time share 200.00 TOTAL (Also enter on line 9, Recapitulation) $ 350.00 (If more space is needed, insert additional sheets of the same size) '~."'m..I* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES ORRIS. MARION B. 21 06 nn::\4Q RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Susan L. Orris Lineal 28,229.84 8507 Quaint Lane Vienna, VA 22182 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 10 Bo CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 10 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ FILE NUMBER (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: _____ _ -___1,27~34 Discount: - ...- - - - ... - g~..Q2 Interest Table Year Days Delinque~~r - -B~J;~~e-D~~- - -T - - - -'~t;r~~t------i this time period! this year _ ___~~~!~___~ -- --~l-~-~~~ ::---- ------ - .1 - - ---~ -- ~~~-~--~~=~===~~=---==r ~~----~=-=====~==~j i ~ i .::~===~t-~::---=~~-::::t===~::~-=~~~::~ --L______________1__ _ ----- ----J I i I -1- - - .-- _n_ _ _ ~ _ _ _ _ ___ --___n_-I -~--- L ____I I j i I ' I . ::---===-E~===__~~::!=::=~==~=j . - - ~-- - j - - ---- ---- - i I _ _i. J Before 1981 1982 i i 1983 I 1984 · 1985 1986 j I I 1987 . _ -I- _ I 1988 thrOU.9t11!!91-/-_ i 1992+ 1993 through _1 ~!!4. .1 1995 through 19!!8 i 1999 2000 i 2001 , 2002 2003 2004 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: I COMMONWEALTH,OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 06-0349 ACN 06128190 DATE 06-19-2006 REV.15~3 EX AFP ",. I., Jil Ie , v i TYPE OF ACCOUNT EST. OF MARION BORRIS 0 SAVINGS S.S. NO. 195-16-4587 OCI CHECKING DATE OF DEATH 04-07-2006 0 TRUST COUNTY CUMBERLAND 0 CERTIF. REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 'it ~,( SUSAN L ORRIS 8507 QUAINT LN VIENNA VA 22182 MEMBERS 1ST FCU has provided the Departaent with the inforaation listed balow which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, YOU were a ioint owner/beneficiary of this account. If yoU feel this inforaation is incorrect, please obtain written correction froa the financial institution, attach a copy to this fo,.. and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Coaaonwealth of Pennsylvania. Questions aay be answered by calling (717) 787-83Z7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 21649-11 Date 02-17-1984 Established Account Balance Percent Taxable Allount Subject to Tax Rate Potential Tax Due x 300.00 50.000 150.00 .045 6.75 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice BUst accoapany Your payaent to the Register of Wills. Make check payable to: "Register of Wills, Agent". Tax x NOTE: If tax payaents are aade within three (3) Bonths of the decedent's date of death, yoU aay deduct a SX discount of the tax due. Any inheritance tax due will becoae delinquent nine (9) aonths after the date of death. PART [!J A. [ CHECK ] ONE BLOCK B. ONLY c. If yoU indicate a different tax rate, please state your relationship to decedent: [J The above inforaation and tax due is correct. 1. You aay choose to reBit paYBent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or YOU aay check box "A" and return this notice to the Register of Wills and an official assessaent will be issued by the PA Departaent of Revanue. ~e abova 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 infor.ation is incorrect and/or debts and deductions were paid by You. You aust coaplete PART ~ and/or PART ~ below. PART ~ 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 PART f!J DATE PAID DEBTS AND DEDUCTIONS CLAIMED OF TAX ON JOINT/TRUST ACCOUNTS 1 2 3 X 4 5 6 7 X 8 PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax COMPutation) I $ of perjury, I declare that the facts I have reported above are true, correct and of ,DIY knOWledge and belief. HOME ( ) WORK ( ) TI=I I=p~n~lI= NIIMRI=P nATI= - GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on infor.aUon sub.itted by the financial institution. Z. Inheritance tax beco.es delinquent nine .onths after the decedent's date of death. 3. A joint account is taxable even though the decedent's na.e was added as a .atter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint na.es within one year prior to death are fullY taxable as transfers. 5. Accounts established jointly between husband and wife .ore 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 infor.ation and co.putation in the notice are correct and deductions are not being clai.ed, place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and sub.it the. with your check for the amount of tax to the Register of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official asses~ent [For. REV-1548 EX) upon receipt of the return fro. 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, Dept Z80601, Harrisburg, PA 17lZ8-0601 in the envelope provided. 3. BLOCK C _ If the notice infor.ation is incorrect and/or deductions are being clai.ed, check block "C" and complete Parts Z and 3 according to the instructions below. Sign two copies and sub.it the. with your check for the a.ount of tax payable to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official asses~ent (For. REV-1548 EX) upon receipt of the return fro. 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 .anner 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 nu.ber 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 fro. 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 Exa.ple: A joint asset registered in the naee of the decedent and two other persons. 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 3 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 16.7X (TAXABLE FOR EACH SURVIVOR) 1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE Example: Joint account registered in the naee 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 SOX (TAXABLE FOR EACH SURVIVOR) 4. The amount subject to tax (line 4) is deter.ined by .ultiplying 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 a.ount taxable (line 6) is deter.ined by subtracting the debts and deductions (line 5) fro. the amount subject to tax [line 4). 7. Enter the appropriate tax rate [line 7) as deter.ined below. MThe tax rate l.posed on the net value of transfers froe 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 OX. 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 co..on with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. Date of Death Spouse Lineal Sibling Collateral 07101/94 to 12131/94 3X 6X lSX lSX 01/01/9S to 06/30/00 OX 6X lSX lSX 07101/00 to present OX 4.SXII! 12X lSX CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are deter.ined as follows: A. You legally are responsible for pay.ent, or the estate subject to administration by a personal representative is insufficient to pay the deductible ite.s. B. You actually paid the debts after death of the decedent and can furnish proof of pay.ent. C. Debts being claimed eust be itemized fully in Part 3. If additional space is needed, use plain paper 8 l/Z" x 11". Proof of pay.ent may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1712B-0601 '* INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 06-0349 ACN 06128188 DATE 06-19-2006 REY-154S EX AF, 109-ln SUSAN L ORRIS 8507 QUAINT LN VIENNA VA 22182 TYPE OF ACCOUNT EST. OF MARION B ORRIS Ii] SAVINGS 5.5. NO. 195-16-4587 0 CHECKING DATE OF DEATH 04-07-2006 0 TRUST COUNTY CUMBERLAND 0 CERTIF. REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has provided the Dapartunt with the infor.ation 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 infor.ation is incorrect. please obtain written correction fro. the financial institution, attach a copy to this for. and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Coe.onwealth of PennsYlvania. Questions .ay be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 158655-05 Date 05-11-1996 Established Account Balance Percent Taxable A.ount Subject to Tax Rate Potential Tax Due x 1,810.53 50.000 905.27 .045 40.74 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice BUst acco.pany Your pay.ent to the Register of Wills. Maka check payable to: "Ragister of Wills, Agent". x NOTE: If tax pay.ents are .ade within three (3) 80nths of the decedent's date of death, YOU .ay deduct a 5% discount of the tax due. Any inheritance tax due will beco.e delinquent nine (9) .onths after the date of death. Tax PART ill A. [ CHECK ] ONE BLOCK B. ONLY c. c=J The above inforeation and tax due is correct. 1. You .ay 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 .ay check box "A" and return this notice to the Register of Wills and an official asses5aent will be issued by the PA Departeent of Revenue. ~e above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. c=J The above infor.ation is incorrect and/or debts and deductions were paid by you. You .ust coeplete PART ~ and/or PART ~ below. 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. A.ount Subject to Tax 5. Debts and Deductions 6. A.ount Taxable 7. Tax Rate 8. Tax Due PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED 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 Co.putationJ I $ of perjury, I declare that the facts I have reported above are true, correct and of .y knowledge and belief. HOME ( WORK ( TFIFPHnNE: > > NUMBER DATE - GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information sub.itted by the financial institution. Z. Inheritance tax beco.es delinquent nine .onths after the decedent.s date of death. 3. A joint account is taxable even though the decedent's na.e was added as a .atter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint na.es within one year prior to death are fully taxable as transfers. 5. Accounts established jointly between husband and wife .ore 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 infor.ation and co.putation in the notice are correct and deductions are not being clai.ed, place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and sub.it the. with your check for the alIount of tax to the Register of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official assessMent (For. REV-1548 EX) upon receipt of the return fro. 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, Dept Z80601, Harrisburg, PA 17lZ8-0601 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 Z and 3 according to the instructions below. Sign two copies and sub.it the. with your check for the amount of tax payable to the Register of Wills of the county indicated. The PA Depart.ent of Revenue will issue an official assessment (For. REV-1548 EX) upon receipt of the return fro. 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 .anner existing at date of death. For a decedent dying after lZ/lZl8Z: Accounts which the decedent put in joint na.es 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 na.e in the address portion of this notice, the $3,000 exclusion already has been deducted fro. 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 deter.ined 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 Exa.ple: A joint asset registered in the na.e of the decedent and two other persons. 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) * .167 X 100 16.7r. (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 50r. (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 detereined 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 deter.ined below. p ounger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is Dr.. 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 co.mon with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. Date of Death Spouse Lineal Sibling Collateral 07101/94 to 12/31/94 3X 6X 15X 1570 01101/95 to 06/30/00 OX 670 15X 1570 07101/00 to present OX 4.570- 1270 15X MThe tax rate im osed on the net value of transfers frOM a deceased ChIld twenty-one years of age or Y CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are determined as follows: A. You legallY are responsible for payment, or the estate subject to ad.inistration by a personal representative is insufficient to pay the deductible ite.s. B. You actually paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claimed must be iteeized fully in Part 3. If additional space is needed, use plain paper 8 l/Z" x II". Proof of payment may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 171Z8-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 06-0349 ACN 06128189 DATE 06-19-2006 REY-154S EX AFP 109-001 SUSAN L ORRIS 8507 QUAINT LN VIENNA VA 22182 TYPE OF ACCOUNT EST. OF MARION BORRIS IiJ SAVINGS S.S. NO. 195-16-4587 0 CHECKING DATE OF DEATH 04-07-2006 0 TRUST COUNTY CUMBERLAND 0 CERTIF. REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has provided the DepartBent with the inforBation 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 inforBatian is incorrect, please obtain written correction froB the financial institution, attach a copy to this forB and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the COBBOnwealth of PennSYlvania. Questions .ay be answered by calling (717) 787-83Z7. COMPLETE PART 1 BELOW · · . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 158655-00 Date 05-11-1996 Established Account Balance Percent Taxable AMOunt Subject to Tax Rate Potential Tax Due x 1,475.85 50.000 737.93 .045 33.21 TAXPAYER RESPONSE To insure proper credit to your account, two (Z) copies of this notice BUSt aCCoBpany your paYBent to the Register of Wills. Make check payable to: "Register of Wills, Agent". Tax x NOTE: If tax pay.ents are Bade within three (3) Bonths of the decedent.s date of death, yoU Bay daduct a SX discount of the tax due. Any inheritance tax due will baeoBe delinquent nine (9) Bonths after the date of death. PART ill A. [ CHECK ] ONE BLOCK B. ONLY c. If yoU indicate a different tax rate, please state your relationship to decedent: c=J The above inforBation and tax due is correct. 1. You Bay choose to reBit pay.ent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or YOU Bay check box "A" and return this notice to the Register of Wills and an official assesssent will be issued by the PA Depart.ent of Revenue. ~e above asset has been or will be reported and tax paid with the PennSYlvania Inheritance Tax return to be filed by the decedent.s representative. c=J The above inforBation is incorrect and/or debts and deductions were paid by You. You BUSt co.plete PART ~ and/or PART ~ below. PART ~ 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 PART @J DATE PAID DEBTS AND DEDUCTIONS CLAIMED OF 1 2 3 4 5 6 7 8 x TAX ON JOINT/TRUST ACCOUNTS x PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knOWledge and belief. ( ) ) NUMBER DATE - GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHENT with applicable interest based Dn infDrmatiDn sub.itted by the financial institutiDn. Z. Inheritance tax becD.es delinquent nine .Dnths after the decedent's date Df death. 3. A jDint accDunt is taxable even thDugh the decedent.s na.e was added as a matter Df cDnvenience. 4. AccDunts (including thDse held between husband and wife) which the decedent put in jDint names within Dne year priDr tD death are fully taxable as transfers. 5. AccDunts established jDintlY between husband and wife .Dre than Dne year priDr tD death are nDt taxable. 6. AccDunts held by a decedent "in trust fDr" anDther Dr Dthers are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAVER RESPONSE 1. BLOCK A _ If the infDr.atiDn and cD.putatiDn in the nDtice are cDrrect and deductiDns are nDt being clai.ed, place an "X" in blDCk "A" Df Part 1 Df the "Taxpayer RespDnse" sectiDn. Sign tWD CDpies and submit them with YDur check fDr the ~Dunt Df tax tD the Register Df Wills Df the cDunty indicated. The PA Depart.ent Df Revenue will issue an Dfficial assess.ent (FDr. REV-1548 EX) upDn receipt Df the return frD. the Register Df Wills. Z. BLOCK B _ If the asset specified Dn this nDtice has been Dr will be repDrted and tax paid with the Pennsylvania Inheritance Tax Return filed by the decedent's representative, place an "X" in blDck "B" Df Part 1 Df the "Taxpayer RespDnse" sectiDn. Sign Dne CDPy and return tD the PA Department Df Revenue, Bureau Df Individual Taxes, Oept Z80601, Harrisburg, PA 171Z8-0601 in the envelDpe prDvided. 3. BLOCK C _ If the nDtice infDr.atiDn is incDrrect and/Dr deductiDns are being clai.ed, check blDCk "C" and CD.plete Parts Z and 3 accDrding tD the instructiDns belDw. Sign tWD CDpies and submit them with YDur check fDr the amDunt Df tax payable tD the Register Df Wills Df the cDunty indiceted. The PA Oepart.ent Df Revenue will issue an Dfficial assesSMent (FDrm REV-1548 EX) upDn receipt Df the return frD. the Register Df Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE L Enter NOTE: the date the accDunt DriginallY was established Dr titled in the manner existing at date Df death. FDr a decedent dying after lZ/lZ/8Z: AccDunts which the decedent put in jDint names within Dne (1) year Df death are taxable fullY as transfers. HDwever, there is an exclusiDn nDt tD exceed $3,000 per transferee regardless Df the value Df the account Dr the nu.ber Df accDunts held. If a dDuble asterisk (NN) appears befDre YDur first name in the address pDrtiDn Df this nDtice, the $3,000 exclusiDn already has been deducted frD. the accDunt balance as repDrted by the financial institutiDn. Z. Enter the tDtal balance Df the accDunt including interest accrued tD the date Df death. 3. The percent Df the accDunt that is taxable fDr each survivDr is deter.ined as fDllDws: A. The percent taxable fDr jDint assets established mDre than Dne year priDr tD the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Exa.ple: A jDint asset registered in the name Df the decedent and tWD Dther persDns. 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 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 16.7X (TAXABLE FOR EACH SURVIVOR) 1 DIVIDED 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 tWD Dther persDns and established within Dne year Df death by the decedent. 1 DIVIDED BY Z (SURVIVORS) = .50 X 100 50X (TAXABLE FOR EACH SURVIVOR) 4. The a.Dunt subject tD tax (line 4) is determined by multiplying the accDunt balance (line Z) by the percent taxable (line 3). 5. Enter the tDtal Df the debts and deductiDns listed in Part 3. 6. The amDunt taxable (line 6) is determined by subtracting the debts and deductiDns (line 5) frD. the amDunt subject tD tax (line 4). 7. Enter the apprDpriate tax rate (line 7) as determined belDw. NThe tex rate 1.PDsed Dn the net value Df transfers frDm a deceased chIld twenty-Dne years Df ege Dr YDunger at death tD Dr fDr the use Df a natural parent, an adDptive parent, Dr a stepparent Df the child is OX. 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 all children Df the natural parents and their descendents, whether Dr nDt they have been adDpted by Dthers, adDpted descendents and their descendants and step-descendants. "Siblings" are defined as individuals whD have at least Dne parent in CDm.Dn with the decedent, whether by blDDd Dr adDptiDn. The "CDllateral" class Df heirs includes all Dther beneficiaries. Date of Death Spouse Lineal Sibling Collateral 07/01194 to 12/31/94 3i: 6i: 15i: 15i: 01/01/95 to 06/30/00 Oi: 6i: 15i: 15i: 07/01100 to present Oi: 4.5i:lli 12i: 15i: CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED AllDwable debts and deductiDns are determined as fDllDws: A. YDU legally are respDnsible fDr payment, Dr the estate subject tD administratiDn by a persDnal representative is insufficient tD pay the deductible ite.s. B. YDU actually paid the debts after death Df the decedent and can furnish prDDf Df payment. C. Debts being claimed must be itemized fully in Part 3. If additiDnal space is needed, use plain paper 8 l/Z" x 11". PrDDf Df pay.ent may be requested by the PA Department Df Revenue. COMMONWEALTH.OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. ZB0601 HARRISBURG, PA 171ZB-0601 '* INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 06-0349 ACN 06128186 DATE 06-19-2006 REY-1545 EX AFP (19-101 SUSAN L ORRIS 8507 QUAINT LN VIENNA VA 22182 TYPE OF ACCOUNT EST. OF MARION BORRIS 0 SAVINGS S.S. NO. 195-16-4587 OCJ CHECKING DATE OF DEATH 04-07-2006 0 TRUST COUNTY CUMBERLAND 0 CERTIF. REHIT PAYHENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 HEHBERS 1ST FCU has provid..d th.. D..part...nt with th.. infor.ation list..d b..low which has b....n us..d in calculating th.. pot..ntial tax du... Th..ir r..cords indicat.. that at th.. d..ath of th.. abov.. d..c..d..nt, yoU w..r.. a joint own..r/b..neficiary of this account. If YOU f....l this inforeation is incorr..ct, pl..as.. obtain written correction froe th.. financial institution, attach a copy to this fore and r..turn it to th.. abov.. addr..ss. This account is taxabl.. in accordanc.. with th.. Inh..ritanc.. Tax Laws of th.. Coeeonw..alth of P..nnsYlvania. Qu..stions eay b.. answ..red by calling (717) 787-83Z7. COMPLETE PART 1 BELOW · · . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 21650-11 Dete 02-19-1980 ('I. Established Account Balance Percent Taxable Allount Subject to Tax Rate Potential Tax Due x 2,865.53 50.000 1 ,432. 77 .045 64.47 TAXPAYER RESPONSE To insur.. prop..r cr..dit to your account, two (Z) copi..s of this notic.. BUst accoepany Your paye..nt to th.. R..gist..r of Wills. Mak.. check payabl.. to: "Regist..r of Wills, Ag..nt". Tax x NOTE: If tax paye..nts ar.. ead.. within thre.. (3) eonths of th.. d..c..d..nt's dat.. of d..ath, YOU BaY d..duct a 5% discount of th.. tax du... Any inh..ritanc.. tax du.. will b..coe.. d..linqu..nt nin.. (9) eooths aft..r th.. dat.. of d..ath. PART III A. [ CHECK ] ONE BLOCK B. ONLY c. If yoU indicate a different tax rate, please state your relationship to decedent: r=J The abov.. inforeation and tax du.. is corr..ct. 1. You eay choos.. to reeit peY...nt to the R..gist..r of Wills with two copies of this notic.. to obtain a discount or avoid int..r..st, or YOU .ay check box "A" and return this notic.. to th.. R..gister of Wills and an official ass..sS8ent will b.. issued by the PA Departe..nt of Rev..nu... ~abov" asset has b....n or will be r..port..d and tax paid with th.. Pennsylvania Inh..ritanc.. Tax r..turn to b.. filed by the d..ced..nt's representativ... r=J Th.. abov.. infor.ation is incorrect and/or d..bts and deductions w..r.. paid by YOU. You .ust coepl..t.. PART ~ and/or PART ~ below. PART ~ TAX RETURN - COMPUTATION lINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Allount Subject to Tax 5. Debts and Deductions 6. Allount Taxable 7. Tax Rate 8. Tax Due PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED OF 1 2 3 4 5 6 7 8 x TAX ON JOINT/TRUST ACCOUNTS x PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on line 5 of Tax COIIPutation) $ HOME WORK ( ( ) ) T I C'DUn&.l~ &.IIIUftr'"n ---- GENERAL INFORMATION 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicabl.. int..rest based Dn infDrllatiDn subllitted by th.. financial institutiDn. z. Inh..ritance tax becDII..s delinquent nin.. eDnths aft..r th.. d..cedent's date Df death. 3. A joint account is taxabl.. even thDugh th.. deced..nt.s naee was added as a lIatt..r Df cDnvenience. 4. AccDunts (including thDse held b..tw....n husband and wife) which the decedent put in jDint nalles within Dne year priDr tD d..ath are fullY taxable as transf..rs. 5. AccDunts established jDintly b..tween husband and wif.. IIDr.. than Dne year priDr tD death are nDt taxable. 6. AccDunts held by a d..cedent "in trust fDr" anDther Dr Dth..rs are taxabl.. fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAVER RESPONSE 1. BLOCK A _ If the infDrllatiDn and cDllputatiDn in th.. nDtic.. are cDrrect and deductiDns are nDt being claill..d, place an "X" in blDck "A" Df Part 1 Df th.. "Taxpayer RespDnse" sectiDn. Sign tWD CDpies and subllit thee with YDur check fDr th.. allDunt Df tax tD the Register Df Wills Df th.. CDunty indicated. The PA Departllent Df Revenu.. will issue an Dfficial assesseent (FDrll REV-1548 EX) upDn receipt Df the return frDII the Register Df Wills. Z. BLOCK B _ If the asset specified Dn this nDtice has b..en Dr will b.. repDrted and tax paid with the Pennsylvania Inheritanc.. Tax Return filed by the decedent's representative, place an "X" in blDck "B" Df Part 1 Df the "Taxpayer RespDnse" sectiDn. Sign Dn.. CDPy and return tD th.. PA Departllent Df Revenu.., Bureau Df Individual Taxes, Dept Z80601, Harrisburg, PA 171Z8-0601 in the envelDpe prDvided. 3. BLOCK C _ If the nDtice infDrllatiDn is incDrrect and/Dr deductiDns are being claill..d, check blDck "C" and CDllplete Parts Z and 3 accDrding tD th.. instructiDns belDw. Sign tWD CDpies and subllit thell with YDur check fDr the allDunt Df tax payable tD th.. Register Df Wills Df th.. cDunty indicated. The PA Depart.ent Df Revenue will issue an Dfficial assessllent (FDre REV-1548 EX) upDn receipt Df the return frDII th.. Register Df Wills. TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Enter NOTE: the date the accDunt DriginallY was established Dr titl..d in th.. lianneI' existing at date Df death. For a decedent dying after lZ/lZ/8Z: AccDunts which th.. decedent put in jDint nall"s within Dne (1) year Df death ar.. taxabl.. fully as transf..rs. HDwever, there is an exclusiDn nDt tD exce..d $3,000 per transfer..e regardless Df the value Df the accDunt Dr th.. nueber Df accDunts held. If a dDUbl.. ast..risk (MM) appears befDre YDur first nalle in the address pDrtiDn Df this nDtice, the $3,000 exclusiDn alreadY has been deducted frDe the accDunt balanc.. as r"pDrted by the financial institutiDn. Z. Ent..r th.. tDtal balance Df the accDunt including int..rest accrued tD the dat.. Df death. 3. Th.. p..rcent Df th.. accDunt that is taxable fDr each survivDr is d..tereined as fDIIDws: A. The percant taxable fDr jDint assets established .Dre than Dne year priDr tD the decedent's death: 1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Exallple: A jDint asset registered in the nail.. Df th.. dec..dent and tWD Dther persDns. B. The percent taxable fDr assets created within Dne year Df the dec..dent's death Dr accDunts Dwned by the decedent but held in trust fDr anDther individual(s) (trust beneficiaries): 1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 16.7Z (TAXABLE FOR EACH SURVIVOR) 1 DIVIDED BY TDTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE Example: JDint accDunt registered in the naee Df the decedent and tWD Dther persDns and established within Dne year Df death by the decedent. 1 DIVIDED BY Z (SURVIVORS) = .50 X 100 50Z (TAXABLE FOR EACH SURVIVOR) 4. The allDunt subject tD tax (line 4) is detereined by eultiplying the accDunt balance (line Z) by the percent taxable (line 3). 5. Enter the tDtal Df th.. debts and deductiDns listed in Part 3. 6. The aIIDunt taxable (lin.. 6) is d..t..reined by subtracting th.. debts and deductiDns (line 5) frDII the allaunt subject tD tax (line 4). 7. Ent..r the apprDpriat.. tax rate (line 7) as detereined belDw. MThe tax rate 1epDs..d Dn the net value Df transfers frDe a deceased Ch11d twentY-Dne years Df age Dr YDunger at death tD Dr fDr the use Df a natural parent, an adDptive parent, Dr a stepparent Df the child is OZ. Th.. lineal class Df heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children whether Dr nDt they hav.. been adDpted by Dthers, adDpted children and step children. "Lineal descendents" includes all children Df the natural parents and their descendents, whether Dr nDt they have been adDpted by Dthers, adDpted descendents and their descendants and step-descendants. "Siblings" are defined as individuals whD have at least Dne parent in CDIIIIDn with the decedent, wheth..r by blDDd Dr adDptiDn. The "CDllateral" class Df h..irs includes all Dther beneficiaries. Oat. of Death Spouse Lineal Sibling Collateral 07101/94 to 12/31/94 370 670 1570 1570 01/01/95 to 06/30/00 OX 670 1570 1570 07101/00 to present OX 4.57011 1270 1570 CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED AIIDwable debts and deductiDns are deter.ined as fDIIDws: A. YDU legally are respDnsible fDr paYllent, Dr the estate subject tD ad.inistratiDn by a persDnal representative is insufficient tD pay the deductible itells. B. YDU actually paid the debts after death Df the decedent and can furnish prDDf Df paYllent. C. Debts being claimed must be itellized fully in Part 3. If additiDnal space is needed, use plain paper 8 l/Z" x II". PrDDf Df pay.ent lIay be requested by the PA Depart.ant Df Revenue. COHHONWEALTH OF PENNSYLVANIA 'DEPARTHENT.OF REVENUE BU~EAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 06-0349 ACN 06128187 DATE 06-19-2006 REY-154J EX AFP 109-01l SUSAN L ORRIS 8507 QUAINT IN VIENNA VA 22182 TYPE OF ACCOUNT EST. OF MARION BORRIS !iJ SAVINGS 5.5. NO. 195-16-4587 0 CHECKING DATE OF DEATH 04-07-2006 0 TRUST COUNTY CUMBERLAND 0 CERTIF. REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has provided the Departaent with the infor.ation 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 ioint owner/beneficiary of this account. If yoU feel this inforaation is incorrect, please obtain written correction froa the financial institution, attach a copy to this fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Coaaonwealth of PennSYlvania. Questions aay be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW · · . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 21650-00 Date 02-27-1979 ~ v ~, Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 2,876.18 50.000 1.438.09 .045 64.71 TAXPAYER RESPONSE NOTE: If tax payaants are aade within three (3) aonths of the decedent's date of death, YOU aay deduct a SX discount of the tax due. Any inheritance tax due will becoae delinquent nins (9) aonths after the date of death. Tax x PART [!J A. [ CHECK ] ONE BLOCK B. ONLY c. If yoU indicate a different tax rate, please state your relationship to decedent: c=J The above inforaation and tax due is correct. 1. You aay choose to reait paY.ent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or YOU aay check box nAn and return this notice to the Register of Wills and an official assesS8ent will be issued by the PA Depart.ent of Revenue. ~ ..... ..... .., .... " .." .. ...',... ... ... .... .,., ... .,..",'..,. '...,'..... ,,, NO'", to be filed by the decedent.s representative. c=J The above inforaation is incorrect and/or debts and deductions were paid by You. You aust co.plete PART ~ and/or PART ~ below. PART ~ TAX RETURN - COMPUTATION OF lINE 1. Date Established 1 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 PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED TAX ON JOINT/TRUST ACCOUNTS x x PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and co.plete to the best of .y knOWledge and belief. I TOTAL CEnter on line 5 of Tax Computation) $ HOME ( WORK ( TE EPHONE ) ) NUMBER DATE 1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHENT with applicable interest based on inforeation sub.itted by the financial institution. Z. Inheritance tax beco.es delinquent nine .onths after the decedent's date of death. 3. A joint account is taxable even though the decedent.s na.e was added as a eatter of convenience. 4. Accounts (including those held between husband and wife) which the decedent put in joint naees within one year prior to death are fully taxable as transfers. 5. Accounts established jointlY between husband and wife .ore than one year prior to death are not taxable. 6. Accounts held bY a decedent "in trust for" another or others are taxable fullY. GENERAL INFORMATION REPORTING INSTRUCTIONS - PART 1 TAXPAYER RESPONSE 1. BLOCK A _ If the inforeation and co.putation in the notice are correct and deductions are not being claieed, place an "X" in block "A" of Part 1 of the "Taxpayer Response" section. Sign two copies and sub. it the. with your check for the a.ount of tax to the Register of Wills of the county indicated. The PA Departeent of Revenue will issue an official asses~ent (For. REV-154B EX) upon receipt of the return fro. 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 Depart.ent of Revenue, Bureau of Individual Taxes, Dept ZB0601, Harrisburg, PA 171Z8-0601 in the envelope provided. 3. BLOCK C _ If the notice inforaation is incorrect andlor deductions are being clai.ed, check block "c" and co.plete Parts Z and 3 according to the instructions below. Sign two copies and sub.it the. with your check for the aeount of tax payable to the Register of Wills of the county indicated. The PA Departaent of Revenue will issue an official assessment (For. REV-1548 EX) upon receipt of the return fro. the Register of Wills. 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 1Z/1Z18Z: Accounts which the decedent put in joint naees 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 nueber of accounts held. TAX RETURN - PART 2 - TAX COMPUTATION If a double asterisk (MM) appears before your first naee in the address portion of this notice, the $3,000 exclusion already has been deducted fro. the account balance as reported by the financial institution. Z. Enter the total be lance of the account including interest accrued to the date of death. 3. The percent of the account that is taxable for each survivor is deter.ined as follows: A. The percent taxable for joint assets established .ore than one year prior to the decedent's death: 1 DIVIDED BV TOTAL NUMBER OF DIVIDED BV TOTAL NUMBER OF X 100 PERCENT TAXABLE JOINT OWNERS SURVIVING JOINT OWNERS Exa.ple: A joint asset registered in the na.e of the decedent and two other persons. 1 DIVIDED BV 3 (JOINT OWNERS) DIVIDED BV Z (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 individua1(s) (trust beneficiaries): 1 DIVIDED BV TOTAL NUMBER OF SURVIVING JOINT OWNERS OR TRUST BENEFICIARIES X 100 PERCENT TAXABLE Example: Joint account registered in the naae of the decedent and two other persons and established within one year of death by the decedent. 1 DIVIDED BV Z (SURVIVORS) = .50 X 100 50~ (TAXABLE FOR EACH SURVIVOR) 4. The a.ount subject to tax (line 4) is deterained by mUltiplying the account balance (line Z) ~y the percent taxable (line 3). 5. Enter the total of the debts and deductions listed in Part 3. 6. The a.ount taxable (line 6) is deterained by subtracting the debts and deductions (line 5) froe the a.ount subject to tax (line 4). 7. Enter the appropriate tax rate (line 7) as detereined below. p g ounger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is O~. 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 coamon with the decedent, whether by blood or adoption. The "Collateral" class of heirs includes all other beneficiaries. Date of Death Spouse Lineal Sibling Collateral 07101/94 to 12/31/94 37- 67- 157- 157- 01101195 to 06/30/00 07- 67- l!i7- 157- 07101/00 to present 07- 4.57-- 127- 157- MThe tax rate T. osed on the net value of transfers froe a deceased chlld twenty-one years of a e or Y CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions are deterained as follows: A. You legallY are responsible for payeent, or the estate subject to adeinis~ation by a personal representative is insufficient to pay the deductible itees. B. You actuallY paid the debts after death of the decedent and can furnish proof of payment. C. Debts being claieed must be ite.ized fullY in Part 3. If additional space is needed, use plain paper 8 l/Z" x 11". Proof of pay.ent may be requested by the PA Department of Revenue. COMMONWEALTH OF PENNSYLVANIA DEPART~NT ~F REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 06-0349 ACN 06128185 DATE 06-19-2006 REY-1545 EX AFP 119-DII EST. OF MARION BORRIS S.S. NO. 195-16-4587 DATE OF DEATH 04-07-2006 COUNTY CUMBERLAND TYPE OF ACCOUNT Ii] SAVINGS o CHECKING o TRUST o CERTIF. SUSAN L ORRIS 8507 QUAINT LN VIENNA VA 22182 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MEMBERS 1ST FCU has provided the Depart.ent Nith the inforntion listed beloN Nhich has bun used in calculating the potential tax due. Their records indicate that at the death of the above decedent, YOU Nere a joint oNner/beneficiary of this account. If yoU feel this inforRation is incorrect, please obtain Nritten correction fro. the financial institution, attach a copy to this for. and return it to the above address. This account is taxable in accordance Nith the Inheritance Tax LOINS of the Co..onNealth of PennSYlvania. Questions .ay be ansNered by calling (717) 787-8327. COMPLETE PART 1 BELOW Account No. 21650-09 f ~hi Account Balence Percent Taxabla ABount Subject to Tax Tax Rate Potential Tax Due · · · SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Date 02-28-1986 EstabUshed x 47,831. 57 50.000 23,915.79 .045 1,076.21 TAXPAYER RESPONSE To insure proper credit to your account, tNo (2) copies of this notice .ust acco.pany Your paY.ent to the Register of Wills. Make check payable to: ftRegister of Wills, Agentft. x NOTE: If tax pay.ants are ..ade Nithin three (3) .onths of the decedent's date of death, YOU ..ay deduct a SX discount of the tax due. Any inheritance tax due Nill beco.e delinquent nine (9) .onths after the date of death. PART ill A. [ CHECK ] ONE BLOCK B. ONLY c. If yoU indicate a different tax rate, please state your relationship to decedent: c=J The above infor.ation and tax due is correct. 1. You .ay choose to re.it pay.ent to the Register of Wills Nith tNO copies of this notice to obtain a discount Dr avoid interest, Dr YOU ..ay check box ftAft and return this notice to the Register of Wills and an official assess.ent Nill be issued by the PA Departaent of Revenue. ~ above asset has been Dr Nill be reported and tax paid with the PennSYlvania Inheritance Tax return to be filed by the decedent's representative. c=J The above infor.ation is incorrect and/or debts and deductions were paid by YOU. You .ust co.plete PART ~ and/or PART [!J beloN. PART ~ TAX RETURN' - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. ABount Subject to Tax 5. Debts and Deductions 6. ABount Taxable 7. Tax Rate 8. Tax Due PART @] DATE PAID DEBTS AND DEDUCTIONS CLAIMED OF 1 2 3 4 5 6 7 8 x TAX ON JOINT/TRUST ACCOUNTS x PAYEE DESCRIPTION AMOUNT PAID perjury, I declare that the facts I have reported above are true, correct and BY knOWledge and belief. .J HOME ( WORK ( TelEPHONE ) ) NUMBER DATE - :j l)ue ~ ~o. c.7\:'- 3Lc.>O - dD N f\.? D 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 DepartMent of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the envelope provided. 3. BLOCK C _ If the notice inforMation is incorrect andlor deductions are being claimed, check block "c" and COMplete Parts 2 and 3 according to the instructions below. Sign two copies and submit theM with your check for the amount of tax payable to the Register of Wills of the county indicated. The PA DepartMent of Revenue will issue an official asseSSMent (ForM REV-1548 EX) upon receipt of the return frOM the Register of Wills. 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. TAX RETURN - PART 2 - TAX COMPUTATION 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: 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 2 (SURVIVORS) = .167 X 100 l6.7Y. (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 2 (SURVIVORS) - .50 X 100 50Y. (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 totel 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 OY.. 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 37- 67- 157- 157- 01101/95 to 06/30/00 07- 67- 157- 157- 07/01/00 to present 07- 4.57-- 127- 157- 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. REAGER & ADLER, PC ATTORNEYS AND COUNSELORS AT LAW 2331 MARKET STREET CAMP HILL, PENNSYLVANIA 17011-4642 717-763-1383 TELEFAX 717-730-7366 WEBSITE: ReagerAdlerPC.com THEODORE A. ADLER + DAVID W. REAGER CHARLES E. ZALESKI LINUS E. FENICLE THOMAS O. WILLIAMS SUSAN J. SMITH SUSAN H. CONFAIR TIFFANY M. CARTWRIGHT PETER R. WILSON JOHN H. PIETRZAK RICHARD J. JOYCE + Certified Civil Trial Specialist Writer's E-Mail Address:MZercher@ReagerAdlerPC.com July 3, 2006 Cumberland County Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, P A 17013 RE: Estate of Marion B. Orris Our file number: 00-899.001 Dear Sir or Madam: "'-.~~....i Enclosed for filing please find the Supplemental Inheritance Tax Retum for the Estate of Marion B. Orris. This Return reports additional joint assets only, therefore no Inventory is required with this filing. An Inventory was filed at the time of the original Inheritance Tax filing. Please time stamp the additional copy and retum it to me in the self-addressed, stamped envelope enclosed. Thank you for your attention to this matter. Very truly yours, : \." L2 t" ~) /1) /' Monica D. Zercher Legal Assistant Enclosures