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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NoTICE OF NONRESIDENT INHERITANCE
TAX APPRAISEMENT, ALLOWANCE OR
DlsALLOWANCE OF DEDUCTIONS,
AND ASSESSMENT OF TAX
AM 8: 41 DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
03-05-2007
HAGN
08-07-2004
99 05-0323
NON-RESIDENT
101
APPEAL DATE: 05-04-2007
( See reverse side under Objections)
A.ount Rellittedl
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
PA DEPARTMENT OF REVENUE
P.O. BOX 280601
HARRISBURG, PA 17128-0601
C:~! _~~'!~~ _ !~!~ _ ~!~~ _ _ _ _ _ ~ _ _ _~~-':~1:.~ _l:.~'!~~ _~~~-':I_~~ _~~~ _~~~~ _~~c:~~~~ _ _ _~_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
REV-537 EX AFP (03-05) NOTICE OF NONRESIDENT INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
GEORGE H FILE NO. 99 05-0323 ACN 101
BUREAU OF INDIVIDUAL TAXE~ -
INHERITANCE TAX DIVISION
PO BOX 2BOli0l
HARRISBURG PA 1712B-01i0l
2007 r~lft.R - 6
Or.r"l'"
,.I\--;i,J1-' 1 ,
r,! ~l;, ,,-- -.
JAMES MCCONVItt~ ESQ
7010 LITTLE RV TPKE 320
ANNANDALE VA 22003
ESTATE OF
HAGN
DATE 03- 05-2007
'*
REV-537 EX AFP (Oli-05)
GEORGE
H
TAX COMPUTATION METHOD ELECTED: (X) FLAT RATE () PROPORTIONATE
TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2.
3.
4.
5.
6.
7.
8.
Stocks and Bonds (Schedule B)
Closely Held Stock/Pa~tne~ship Inte~est (Schedule C)
Mo~tgages/Notes Receivable (Schedule D)
Cash/Bank Deposits/Misc. Pe~sonal P~ope~ty (Schedule E)
Jointly Owned P~ope~ty (Schedule F)
T~ansfe~s (Schedule G)
Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Fune~al Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mo~tgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Retu~n
13. Cha~itable/Gove~nmental Bequests (Schedule J)
14. Net Value of Estate Subject to Tax
(1)
(2)
(3)
(4)
(5)
(6)
(7)
320,000.00
.00
.00
.00
.00
.00
.00
NOTE: To insu~e p~ope~
c~edit to you~ account,
submit the uppe~ po~tion
of this fo~m with you~
tax payment.
(8)
320,000.00
(9)
(0)
.00
.00
(11)
(2)
(3)
(4)
.00
320,000.00
.00
320,000.00
NOTE: If an assess.ent was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ~ returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal ~ate OS)
16. Amount of Line 14 taxable at Lineal/Class A ~ate (6)
17. Amount of Line 14 at Sibling ~ate (7)
18. Amount of Line 14 taxable at Collate~al/Class B ~ate (8)
19. P~incipal Tax Due
NUMBER (-)
05-06-2005 NROOnOO .00
II
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN *1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
~
.00 X 00
320,000.00 X 045
.00 X 12
.00 X 15
AMOUNT PAID
14,400.00
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
(19)
.00
14,400.00
.00
.00
14,400.00
14,400.00
.00
.00
.00
,/173702 EX + \:;I-U,*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
NONRESIDENT DECEDENT
ESTATE OF
SCHEDULE A, PART 1
REAL ESTATE
IN PENNSYLVANIA
FILE NUMBER
Part 1 must include all real property owned by the decedent individually or as a tenant in common with another party(ies), having its
situs in Pennsylvania. Property which is jointly-owned with right of survivorship should be disclosed on Schedule F. All real estate
must be reported at fair market value which is defined as the price at which property would be exchanged between a willing buyer and
a willing seller, neither being compeM~d to buy or sell, both having reasonable knowledge of the relevant facts.
ITEM ,.:~
NUMBER DESCRIPTION VALUE AT DATE OF DEATH
1. "....... S S~""~'^) ~().'C ~,'v\ S- ~ ~d..O ~(jO
(.lOO
)
~"'Y'\ \~\~ 9~
~ \)~\~v\u~~ ~~~Y7
\
\
I
,.
,
PARI 'I lOTAL
.. $
. .
PARI 2 lOTAL
Proportionate Method Only from reverse side $
TOIAL (Also enter on line 1, Recapitulation) $ .]~O vlfu
. .
(If more space IS needed, Insert additional sheets of the same size)
,OMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
-Ft.N.....VLVANIA
INHERITANCE AND EsTATE TAX
~~':rl~l* "~CEIPT
Ual h;.PNo. NR007100
RECEIVED FROM:
JAMES MCCONVILLE ESQ
7010 LITTLE RIVER TURNPIKE # 320
ANNADALE VA 22003
ESTATE INFORMATION
FILE NUMBER
99 05-0323
NAME OF DECEDENT (LAST)
HAGN
DATE OF PAYMENT
POSTMARK DATE
COUNTY
Non-Resident
DATE OF DEATH
REMARKS
VA
SEAL
ACN
ASSESSMENT
CONTROL
NUMBER
101
(FIRST)
GEORGE
5/11/2005
5/6/2005
(MI)
H
8/7/2004
TOTAL AMOUNT PAID
RECEIVED BY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
Register
AMOUNT
14,400.00
$14.400.00
John M. Riedman