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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
*'
DATE 06-05-2007
ESTATE OF MOORE CARRIE M
DATE OF DEATH 09-27-2006
FILE NUMBER 21 06-1152
COUNTY CUMBERLAND
ACN 101
APPEAL DATE: 08-04-2007
( See reverse side "nder Objections)
A.ount Re.lttedl I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
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REV-1547 EX AFP C03-05} NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF MOORE CARRIE M FILE NO. 21 06-1152 ACN 101 DATE 06-05-2007
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO lOX 210601
HARRISIURG PA 17128-0601
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III
ANDREW C SHEELY
127 S MARKET ST
PO BOX 95
MECHANICSBURG
PA 17055
REV-1547 EX AFP (06-05)
( ) CHANGED
TAX RETURN WAS: (X) ACCEPTED AS F I LED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/AdM. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/GovernMental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
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 ALL returns assessed to date.
ASSESSMENT OF TAX:
15. AMount of Line 14 at Spousal rate
16. AMount of Line 14 taxable at Lineal/Class A rate
17. AMount of Line 14 at Sibling rate
18. AMount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
NOTE:
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
NOTE: To insure proper
credit to your account,
SUbMit the upper portion
of this form with your
tax paYMent.
4,099.51
156,092.78
.00
(8)
160,192.29
(9)
(10)
2,770.00
3,920. 16
(11)
(12)
(13)
(14)
&.1090 1&
153,502.13
.00
153,502.13
(15)
(16)
(17)
(18)
.00 X
153,502.13 X
.00 X
.00 X
00 .
045.
12 =
15 .
.00
6,907.59
.00
.00
6,907.59
(19).
NUMBER
CD00761 7
CD007969
+
INTEREST/PEN PAID (-)
13.61
.00
AMOUNT PAID
258.58
6,525.99
DATE
12-27-2006
04-04-2007
PAYMENT MUST BE MADE BY 06-27-2007-.
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
6,798.18
109.41
.00
109.41
( 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.)