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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 2BO'01
HARRISBURG PA 17128-0'01
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAIsEMENT, ALLOWANCE OR DISALLOWANCE
OFUEDUCTIONS AND ASSESSMENT OF TAX
*'
REV-1547 EX AFP (06-05)
DATE 05-28-2007
ESTATE OF KEIM HELEN W
DATE OF DEATH 02-23-2006
FILE NUMBER 21 06- 0269
COUNTY CUMBERLAND
ACN 101
APPEAL DATE: 07-27-2007
( 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 (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF KEIM HELEN W FILE NO. 21 06-0269 ACN 101 DATE 05-28-2007
:"7 ,.:' I ' ,,' Ir) I L
j ...' ',I, - j I h ,(.,.:::,
THOMAS E FLOWER p~
SAlOIS ETAL
2109 MARKET ST
CAMP HILL PA 17011
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. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Pa~tne~ship Inte~est (Schedule C)
4. Mo~tQaQes/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Pe~sonal P~ope~ty (Schedule
,. Jointly Owned P~ope~ty (Schedule F)
7. T~ansfe~s (Schedule G)
8. Total Assets
(1) .00
(2) .00
(3) .00
(4) .00
E) (5) .00
(6) 85,989.00
(7) .00
(8)
NOTE: To insu~e p~ope~
c~edit to YOu~ account,
submit the uppe~ po~tion
of this fo~m with YOu~
tax payment.
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Fune~al Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mo~tQaQe Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Retu~n
13. Cha~itable/Gove~nmental Bequests; Non-elected 9113 T~usts (Schedule
14. Net Value of Estate Subject to Tax
85,989.00
(9)
CIO)
.00
.00
(11) on
CI2) 85,989.00
J) CI3) .00
CI4) 85,989.00
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 ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal ~ate
16. Amount of Line 14 taxable at Lineal/Class A ~ate
17. Amount of Line 14 at SiblinQ ~ate
18. Amount of Line 14 taxable at Collate~al/Class B ~ate
19. P~incipal Tax Due
DATE
NUMBER
+
INTEREST/PEN PAID (-)
CI5) 85,989.00 X 00 .00
(U) .00 X 045.. .00
CI7) .00 X 12 .. .00
CI8) .00 X 15 .. .00
CI9).. .00
AMOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.00
.00
.00
.00
* 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.)