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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 2B0601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
"";Cr/1lop;p:~r~~E.MJ:NT, ALLOWANCE OR DISALLOWANCE
- 'O'F' D!DlICTIONS AND ASSESSMENT OF TAX
2007 JUL 30 PN I: 25
'*
REV-1547 EX AFP (06-05)
DATE 07-23-2007
ESTATE OF UZEMACK PATRICIA G
DATE OF DEATH 01-19-2007
FILE NUMBER 21 07-0082
COUNTY CUMBERLAND
ACN 101
APPEAL DATE: 09-21-2007
( See reverse side under Objections)
A.ount Remittedl 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 UZEMACK PATRICIA G FILE NO. 21 07-0082 ACN 101 DATE 07-23-2007
CLEr~'}\ Or:
ORPJ-it\~\i'C; r'J'
GERALD J SHEKLETW;VES/t' . ',.:..IC upr .
STONE ETAL P':i
PO BOX E
NEW CUMBERLAND PA 17070
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of Abh 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
TA CR DITS:
AY ENT
DATE
04-13-2007
05-14-2007
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Mortgages/Notes Receivable (Schedule D) (4)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
238,000.00
24,494.15
.00
.00
139,980.27
106.57
75,641.78
(8)
8.
Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
(9)
(0)
62,372.81
.00
(1)
(2)
(3)
(4)
10.
II.
12.
13.
14.
Debts/Mortgage Liabilities/Liens (Schedule I)
Total Deductions
Net Value of Tax Return
Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
Net Value of Estate Subject to Tax
NOTE:
(5)
(6)
(7)
(18)
.00
379,954.79
.00
35,895.17
X 00
X 045 =
X 12 =
X 15 =
RECEIPT
NUMBER
CD008021
CD008162
DISCOUN (+)
INTEREST/PEN PAID (-)
1,052.63
.00
AMOUNT PAID
20,000.00
1,429.65
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
478,222.77
~?37?*Rl
415,849.96
.00
415,849.96
(9)=
.00
17,097.97
.00
5,384.28
22,482.25
22,482.28
.03CR
.00
.03CR
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE D
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)