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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 2B0601
HARRISBURG PA 1712B-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
:A:PP/t.(I:SEMENT, ALLOWANCE OR DISALLOWANCE
-O~DEDUCTIONS AND ASSESSMENT OF TAX
*'
REV-1547 EX AFP <06-05)
DATE 09-24-2007
ESTATE OF RAFALOVICH MARK
DATE OF DEATH 12-31-2004
FILE NUMBER 21 07-0263
COUNTY CUMBERLAND
ACN 101
APPEAL DATE: 11-23-2007
( 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 RAFALOVICH MARK FILE NO. 21 07-0263 ACN 101 DATE 09-24-2007
2007 OCT -I AH 10: 47
ZHANNA KORSUNSKY
121 N LAKEVIEW DR
HBG PA 17110
r': fT;/ (iF
ODp~j7\'i'''' '<(II !PT
)1 I I I. . ; '.j', j P ; I
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.
Closely Held Stock/Partnership Interest (Schedule C)
Mortgages/Notes Receivable (Schedule D)
Cash/Bank Deposits/Misc. Personal Property (Schedule E)
Jointly Owned Property (Schedule F)
Stocks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
S,DDD.DD
.00
.00
(8)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
Transfers (Schedule G)
Total Assets
S,DDD.DD
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
(9)
CIO)
.00
.00
(11)
CI2)
CI3)
(14)
no
S.DDD.DD
.00
S,DDD.DD
NOTE:
If an assess.ent was issued previoUSly. lines 14, IS 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. Tax Due
CIS)
(16)
CI7)
(18)
S/DDD.DD X DO .00
.00 X D4S = .00
.00 X 12 = .00
.00 X IS = .00
(19)= .00
AMOUNT PAID
C
NUMBER
(+)
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 D
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)