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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 10-01-2007
ESTATE OF SHELLEMAN ROMAYNE W
DATE OF DEATH 08-22-2006
FILE NUMBER 21 06 -1 006
COUNTY CUMBERLAND
ACN 101
APPEAL DATE: 11-30-2007
(See reverse side under Objections)
Amount Remittedl 1
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 SHELLEMAN ROMAYNE W FILE NO. 21 06-1006 ACN 101 DATE 10-01-2007
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 2B0601
HARRISBURG PA 17128-0601
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COOPER J WARD
4401 CARLISLE
GARDNERS
RD
PA 17324
REV-1547 EX AFP (06-05)
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/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.
13.
14.
Net Value of Tax Return
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
2,530.72
.00
.00
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
(8)
2,530.72
(9)
(10)
8,802.69
2.480.39
(11 )
(12)
(13)
(14)
11.~83 08
8.752.36-
.00
8,752.36-
Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
If an assessment was issued preViOUSly, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of Ahh 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
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
Net Value of Estate Subject to Tax
NOTE:
*
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.)
~
(15)
(16)
(17)
(18)
.00
.00
.00
.00
.00
.00
.00
.00
.00
X 00
X 045 =
X 12
X 15 =
(19)=