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DATE 11-05-2007
ESTATE OF EBY JR DOUGLAS S
DATE OF DEATH 06-25-2005
FILE NUMBER 21 05-0606
COUNTY CUMBERLAND
ACN 101
APPEAL DATE: 01-04-2008
( See reverse side "nder Objections)
A.ount Re.ittedl 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 EBY JR DOUGLAS S FILE NO. 21 05-0606 ACN 101 DATE 11-05-2007
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
-,',,- i"'-,N,OTlCE OF INHERITANCE TAX
ApPRArs-EHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
nOl ~\:QV -9 PH 12: 2 tj.
DOUGLAS S EBY
11 HIGHLAND DR
CAMP HILL
PA 17011
'*
REV-15~7 EX AFP (06-05)
TAX RETURN WAS: (X) ACCEPTED AS F I LED
( ) 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)
S. Total Assets
(l)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
5.00
.00
.00
(S)
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
.00
(9)
(10)
16.281. 94
ell)
(12)
(13)
(14)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
5.00
l~.:;JRl 96
16,276.94-
.00
16,276.94-
NOTE: If an assess.ent was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 wUI
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15) .00 X 00 .00
16. Amount of Line 14 taxable at Lineal/Class A rate (16) .00 X 045 = .00
17. Amount of Line 14 at Sibling rate (17) .00 X 12 = .00
18. Amount of Line 14 taxable at Collateral/Class B rate <1S) .00 X 15 = .00
19. Principal Tax Due (19)= .00
TAY L:II!I":U.l s:
PAYMENT '''''''c J (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
{ IF TOTAL DUE IS LESS THAN .1, NO PAYMENT IS REQUIRED. (\J
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE Dllr\)
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)