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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
ffOtICE OF INHERITANCE TAX
APJlRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF ..DEDUCTIONS AND ASSESSMENT OF TAX
DATE 11-05-2007
ESTATE OF GOENS EVALINE K
DATE OF DEATH 11-03-2003
FILE NUMBER 21 06 - 0752
COUNTY CUMBERLAND
ACN 101
APPEAL DATE: 01-04-2008
( See reverse side under Objections)
A.ount Re.ittedl I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
~~!_~~~~~_!~!!_~!~~------~--_!~!~!~-~~~~!_~~!!!~~-~~!-!~~!_!~~~!~!_-~--------------------
REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF GOENS EVALINE K FILE NO. 21 06-0752 ACN 101 DATE 11-05-2007
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
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THOMAS E FLOWER
SAIDIS ETAL
2109 MARKET ST
CAMP HILL
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PA 17011
T AX RETURN WAS: (X) ACCEPTED AS F I LED
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
( ) CHANGED
(1)
(2)
(3)
(4)
(5)
(6)
(7)
67,500.00
.00
.00
.00
.00
.00
.00
(8)
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
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 Abl 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
TS:
NOTE:
C
NUMBER
CD008609
+
INTEREST/PEN PAID (-)
385.17-
DATE
08-29-2007
(9)
ClO)
17,841.75
987.04
(11)
Cl2)
Cl3)
Cl4)
Cl5)
Cl6)
Cl7)
(18)
.00 X
48,671.21 X
.00 X
.00 X
AMOUNT PAID
2,575.37
BALANCE OF UNPAID INTEREST/PENALTY AS OF 08-30-2007 TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
*'
REV-1547 EX AFP <06-05)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
67,500.00
lA.8?8.79
48,671.21
.00
48,671. 21
00
045 =
12 =
15 =
.00
2,190.20
.00
.00
2,190.20
Cl9)=
2,190.20
.00
29.58
29.58
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN *1, NO PAYMENT IS REQUIRED. Pb
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE U
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)