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DATE 12-17-2007
ESTATE OF KELL Y JEANNE M
DATE OF DEATH 10-07-2006
FILE NUMBER 21 06-0898
COUNTY CUMBERLAND
ACN 101
APPEAL DATE: 02-15-2008
( See reverse side under Objections)
Amount 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 KELLY JEANNE M FILE NO. 21 06-0898 ACN 101 DATE 12-17-2007
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
,.Q.J;;~~;rMENT OF REVENUE
:.IHJ+I~E)OF INHERITANCE TAX
',APPRAfSEMSNT:'-:ALLOWANCE OR DISALLOWANCE
': - " -' )
OF DEDUCTI'ONS AND ASSESSMENT OF TAX
2QDi OEe 21 P:1 I: 03
LISA MARIE COYNE
COYNE & COYNE
3901 MARKET ST
CAMP HILL PA 17011
REV-1547 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)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
88,899.99
.00
1,473.25
(8)
8.
Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
19,100.06
(9)
(10)
7.450.50
(11)
(12)
(13)
(14)
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: To insure proper
credit to your account.
submit the upper portion
of this form with your
tax payment.
90,373.24
"1>."i"i0."i1>
63,822.68
.00
63,822.68
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of !!:.b. 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) 63,822.68 X 045 = 2,872.02
17. Amount of Line 14 at Sibling rate (17) .00 X 12 = .00
18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 = . DO
19. Principal Tax Due (19)= 2,872.02
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
01-05-2007 CD007665 143.60 3,200.00
TOTAL TAX CREDIT 3,343.60
BALANCE OF TAX DUE 471.58CR
INTEREST AND PEN. .00
TOTAL DUE 471.58CR
* IF PAID AFTER DATE INDICATED. SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)