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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
Nonce OF INHERITANCE TAX
. APPRAISEI1ENT',' ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS' AND ASSESSMENT OF TAX
REV-1547 EX AFP (06-05)
II: ! 7 DATE 01-07-2008
ESTATE OF STATLER MABEL L
DATE OF DEATH 11-26 -2006
FILE NUMBER 21 07-0026
COUNTY CUMBERLAND
ACN 101
APPEAL DATE: 03-07-2008
( 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 STATLER MABEL L FILE NO. 21 07-0026 ACN 101 DATE 01-07-2008
: ,~ \;
,-; ::' ~
GEORGE F DOUGLAS III
SAIDIS ETAL
26 W HIGH ST
CARLISLE PA 17013
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
35,130.15
.00
.00
82,230.22
.00
.00
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
8.
Total Assets
(8)
117,360.37
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)
(10)
7,758.89
1.544.65
(11)
(12)
(13)
(14)
9.303.1i4
108,056.83
.00
108,056.83
NOTE: 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 !hh 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
RECEIPT
NUMBER
CD007840
CD008819
DISCOUNT (+)
INTEREST/PEN PAID (-)
163.16
12.28-
(IS) .00 X 00 . DO
(16) 108,056.83 X 045 = 4,862.56
(17) .00 X 12 = .00
(18) .00 X 15 = .00
(19)= 4,862.56
AMOUNT PAID
3,100.00
1,611.68
19. Principal
TAX CREDITS:
PAYMENT
DATE
02-26-2007
10-16-2007
Tax Due
BALANCE OF UNPAID INTEREST/PENALTY AS OF 10-17-2007 TOTAL TAX CREDIT 4,862.56
BALANCE OF TAX DUE .00
INTEREST AND PEN. 5.58
TOTAL DUE 5.58
* IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. (' -1;
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DU~fJ
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)