HomeMy WebLinkAbout04-13-09COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
BUREAU OF INDIVIDUAL TAXES ( ~p~'~R;(~E~1~~N,T' ~,A~kOWANCE OR DISALLOWANCE
INHERITANCE TAX DIVISION _` ~ ED,i1CT;ONSfAND ASSESSMENT OF TAX
PO BOX 280601 _Q ~ ~ _ +„
HARRISBURG PA 17128-0601 ^''-~ ~ ~I~~ .. +' i -_ REV-1547 EX AFP CO1-09)
2DQ9 APR 13 Q~4 E[~: S6 DATE 04-06-2009
ESTATE OF BURRIS THELMA N
DATE OF DEATH 02-19-2008
~( ~(~(( ()(- FILE NUMBER 21 08-0840
Qf~~j-{fa,~,~'4 ~~~;~~T COUNTY CUMBERLAND
MARTIN H ROUSE CiU~Er~-~ ,r, ; •(l PA ACN 101
2707 WALNUT ST ~ APPEAL DATE: 06-05-2009
CAMP H ILL PA 17011 (See reverse side under Objections)
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
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 (Oi-09~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BURRIS THELMA N FILE N0. 21 08-0840 ACN 101 DATE 04-06-2009
TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) .00 NDTE: To insure proper
credit to your account,
2. Stocks and Bonds (Schedule B) C2) .00
3. Closely Held Stock/Partnership Interest (Schedule C) ~3) .~~ submit the upper portion
of this form with your
4. Mortgages/Notes Receivable (Schedule D) (4) .00 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) C5) 12,354.4 0
6. Jointly Owned Property (Schedule F) C6) 3,207.19
7. Transfers (Schedule G) (7) .00
8. Total Assets cB) 15,561.59
APPROVED DEDUCTIONS AND EXEMPTIONS: 5,183.64
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 2.8 37.31
11. Total Deductions (11) 8.02 _ 95
12. Net Value of Tax Return (12) 7,540.64
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00
14. Net Value of Estate Subject to Tax C14) 7,540.64
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 ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate C15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAY CRFTITTS~
.00 X
.00 X
.00 X
00 _ .00
045 = . 00
12 = .00
15 = 1,131.09
c19)= 1,131.09
PAYMENT
DATE RECE PT
NUMBER DISCOUNT C+)
INTEREST/PEN PAID (-)
AMOUNT PAID
11-18-2008 (0010537 .00 1,131.09
TOTAL TAX CREDIT 1,131.09
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00 -~
* IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
7,540.64 X