HomeMy WebLinkAbout04-13-09COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17126-0601
~ -r, rat-r ~:lIDT.ECE OF INHERITANCE TAX
-!-AF~PRWISEMENT, ALLOWANCE OR DISALLOWANCE
r ~~ ~'QE',p~DLfCTIONS AND ASSESSMENT OF TAX
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MARIELLE F HAZEN C~,IA"~~--" ~~'C! ~.f ',r~~
HAZEN ELDER LAW
2000 LINGLESTOWN RD 2
HBG PA 17110
REV-1547 EX AFP (01-09)
DATE 04-06-2009
ESTATE OF SHAW DONALD
DATE OF DEATH 02-27-2008
FILE NUMBER 21 08-1145
COUNTY CUMBERLAND
ACN 101
APPEAL DATE: 06-05-2009
(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 CO1-09) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SHAW DONALD FILE N0. 21 08-1145 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) C1) .00 NOTE: To insure proper
2. Stocks and Bonds (Schedule B) (2) 6 9,4 69.06 credit to your account,
3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 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) 760.00
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) 20,294.39
8. Total Assets (e) 90,523.45
APPROVED DEDUCTIONS AND EXEMPTIONS:
3,060 .76
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) C9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) C10) .00
11. Total Deductions (11) 3. X60 _ 76
12. Net Value of Tax Return C12) 87,462.69
13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (Schedule J) C13) .00
14. Net Value of Estate Subject to Tax C14) 87,462.69
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) 87,462.69 X 00 _ .00
16. Amount of Line 14 taxable at Lineal/Class A rate (16) •00 X 04 5 = .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 C18) •00 X 15 _ .00
19. Principal Tax Due C19)= .00
TAY /`DCTTTC.
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT C+)
INTEREST/PEN PAID C-)
AMOUNT PAID
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* IF PAID AFTER DATE INDICATED, SEE REVERSE C 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 DU
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)