HomeMy WebLinkAbout08-31-09COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
_ __ _ ,__,.~I~I6~-.OF,INHERITANCE TAX
BUREAU OF INDIVIDUAL TAXES ~ APPRAZS~h~6NT, AL`L'OWANCE OR DISALLOWANCE
INHERITANCE TAX DIVISION -.OF ~DEDUCTI;ON'S f-ND ASSESSMENT OF TAX
PO BOX 280601 ; : . °, •~ ..~ .. _
HARRISBURG PA 17128-0601 ~~ REY-1547 EX AFP CO1-09)
~~~~ ~~~ ~ ~ p~ ~: ~~DATE 08-24-2004
ESTATE OF BLAIR JR ELLIS C
DATE OF DEATH 05-14-2006
(~,~~~~ ~r FILE NUMBER 21 OS-0858
(~~P~-({~I~~ ~~~~T COUNTY CUMBERLAND
CAROLYN D BIAIR c~~~;~~',~ j":-,rs[;~ ~;i~., ~~ ACN 101
1205 N 14TH ST APPEAL DATE: 10-23-2009
H B G P A 1710 3 (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 BLAIR JR ELLIS C FILE N0. 21 08-0858 ACN 101 DATE 08-24-2009
TAX RETURN WAS: C 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) .0 0 NOTE: To insure proper
2. Stocks and Bonds (Schedule B) t2) 11 , 949.75 credit to your account,
.0 0 submit the upper portion
3. Closely Held Stock/Partnership Interest (Schedule C) C3) of this form with your
4. Mortgages/Notes Receivable (Schedule D) C4) .0 0 tax payment.
5. CashlBank Deposits/Misc. Personal Property (Schedule E) C5) .0 0
6. Jointly Owned Property (Schedule F) C6) .0 0
7. Transfers (Schedule G) C7) .0 0
s. Total Assets C8) 11 , 949.75
APPROVED DEDUCTIONS AND EXEMPTIONS: 6,105.00
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) C9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) C10) .0 0
11 . Total Deductions C11) 6 . 1 OS . Dn
5,844.75
12. Net Value of lax Return C12)
.0 0
13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (Schedule J) C13)
5, 844.75
14. Net Value of Estate Subject to Tax C14)
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:
5, 844.75 X 00 =
. 00
15. Amount of Line 14 at Spousal rate C15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16) • 00 X 045 = . 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) •0 0 X 15 = .0 0
19. Principal Tax Due C1g)= .0 0
V J i
DATE
R C I T
NUMBER
ISCOUN C+)
INTEREST/PEN PAID (-)
AMOUNT PAID
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
C IF TOTAL DUE IS LESS THAN O1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)