HomeMy WebLinkAbout07-10-09COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
;4LflT3°C'E';AF: Tt~fHERITANCE TAX
BUREAU OF INDIVIDUAL TAXES APpRA~-$!EMEIiT, ALLOWANCE OR DISALLOWANCE
INHERITANCE TAX DIVISION ;'OK,+OE'DUCTIONB AND ASSESSMENT OF TAX
PO BOX 280601 i.,_ ,,;;,,; ; ~_, ~ -- -
HARRISBURG PA 17128-0601 REV-1547 EX AFP (01-09)
2~9,l~1L ~~ ~ ~; ~(~ATE 07-06-2009
ESTATE OF TESNO ROLAND R
DATE OF DEATH 05-17-2008
G~~ttt~ C~ FILE NUMBER 21 08-0634
~~PC'~~,f\~`v v~~~ D COUNTY CUMBERLAND
MARIELLE F HAZEN ~Lf`;:' ~ ~ ' ~'~ ACN 101
HAZEN ELDER LAW APPEAL DATE: 09-04-2009
2000 LINGLESTOWN RD (See reverse side under Objections)
HBG PA 17110 Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE _ ~ R_ETA_IN LOWER POR_TION_ FOR YOUR RECORDS ~ _ _______________
REV-1547 EX AFP CO1-09) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF TESNO ROLAND R FILE N0. 21 08-0634 ACN 101 DATE 07-06-2009
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) .00 NOTE: To insure proper
Stocks and Bonds (Schedule B)
2 (2) 44,072.00 credit to your account,
. 00 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) .00 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 594, 175.97
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) C7) 44,392.92
CB) 682, 640 .89
s. Total Assets
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;
14. Net Value of Estate Subject to Tax
c14) 624, 656.51
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 assess ed to date.
ASSESSMENT OF TAX:
00
00
. 00
15. Amount of Line 14 at Spousal rate C15) • X =
16. Amount of Line 14 taxable at Lineal/Class A rate C16) •00 X 045 = .0 0
17. Amount of Line 14 at sibling rate I1~) 260,294.37 X 12 = 31,235.32
18. Amount of Line 14 taxable at Collateral/Class B ra te C18) 364,362.14 X 15 = 54,654.32
19. Principal Tax Due C19)= 85,889.64
1NA ~.ALY11
PAYMENT
DATE
RECEIPT
NUMBER
DISCOUNT C+)
INTEREST/PEN PAID (-)
AMOUNT PAID
08-15-2008 CD010156 2,684.21 51,000.00
02-17-2009 CD010920 .00 32,205.43
C9)
46,357.53
C10) 11.626.85
C11) 57.984.38
c12) 624, 656.51
Non-elected 9113 Trusts (Schedule J) (13) .00
TOTAL TAX CREDIT 85,889.64
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), YDU MAY BE DUE `
n Rccnun ccc RpVFRSF STnF OF THIS FORM FOR INSTRUCTIONS.)