HomeMy WebLinkAbout09-28-09 COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
_ "` ". KaYICE OF INHERITANCE TAX
BUREAU OF INDIVIDUAL TAXES - /CPPRgISERENT, ALLOWANCE OR DISALLOWANCE
INHERITANCE TAX DIVISION __. !
UF DE~)UCTIONS AND ASSESSMEN
PO BOX 280601 .
T OF TAX
~ ....,. .._ ,...
HARRISBURG PA 17128-0601 REY-1547 EX AFP CO1-09)
ZU~~ ~~~ ~~ j ~~ ~: ~9 DATE 09-21-2009
ESTATE OF KAUFFMAN CLINTON E
~,~ ra'y` v:r DATE OF DEATH 07-30-2008
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~~- FILE NUMBER 21 08-0826
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THOMAS E FLOWER > -
,
ACN 101
SAIDIS ETAL APPEAL DATE: 11-20-2009
210 9 MAR K E T S T (See reverse side under Objections)
CAMP HILL PA 17011 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 F-
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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 KAUFFMAN CLINTON E FILE N0. 21 08-0826 ACN 101 DATE 09-21-2009
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)
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)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
L0. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
cl) 180,041.40
c2) . 00
c3) .00
c4) .00
c5) 10.698.48
c6) 3, 726.52
c7) .00
29,426.07
(9)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
cs) 194,466.40
clo) 199.240.17
C11) 978.666.74
cl2) 34, 199.84-
13. Charitable/Governmental Bequests; Nonelected 9113 Trusts (Schedule J) (13)
14. Net Value of Estate Subject to Tax C14)
.00
34,199.84-
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
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
19. Principal Tax Due
rwv rornrrc_
cis) • 00 X 00 _ . 00
c16) .00 X 045 _ .00
cln .00 X 12 _ .00
cis) .00 X 15 _ .00
(19)= • 00
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT C+)
INTEREST/PEN PAID (-)
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 ( IF TOTAL DUE IS LESS THAN $1, 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.)