HomeMy WebLinkAbout03-31-10REV-1162 EX111-961
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
ADAMS H ANTHONY
4g WEST ORANGE STREET
SUITE 3
SHIPPENSBURG, PA 17257
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PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ACN
ASSESSMENT
CONTROL
NUMBER
ESTATE INFORMATION: SSN:
FILE NUMBER: 2108-0207
DECEDENT NAME: ZOOK DORA K
DATE OF PAYMENT: 03/ 31 / 2010
POSTMARK DATE: 03/30/2010
COUNTY: CUMBERLAND
DATE OF DEATH: 01 / 1 4/ 2008
TOTAL AMOUNT PAID:
REMARKS:
CHECK#13400
SEAL
INITIALS: CJ
RECEIVED BY:
N0. CD 012546
AMOUNT
$17.46
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
TAXES OF DEDUCTIONS AND ASSESSMENT OF TAX
H ANTHONY ADAMS
STE 3
49 W ORANGE ST
SHIPPENSBURG PA 17257
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DEPARTMENT OF REVENUE
REV-1547 EX AFP (12-09)
DATE 03-22-2010
ZOOK DORA K
ESTATE OF
DATE OF DEATH 01-14-2008
FILE NUMBER 21 08-0207
COUNTY CUMBERLAND
ACN 101
APPEAL DATE: 05-21-2010
(See reverse side under Objections )
Amount Remitted
MAKE REGISTERA OF WI A gD REMIT PAYMENT T0:
1 COURTHOUSE SQUARE
CARLISLE PA 17013
-
CUT ALONG THIS LINE _ __ ~"> __RETAIN-LOWER~PORTION FOR_YOURsRECORDS_
REV-1547rEXyAFP-CI2-09)DISALLOWANCENOFRDEDUCTIONS ANDRASSESSMENTAOF
KFILE N0.:21 08-0207 ACN:
ESTATE OF: ZOOK DORA
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
ORIGINAL RETURN
APPRAISED VALUE OF RETURN BASED ON: ~1)
1. Real Estate (Schedule A) C2)
2. Stocks and Bonds (Schedule B) (3)
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)
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
JWANCE OR
TAX
101 DATE: 03-22-2010
.00 NOTE: To ensure proper
.00 credit to your account,
.00 submit the upper portion
of this form with your
(4) .00 tax payment.
c5) 50,000.00
c6) .00
~~) .00
c8) 50.000.00
c9) 3 647.00
clo) .00
Non-elected 9113 Trusts (Schedule J)
NOTE: If an assessment was issued previously,
reflect figures that include the total
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate
16. Amount of Line 14 taxable at Lineal/Class A rate
7 Amount of Line 14 at Sibling rate
cll) 3, 647.00
cl2) 46,353.00
c13) .00
c14) 46,353.00
lines 14, 15 and/or 16, 17, 18 and 19 will
or w~L returns assessed co dace.
1 .
18. Amount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS: DISCOUNT C+)
PAYMENT RECEIPT
NUMBER INTEREST/PEN PAID C-)
DATE . 00
08-25-2009 CD011657
00 = .00
045 = 367.94
12 = .00
15 = .00
c19)= 367.94
.9
TOTAL TAX PAYMENT 367.94
BALANCE OF UNPAID INTEREST/PENALTY AS OF 08-26-2009 BALANCE OF TAX DUE .00
INTEREST AND PEN. 17.46
TOTAL DUE 17.46
~ IF PAID AFTER DATE INDICATED, SEE REVERSE AFREFUND.DSEEIREVERSECSIDEAOFATHISEFORM FOR)INSTRUCTIONS DUE
FnR CALCULATION OF ADDITIONAL INTEREST.
c15) 38,176.50 x
(16) 8 176.50 x
(17) .00 x
C18) . 00 x
AMOUNT PAID
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