HomeMy WebLinkAbout05-21-10BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
r, ,N~T~C6.z•,~OF INHERITANCE TAX
"yA'~~#tA''.IS~ME,'~+h"~''ALLOWANCE OR DISALLOWANCE
-• OF_:"pEDUE;~T~`QNS AND ASSESSMENT OF TAX
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ANDREW C SHEELY ESG(~~,~~.~:-~_~'~ -~ -
127 S MARKET ST
PO BOX 95
MECHANICSBURG PA 17055
Pennsylvania ~
DEPARTMENT OF REVENUE
REV-1547 EX AFP C12-09)
DATE 05-17-2010
ESTATE OF COOK LAVERE A
DATE OF DEATH 12-02-2008
FILE NUMBER 21 08-1204
COUNTY CUMBERLAND
ACN 101
APPEAL DATE: 07-16-2010
(See reverse side under Objections)
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP C12-09~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: COOK LAVERE AFILE N0.:21 08-1204 ACN: 101
OR
DATE: 05-17-2010
TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) C1) •0 0 NOTE: To ensure proper
2. Stocks and Bonds (Schedule B) C2)
credit to your account,
3. Closely Held Stock/Partnership Interest (Schedule C) C3) •0 0 •submit the upper portion
of this form with your
4. Mortgages/Notes Receivable (Schedule D) C4) •0 0 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 16,275.30
6. Jointly Owned Property (Schedule F) (6) .0 0
7. Transfers (Schedule G) (7) .0 0
8. Total Assets (8) _ 16 , 275.30
APPROV ED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (q) 9.6 5 3.0 0
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .0 0
11. Total Deductions C11) 9,653.00
12. Net Value of Tax Return C12) 6,622.30
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .0 0
14. Net Value of Estate Subject to Tax C14) 6, 622.30
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 (15) 6, 622.30 X 00 = . 00
16. Amount of Line 14 taxable at Lineal/Class A rate (16) .0 0 x 0 4 5 = .0 0
17. Amount of Line 14 at Sibling rate C17) .0 0 X 12 - .0 0
18. Amount of Line 14 taxable at Collateral/Class B rate C18) .0 0 X 15 = .0 0
19. Principal Tax Due (19)= .0 0
TAX CREDITS:
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT C+)
INTEREST/PEN PAID C-) AMOUNT PAID
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE
FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.