HomeMy WebLinkAbout09-03-10NOTICE OF INHERITANCE TAX p~nnsylvan~a ~ ~
APPRA~ISEMENT, ALLOWANCE OR DISALLOWANCE CiEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES '
INHERITANCE TAX ~rv1s1oN - OF' DEDUCTIONS AND ASSESSMENT OF TAX RIEV-1547 EX AFP (12-09)
PO BOX 280601
HARRISBURG PA 17128-0601
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MAR( I S M , ~ L~,ER. ESC! ; ~ •=~
2000 LINGLESTOWN ROAD
SUITE 202
HARRISBURG PA 17110
DATE 08-30-2010
ESTATE OF (LOOS TIMOTHY N
DATE OF DEATH 03-25-2010
FILE NUMBER 21 10-0626
COUNTY CUMBERLAND
ACN 101
APPEAL DATE: 10-29-2010
(See reverse side under O~ jections )
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE _'~-~ R_ETA_IN LOWER POR_TION_ FOR YOUR RECORDS E~- _ _____________ _
REV-1547 EX AFP C12-09~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR -
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: CLOGS TIMOTHY NFILE N0.:21 10-Ob2b ACN: 101 DATE: 08-30-2010
TAX RETURN WAS: t X) ACCEPTED AS FILED t ) CHANGED
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate tSchedule 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)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
tl) .00
t2) .00
t3) .00
t4) .00
t5) 39,436.71
t6) .00
c7) 38, 151 .40
NOTE: To ensure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
t8) _ 77 , 588.11
c9) 4 , 923.00
tlo) 884.84
tll) 5,807.84
11. Total Deductions _
t12) 71 , 780.27
12. Net Value of Tax Return _
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) t13) _ .0 0
4 te Subject to Tax
f E
t
t V
l
N (14) 71 , 780.27
1
. a
ue o
s
a
e _
NOTE: If an assessment was issued previously, lines 14, 15 and/or lb, 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 C15) 71 , 780.27 X 00 - . 00
16. Amount of Line 14 taxable at Lineal/Class A rate tld) _ DO x 045 := . 00
17. Amount of Line 14 at Sibling rate t17) .0 0 X 12 ~ .0 0
18. Amount of Line 14 taxable at Collateral/Class B rate (18) .0 0 X 15 =° .0 0
19. Principal Tax Due t19)~ .0 0
TOX CRFnTTS~
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT t+)
INTEREST/PEN PAID C-) AMOUNT PAID
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE ,Q0
INTEREST AND PEN. .00
TOTAL DUE .00
* IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A "CREDIT" l:CR), YOU MAY BE DUE
FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.