HomeMy WebLinkAbout12-10-10NOTICE OF INHERITANCE TAX pennsylvan~a ~ .
APPRAI,~F~I,.Eb ,~~ALLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES TT~~ ~~ n
~.,}
INHERITANCE TAX DIVISION OF L bU'~t'~tIN~`#~ I,~ ~SESSMENT OF TAX REY-1547 EX AFP C12-09)
PO BOX 280601 -'~'l'~" ' `~'`~" _
HARRISBURG PA 17128-0601 ~~Y.~.,7w ~ ~~~ tJ~ ~ y''
~~~~ ~~e I Q A~ ~~ r +DSTATE OF MOUNTZ2010 DONNA M
!~
DATE OF DEATH 07-19-20D9
~~~~ ~~ FILE NUMBER 21 09-0801
~~~'~ CV~'RT COUNTY CUMBERLAND
AMY M MOYA CU~~~~RLr,t~sn r~~ ~~ ACN APPEAL DATE : 02 - 04 - 201 1
5011 LOCUST LANE
H A R R I S B U R G P A 1710 9 (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 OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: MOUNTZ DONNA MFILE N0.:21 09-0801 ACN: 101 DATE: 12-06-2010
TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED
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)
C1) .00
C2) • 0D
c3) .00
c4) .00
C5) 384.80
C6) .00
C7) 6,437.59
NOTE: To ensure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
C8) 6 , 822.39
c9) 9 , 708.89
clo) 709.82
C11) 10,418.71
11. Total Deductions C12) 3,596.32-
12.
13. Net Value of Tax Return
Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C13) .0 0
Subject to Tax
tat
f E
t V
l
N C14) 3,596.32-
14. s
e
ue o
e
a
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 C15) .00 X 00 = .00
16. Amount of Line 14 taxable at Lineal/Class A rate C16) .0 0 x 04 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 t19)= .0 0
TsY CRFi~TTS:
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.
~~