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F NDIVIDUAL TAXES ~~' '-~"".~;~~ LOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE •,
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INHERITANCE TAX DIVISION -i~1Q~C~~~ AND ASSESSMENT OF TAX REV-1547 EX AFP C12-10)
PO BOX 280601
HARRISBURG PA 17128-0601
~' ~-~ ~~ ~~ ~ ~ ~ J DATE 12-20-2010
ESTATE OF COULSON JEAN E
~~.ERK ~~ DATE OF DEATH 04-09-2010
(?Ri~i~'v ~(~~~~~' F I L E NUMBER 21 10 - 0 6 2 9
~~~~~3 ,~~~ ~'{'1 ~ ~~ COUNTY CUMBERLAND
BENJAMIN J BUTLER ACN 101
500 N 3RD ST APPEAL DATE: 02-18-2011
P O BOX 10 0 4 (See reverse side under Objections )
HBG PA 17108 Amount Remitte d
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 ~ _ __________ ____
REV-1547 EX AFP C12-10~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR -
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: COULSON JEAN EFILE N0.:21 10-0629 ACN: 101 DATE: 12-20-2010
TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) .0 0 NOTE: To ensure proper
2. Stocks and Bonds (Schedule B) (2) .0 0 credit to your account,
.0 0 submit the upper portion
3. Closely Held Stock/Partnership Interest (Schedule C) C3) of this form with your
4. Mortgages/Notes Receivable (Schedule D) (4) .0 0 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) C5) 8,2 3 2.19
6. Jointly Owned Property (Schedule F) (6) .0 0
7. Transfers (Schedule G) (7) .0 0
s. Total Assets (s) 8 , 232.19
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) C9) 5.0 6 3.3 5
10. Debts/Mortgage Liabilities/Liens (Schedule I) C10) 38,218.43
11. Total Deductions (11) 43,281.78
12. Net Value of Tax Return C12) 35,049.59-
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C13) .0 0
14. Net Value of Estate Subject to Tax C14) 35, 049 .59-
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) .0 0 X 0 0 = .0 0
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 (17) .0 n 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 (-)
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.