HomeMy WebLinkAbout01-03-11NOTICE OF INHERITANCE TAX
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BUREAU OF INDIVIDUAL ~`i~F) ~~1 r t ;
INHERITANCE TAX DIVISION ~_ ~ ~.F EDUCTIONS AND ASSESSMENT OF TAX
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PO BOX 280601 ~~r' ~ `'~
HARRISBURG PA 17128-0601
GREGORY R ~~.~~ 'r ~fv'~ ~`,
3120 PARKVIEW LN
HARRISBURG PA 17111
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DEPARTMENT OF REVENUE
REV-1547 IX AFP C12-10)
DATE 12-27-2010
ESTATE OF ADAMS DAVID M
DATE OF DEATH 01-16-2010
FILE NUMBER 21 10-0063
COUNTY CUMBERLAND
ACN 101
APPEAL DATE: 02-25-2011
(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 -- -~-- R_ETA_IN LOWER POR_TION_ FOR YOUR RECORDS F-
REV-1547 EX AFP C12-10~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE-
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: ADAMS DAVID MFILE N0.:21 10-0063 ACN: 101 _______________
OR
DATE: 12-27-2010
TAX RETURN WAS: CX) 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,
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) (4) .0 0 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) C5) 15, 006.44
6. Jointly Owned Property (Schedule F) (6) .0 0
7. Transfers (Schedule G) (7) .0 0
8. Total Assets (8) 15, 006 .44
APPROV ED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (q) 6.37 3.94
10. Debts/Mortgage Liabilities/Liens (Schedule I) C10) 14,070.92
11. Total Deductions C11) 20,444.86
12. Net Value of Tax Return C12) 5,438.42-
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C13) .0 0
14. Net Value of Estate Subject to Tax C14) 5,438.42-
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 x 04 5 = .0 0
17. Amount of Line 14 at Sibling rate (17) _ 00 X 12 = . 00
18. Amount of Line 14 taxable at Collateral/Class B rate C18) .0 0 X 15 = .0 0
19. Principal Tax Due C19)= .0 0
TAX CREDITS:
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT (+)
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.
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