HomeMy WebLinkAbout01-27-11COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
PETRIE CHARLES E
3528 BRISBAN ST
HARRISBURG, PA 17111
-------- fold
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 ~ $847.25
ESTATE INFORMATION: SSN: 048-12-6771
FILE NUMBER: 2110-0245
DECEDENT NAME: BLACKWELDER CLAIRE G
DATE OF PAYMENT: 01 / 27/ 201 1
POSTMARK DATE: 01 /27/201 1
COUNTY: CUMBERLAND
DATE OF DEATH: 02/ 28/ 201 0
REMARKS: RECEIPT TO ATTY
CHECK# 2166
SEAL
TOTAL AMOUNT PAID:
$847.25
INITIALS: HMW
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
REV-1162 EX(11-96)
NO. CD 013950
NOTICE OF INHERITANCE TAX
BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
INHERITANCE TAX DIVISION OF DEDUCTIONS AND ASSESSMENT OF TAX
PO BOX 280601
HARRISBURG PA 17128-0601
CHARLES E PETRIE
3528 BRISBAN ST
HARRISBURG PA 17111
C1) 127,698.b0
C2) .00
C3) .00
C4) .00
C5) 174, 799.67
C6) 99, 149.00
C7) .00
CUT ALON_6 THIS LINE _ ~ R_ETA_IN LOWER POR_TION_ 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: BLACKWELDER CLAIRE GFILE N0.:21 10-0245 ACN: 101 DATE: 08-30-2010
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)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
~.~~
pennsylvan~a ~ . ~k
DEPARTMENT OF REVENUE
REV-1547 EX AFP C12-09)
NOTE: To ensure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
C8) 401 , 647.27
Cq) 24.805.86
Clo) 283.92
11 . Total Deductions C11) 25, 089.78
12. Net Value of Tax Return C12) 376,557.49
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C13) .0 0
14 Net Value of Estate Subject to Tax C14) 376,557.49
.
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 d ate.
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) 376.557.49 X 045 = 16,945.09
17. Amount of Line 14 at Sibling rate C17) .0 D X 12 u .0 0
18. Am.opnt of Line 14 taxable at Collateral/Class B rate C18) .0 0 X 15 = .0 0
~v.l,~. Prycipal Tax,~ue C19)= 16,945.09
-- PAYMENT,-.
DATE "~~ t~~'~' f~2ECEIPT
l.,J w..
{_);~ •, 'NUMBER DISCOUNT C+)
INTEREST/PEN PAID C-) AMOUNT PAID
06-22-2~„~,0
.. _~~,-~f 012966 . 00 16, 097.84
c ~J w .~. _,.
E-y~
r U ~ ~ ~
_----
~
PAYMENT ~~1rfUST BE h~DE BY 11-28-2010.
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST._
DATE 08-30-2010
ESTATE OF BLACKWELDER CLAIRE G
DATE OF DEATH 02-28-2010
FILE NUMBER 21 10-0245
COUNTY CUMBERLAND
ACN 101
APPEAL DATE: 10-29-2010
(See reverse side under Objections )
Amount Remitted 1
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TOTAL TAX PAYMENT 16,097.84
BALANCE OF TAX DUE 847.25
INTEREST AND PEN. .00
TOTAL DUE 847.25
IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.