HomeMy WebLinkAbout01-31-11BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
MICHAEL CHEREWKA ESQ
624 N FRONT ST
NOTICE OF INHERITANCE TAX Pennsylvania ~~~~ ~
APPI~#IS,ErMEN7`, A~'L~OW~kNCE OR DISALLOWANCE
OF, .DEDUCTIONS ~~Y4Nfl ASSESSMENT OF TAX DEPARTMENT OF REVENUE
_ REV-1547 EX AFP (12-10)
- - ' ;;DATE 01-25-2011
ESTATE OF KOONTZ CLARA M
:-r ~ ~~, , ,-_ DATE OF DEATH 09-29-2009
~~~ l FILE NUMBER 21 09-0923
~~~~~ r,,^ , ~`~ ~;~-;~, COUNTY CUMBERLAND
_ ~ i~.
WORMLEYSBURG PA 17043
ACN 101
APPEAL DATE: 03-26-2011
(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 ~
REV-15 _
_
_
47 EX AFP C12-10~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE
OR -
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE 0F: KOONTZ CLARA MFILE N0.:21 09-0923 ACN: 101 DATE: 01-25-2011
TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) C1) 0 0
2.
Stocks and Bonds (Schedule B) C2) .
,0 0 NOTE: To ensure proper
credit to your account,
3. Closely Held Stock/Partnership Interest (Schedule C) (3) .0 0 submit the upper portion
4. Mortgages/Notes Receivable (Schedule D)
C4)
00 of this form with your
5.
Cash/Bank Deposits/Misc. Personal Property (Schedule E) C5) .
7,9 3 2.0 3 tax payment.
6. Jointly Owned Property (Schedule F) C6) .0 0
7. Transfers (Schedule G) C7) .0 0
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS: c8) 7 , 932.03
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) C9)_ 1_7_,4 O1 6 7
10. Debts/Mortgage Liabilities/Liens (Schedule I) C10) 1+5 34.10
11 . Total Deductions
12.
Net Value of Tax Return C11) 13, 935.77
13.
Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule C12)
J) 6, 003. 74-
14.
Net Value of Estate Subject to Tax C13) .0 0
C14) _ 6, 003. 74-
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17 18 and 19
,
reflect figures that include the total of ALL returns
will
ASSESSM
ENT OF TAX• assessed to date.
15. Amount of Line 14 at Spousal rate
16. Amount of Line 14 taxable at Lineal/Class A rate
17. Amount of Line 14 at Sibling rate
18. Amount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT C+)
DATE NUMBER INTEREST/PEN PAID C-)
C15) .00 X 00 = .00
C16) nn x 045 = .00
C17) nn x 12 = .00
C18) .00 x 15 = .00
c19)= . 00
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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