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~~;~' ~ ~ ~ ~'~',~,~CI,~~CE OF INHERITANCE TAX pennsylvan~a ~
APPRAI~S'ffME,NT, ALLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE ,.
BUREAU OF INDIVIDUAL TAXES ~,:.. ~~ ~ ~ ~
INHERITANCE TAX DIVISION ~ `- - Of d~ISUCTIONS AND ASSESSMENT OF TAX REV-15G7 EX AFP (12-10)
PO BOX 2806D1
HARRISBURG PA 17128-0601
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LISA MARIE COYNE
3901 MARKET ST
CAMP HILL PA 17011
DATE 02-21-2011
ESTATE OF RIVERS JEROME J
DATE OF DEATH 06-08-2009
FILE NUMBER 21 09-0598
COUNTY CUMBERLAND
ACN 101
APPEAL DATE: 04-22-2011
(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 OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: RIVERS JEROME JFILE N0.:77 n9-n~9R ecN~ in, neT~. n~_~i_~n „
TAX RETURN WAS: C X) ACCEPTED AS FILED ( ) CHANGED
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) 135, 000.00
2. Stocks and Bonds (Schedule B) _ (2) 2, 373.14
3. Closely Held Stock/Partnership Interest (Schedule C) (3) .0 0
4. Mortgages/Notes Receivable (Schedule D) (4) .0 0
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 18,8 8 3.98
6. Jointly Owned Property (Schedule F) (6) 9,905.10
7. Transfers (Schedule G) C7) 36,449.47
NOTE: To ensure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
8. Total Assets (8) 202,611.69
APPROV ED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (q) 5 0.7 4 9.3 2
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 4,5 0 9.8 9
11. Total Deductions C11) 55,259.21
12. Net Value of Tax Return (12) 147, 352.48
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .0 0
14. Net Value of Estate Subject to Tax (14) 147,352.48
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 (15) .0 0 X 0 0 = .0 0
16. Amount of Line 14 taxable at Lineal/Class A rate (16) 147.35?.48 X 045 = 6,630.86
17. Amount of Line 14 at Sibling rate C17) _0 ~ X 12 = .0 0
18. Amount of Line 14 taxable at Collateral/Class B rate (18) .0 0 X 15 = .0 0
19. Principal Tax Due (19)= 6, 630 .86
TAX CREDITS:
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT (+)
INTEREST/PEN PAID (-)
AMOUNT PAID
09-08-2009 CD011733 331.54 6,500.00
TOTAL TAX PAYMENT 6,831.54
BALANCE OF TAX DUE 200.68CR
INTEREST AND PEN. .00
TOTAL DUE 200.68CR
* 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.