HomeMy WebLinkAbout07-15-11BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
NOTICE OF INHERITANCE TAX
rr ~ n"~^s~ '" "~ LLOWANCE OR DISALLOWANCE
r~r_~-~a~A_~~s,r+~t~{y~ Q~
~~, ~ ,r~,~ _D.ED~;~i,if~I(pNS AND ASSESSMENT OF TAX
J
CLERK ~F
ORPHAI~1'S CQI,;PT
LISA MARIE COYNE ~~~'..
COYNE COYNE
3901 MARKET ST PA 17011-4227
CAMP HILL
I ~_,-
pennsylvania ~
DEPARTMENT OF REVENUE '
REV-1547 EX AFP (12-10)
DATE 07-12-2011
FOX SHIRLEY L
ESTATE OF
DATE OF DEATH 08-28-2010
FILE NUMBER 21 10-0936
COUNTY C1IMBERLAND
ACN 101
APPEAL DATE: 09-10-2011
(See reverse side under Objections)
Amount Remitted
MAKE REGISTER OF WI AND REMIT PAYMENT T0:
1 COURTHOUSE SQUARE
CARLISLE PA 17013
- - -------------------
CUT ALONG_ THIS__LINE- -__"~ __RETAIN-LOWER PORTION FOR-YOUR-R_E_CD_RDS--_ _
------------ - ALLOWANCE OR
REV-1547 EX AFP (12-10~DISALLOWANCENOFRDEDUCTIONS ANDRASSESSMENT OF TAX DATE: 07-12-2011
ACN: 101
curciFY LFILE N0.:21 10-0936
ESTATE OF: FDx -~~- ( ) CHANGED
~rTUOU WCS: (X) ACCEPTED AS FILED
ORIGINAL RETURN
APPRAISED VALUE OF RETURN BASED ON:
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)
NOTE: To ensure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
(B) 37 710.86
g. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS: lr~ 1
1 Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 7,537.10
(10) -~--
9. Funera
Liabilities/Liens (Schedule I
23,426.01
10. Debts/Mortgage (11) 284.85
14
11. Total Deductions (12)
(13) ,
, 00
12. Net Value of Tax Return
mental Bequests; Non-elected 9113 Tru
sts (Schedule J (14) 14 , 284.85
13. Charitable/Govern
14. Net Value of Estate Subject to Tax
15 and/or 16, 17, 18
14
and 19 wil
If an assessment was issued previously, li ,
nes
da e
ALL returns ass
d •
NOTE:
that include the total of
UU
reflect figures 00 00
ASSESSMENT OF TAX:
14 at Spousal rate (15) x 045 =
?i~.-
6) 14s 642.82
15. Amount of Line
e 14 taxable at Lineal/Class A rate
i ,
(1
~ X 12 = ,00
n
16. Amount of L (17) 00
17. Amount of Line 14 at Sibling rate
llateral/Class B rate .00 x 15 =
(I8)
(l9)= .
642.82
lg. Amount of Line 14 taxable at Co
19. Principal Tax Due
TAX CREDITS; DISCOUNT (+) AMOUNT PAID
PAYMENT RECEIPT
INTEREST/PEN PAID (-)
00
760
NUMBER
DATE 32.14 .
11-18-2010 CD013672
TOTAL TAX PAYMENT 792.14
BALANCE OF TAX DUE 149.32CR
.00
INTEREST AND PEN.
149.32CR
TOTAL DUE
~ IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
AFREFUND.DSEEIREVERSECSIDEAOFATHISEDORM FOR)INSTRUCTIONS.DUE
(1) -~"~
18,5~~
(2) -
C3) -~
(6) -~
( 7 ) -~~-----