HomeMy WebLinkAbout09-14-11 (2)BUREAU OF INDIVIDUALr ~E,~ NOTICE OF INHERITANCE TAX
INHERITANCE TAX DIVISION r'"I f _; •, AP.PRAISEMENT, ALLOWANCE OR
PO BOX 280601
HARRISBURG PA nlza-oeol ~ ~a~~DEDUCTIONS DISALLOWANCE
~~-( , ,,;, i ~ AND ASSESSMENT OF TAX
_. 'J
~ ~J~'.r 1 ~ ~'~' ~~ ~ ~) .
' ' ~
~~~~ CLERK ~~
82 NF I S O ~'Lli~ ~ .~~4URT
AIRWAY ,-1.''."('1 :' : "~ {JA
CAMP HILL
PA 17011
pennsyLvania
DEPARTMENT OF REVENUE
REV-1547 EX AFP C12-10) - -~
DATE
ESTATE OF 09-05-2011
DATE JACKSON
OF DEATH 04-22-2611 DAISY B
FILE NUMBER 21 11-0515
COUNTY CUMBERLAND
ACN
APPEAL 101
DATE: 11-04_2011
(See reverse side under'Objections)
Amount Remitted
MAKE CHECK P
REGISTER OFBLE AND REMIT PAYMENT
1 COURTHOUSEWILLS T0:
CUT ALON_6 THIS CARLISLE SQUARE
REV- - - -_~INE- y RETAIN PA 17013
1547 EX AFP C12_--'- _-_ - LOWER POR__T_ION_ FOR
10) NOTICE OF INHERITANCE YOUR RECORDS
ESTATE pF; DISALLOWANCE OF DEDUCTIONS APPRAISEMENT, ALLOWq ~~"~R _____
JACKSON AND ASSESSMENT
DAISY BFILE OF TAX
N0.:21 11-0515
APPRAISED TAX RETURN WqS: ACN: 101
VALUE OF RETURN ~X) ACCEPTED AS FILED ~ ) DATE: 09-05_2011
1 • Real Estate (Schedule A) BASED ON: ORIGINAL CHANGED
2• stocks and Bonds cscnedule B) RETURN
3• Closely Held C1) .00
Stock/Partnership Interest NOTE.
4• Mortgages/Notes C2) TO ensure proper
Receivable Schedule C) •00 credit
5• Cash/Bank (Schedule D) C3) .00 submit theYOUr account,
Deposits/Mist, Personal Pro upper
6• Jointly Owned Pro Pert C4) of this form with portion
party (Schedule F) y Schedule E) (5) •00 Your
7• Transfers (Schedule G) 8,379,00 tax payment
8• Total Assets (6) •00
APPROVED DEDUCTIONS ~~) 173'849.00
AND EXEMPTIONS:
9• Funeral Expenses/Adm, Costs/Misc.
ca) 182 228.00
30. Debts/Mortgage Liabilities/Liens Expenses
(Schedule H)
11. Total Deductions Schedule I) (9)
12. Net Value of Tax (30) 78.00
13. Charitable/Governmental Bequests;
14. Net Value of Estate Subject to Tax C11) 3, 074.00
MOn-elected 9113 Trusts (Schedule J)
NOTE: C12) 179,154.00
If an assessee (13)
reflect nt was issued previously, •00
ASSESSMENT OF figures that lines C14) 179 154.00
TAX: include the total 14' 15 and/or
15. Amount of Line 14 at Spousal rate of A~ returns 16' 17' 18 and
16. Amount of Line 14 taxable at Lineal/Class q r assessed t0 da'te, 19 will
17• Amount of C15)
Line 14 at Siblin ate C16) • 00 X 00 -
18. Amount of g rate X179 1 ~~ ., . 00
Line 14 taxable at Collateral/Class C17j ~~~ X 045 =
19. Principal Tax Due 8, 062, 00
TAX CREDITS: B rate ~lB) x 12 =
DATE "°`'e+rT
NUMBER DISCOUNT ~+)
-09-2011 CD014563 INTEREST/PEN PAID ~_)
403.1n
•00 x 15 = •00
c19)= ' 00
8,062.00
AMOUNT PAID
,o7y,
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
TOTAL TAX PAYMENT
BALANCE OF TAX DUE 8'062'10
INTEREST AND pEN• •10CR
TOTAL DUE •00
IF TOTAL DUE IS REFLECTED AS „ ' 1 OCR
A REFUND. SEE REVERSE SIDE A CREDIT~~
OF THIS FO CCR)''YOU MAY BE DUE
RM FOR INSTRUCTIONS.