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,.NICE OF INHERITANCE TAX Pennsylvania ~
BUREAU OF INDIVIDUAL TAXES PI'r~ t ~, , -,~.~, ~~
APPRW(r`$d~t-~~`p~'~,)~~~jI~ICE OR DISALLOWANCE
INHERITANCE TAX DIVISION 0 F' "~ I DEPARTMENT OF REVENUE
PO BOX 280601 f ~`.;,~~~ ,!QL~ISj:;A,~tD ASSESSMENT OF TAX
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HARRISBURG PA 17128-0601 ~" "' ° REV-1547 EX AFP (12-10)
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` ~' ~ =:~; ;~;~;.'' "DATE 10-10-2011
ESTATE OF SZAJEK JOSEPH p
C'(~~K r_r DATE OF DEATH 01-22-2011
Q~'~ t~1~~'y r~~,~';-aT FILE NUMBER 21 11-0355
JOEL A SZAJEK C~ "~~~~{'~ht~•} l.i~., Pq ACNNTY CUMBERLAND
1014 SOUTHFIELD COURT 101
HARRISBURG APPEAL DATE: 12-09-2011
PA 17111- 3 0 25 (See reverse side under Objections )
Aeount Reaitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE y --R_ETA_IN-LOWER POR_TION_ FOR YOUR RECORDS ~
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REV-1547 EX AFP C12-10) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
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ISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: SZAJEK JOSEPH PFILE N0.:21 11-0355 ACN: 101 DATE: 10-10-2011
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 fSchedule B) fl) '00 NOTE: To ensure proper
3. Closely Held Stock/Partnership Interest (Schedule C) f2) •00 credit to your account,
C3) .~~ submit the upper portion
4. Mortgages/Notes Receivable (Schedule D) of this form with
f4) your
5. Cash/Bank Deposits/Misc. Personal Property fSchedule E) f5) •UO tax payment.
6. Jointly Owned Property fSchedule F) •00
7. Transfers (Schedule G) f6) 7,90 7.51
c7) 12, 562.00
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS: C6) 20,469 51
9. Funeral Expenses/Adm. Costs/Misc. Expenses fSchedule H) fg)_ I 6 6 0
10. Debts/Mortgage Liabilities/Liens (Schedule I)
no) .00
11. Total Deductions
12• Net Value of Tax Return C11) 1,626.50
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts fSchedule J) f12) 18,84 3.01
14. Net Value of Estate Subject to Tax C13) •00
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16,1417 18,843 O1
reflect figures that include the total of ALL returns assessed to d to and 19 will
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate
16. Amount of Line 14 taxable at Lineal/Class A rate (15) _~ ~ ~ x 00 = .00
17. Amount of Line 14 at Sibling rate f16) lA RL•; ~~ x 04 5 =
847.94
f17) no x 12 =
18. Amount of Line 14 taxable at Collateral/Class B rate C18) •00
19. Principal Tax Due • 00 X 15 = . 00
TAX CREDITS: f19)= 847.94
PAYMENT RECEI T
DATE DISCOUNT (+)
NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
09-19-2011 r_nnl~oQ:
4.
INTEREST IS CHARGED THROUGH 10-25-2011
AT THE RATES APPLICABLE AS OUTLINED ON THE TOTAL TAX PAYMENT
BALANCE OF TAX DUE 34.16
REVERSE SIDE OF THIS FORM 813.78
INTEREST AND PEN. .20
TOTAL DUE 813.98
~ IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A "CREDIT" fCR), YOU MAY BE D
FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.