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'~ Nr~OT',~'„Q OF INHERITANCE TAX Pennsylvania ~
~,r ~~~'S,Er1a~ry~~~LLOWANCE OR DISALLOWANCE
BUREAU OF INDIVIDUAL TAXES r~r ~~P' 1~ DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION ~~r .(~~ DE'DUF~'~T~10N$ AND ASSESSMENT DF TAX
PO BOX 280601 F'~'~~ ~. .~..`J REV-1547 EX AFP C12-10)
HARRISBURG PA 17128-0601
CLERK C~
r~~~~~,~,iv~~ ~~`..~~T
ANDREW J BENDER ES'Q~r~,rA f ','" ~~ r`'~-~ , ~a
61 W LOUTHER ST
CARLISLE PA 17013
DATE 10-18-2011
ESTATE OF BROLLY HELEN M
DATE OF DEATH 02-06-2011
FILE NUMBER 21 11-0275
COUNTY CUMBERLAND
ACN 101
APPEAL DATE: 12-17-2011
(See reverse side under Objections)
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
___________________~____ ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ _____
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REV-15476EXHAFPLC12~10) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: BROLLY HELEN MFILE N0.:21 11-0275 ACN: ~n) nerF. ,n_,Q_~n,
TAX RETURN WAS: C X) ACCEPTED AS FILED
APPRAISED VALUE OF ETURN BASED DN: ORIGINAL RETURN
1. Real Estate (Sch~dule A)
2. Stocks and Bonds',CSehedule B)
3. Closely Held Stotk/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 CSched~le G)
8. Total Assets
APPROVED DEDUCTIDNSIAND EXEMPTIONS:
9. Funeral Expenses.VAdm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage L$abilities/Liens (Schedule I)
[1) .00 NOTE: To ensure proper
C2) .00 credit to your account,
C3) .00 submit the upper portion
of this form with your
C4) .00 tax payment.
c5) 106, 765.09
c6) .00
Cn .00
c8) 106.765.09
C9)_- 24.042.74
Clo) 264.35
11. Total Deductions C11) 24,307.09
12. Net Value of Tax ',Return C12) 82,458.00
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C13) .00
14. Net Value of Estate Subject to Tax C14) 82 458.00
NOTE: If an assess~ent was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figulres that include the total of ALL returns assessed to date
ASSESSMENT OF TAX: .
15. Amount of Line 14, at Spousal rate C15) .0 0 X 00 = .00
16. Amount of Line 14~ taxable at Lineal/Class A rate (16) R2.4~8 On x 045 = 3,710.b1
17. Amount of Line 14 at Sibling rate (17) n0 X 12 =
18.
Amount of Line 1~' taxable at Collateral/Class B ra
te C18)
.00 X 15 = .0 0
.00
19. Principal Tax Due
TAX CREDITS: C19)= 3,710.61
DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID
05-04-2011 CD0~4409 178.95 3,400.00
07-05-2011 CD014657 .00 131.67
TOTAL TAX PAYMENT 3,710.62
BALANCE OF TAX DUE .O1CR
INTEREST AND PEN. .00
TOTAL DUE .O1CR
C ) CHANGED
l
+~ IF
FOR PAID AFTER DATE
CALCULATION OF INDIICATED,
ADDI~
TIONAL SEE REVERSE
INTERE IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DU
,
i ST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.