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NOTICE OF INHERITANCE TAX Pennsylvania ~ ~ ''
BUREAU OF INDIVIDUAL TAXES APPRAj~{~$ ~ ~j.1~~4 ~ A CE OR DISALLOWANCE DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION UF' ll~~U~~lUNS~~~SSESSMENT OF TAX REY-1547 EX AFP (12-11)
PO BOX 280601 ~~I, ~ r l `;;~ ~ (~
HARRISBURG PA 17128-0601 L ~' " ~--' - - ~ ..~_~J
~~i DATE 04-02-2012
2 ~~~ ~~ f i~ I~~ ~ STATE OF OMMERT ISABELLE F
DATE OF DEATH 09-17-2011
C~ERK r~ FILE NUMBER 21 11-1007
ORPH/'~(1I'~ v°~.lU1lT COUNTY CUMBERLAND
JOSEPH J DIXON ~(~~j~~'^_~~ ~a°~i~-~ nib PA ACN 101
126 STATE ST APPEAL DATE: 06-01-2012
H A R R I S B U R G P A 17101 ( 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 ---- -- RETAIN LOWER PORTION FOR YOUR RECORDS E~
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REV-1547 EX AFP C12-11~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: OMMERT ISABELLE FFILE N0.:21 11-1007 ACN: 101 DATE: 04-02-2012
TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
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)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
C1) •00 NOTE: To ensure proper
C2) 376,952.67 credit to your account,
.00 submit the upper portion
(3) of this form with your
C4) • 00 tax payment.
c5) 158,565.93
c6) 36, 118.00
C7) .00
c8) 571 , 636.60
Cg) 33.043.02
clo) 57.25
11. Total Deductions C11) 33, 101.17
12. Net Value of Tax Return (12) 538,535.43
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C13) .00
14. Net Value of Estate Subject to Tax (14) 538,535.43
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 C15) .00 X 00 - .00
16. Amount of Line 14 taxable at Lineal/Class A rate C16) .00 x 045 = .00
17. Amount of Line 14 at Sibling rate C17) .00 X 12 = .0 0
18. Amount of Line 14 taxable at Collateral/Class B rate (18) 538,535.43 X 15 - 80,781.00
19. Principal Tax Due (14)= 80,781.00
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT C+)
DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID
12-09-2011 CD015315 4,039.05 76,741.87
03-26-2012 SBADJUST .00 .08
TOTAL TAX PAYMENT 80,781.00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
+ 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. n
REV-1470 EX (01-10) ~
•
~ pennsylvan~a INHERITANCE TAX
~° DEPARTMENT OF REVENUE EXPLANATION
BUREAU OF INDIVIDUAL TAXES OF CHANGES
Po BoX 2BOSOi
DECEDENT'S NAME FILE NUMBER
Isabelle F Ommert 2111-1007
REVIEWED BY ACN 101
Yvonne Bricker
ITEM EXPLANATION OF CHANGES
SCHEDULE NO.
The value of the estate has been adjusted as the result of the correction of an error in
arithmetic on lines 8, 12, 14, 18, and 19.
Row Paae 1