HomeMy WebLinkAbout03-05-12 (2)BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIYISION
PO BOX2806 D1
HARRISBURG PA 17128-0601
ANDREW C SHEELY ES4
127 S MARKET STREET
PO BOX 95
NOTICE OF INHERITANCE TAX
APPRA ~FNIr ¢$t E OR DISALLOWANCE
OF ~ ~7~~bN$~ , OASSESSMENT OF TAX
~ ~. .. ~.. ..7J
pennsylvania ~
DEPARTMENT OF REVENUE
REV-1547 EX AFP (12-ill
G~lZ ~iAR -~ PiR I2' ~~TATE OF CLEM8-2012 S R
DATE OF DEATH 03-27-2009
CLERK CF FILE NUMBER 21 11-0911
ORFI`ZAPI~S COURT COUNTY CUMBERLAND
C.U~~f3F(i~ N?jia ~~.. PA ACN 101
MECHANICSBURG PA 17055-0095
APPEAL DATE: 04-28-2012
(See reverse side under Objections)
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE F'A 17013
CUT ALONG THIS LINE ~- RETAIN LOWER PORTION FOR YOUR RECORDS l'~
REV-1547 EX AFP C12-11) NOTICE OF INHERITANCE TAX APPRAISEMEN7, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: CLEM S RFILE N0.:21 L1-0911 ACN: 101 DATE: 02-28-2012
TAX RETURN WAS: C g J ACCEPTED AS FILED C ) CHANGED
APPRAISED VALUE OF RETURN BASED ON• ORIGINAL RETURN
1. Real Estate (Schedule A) (1) .00
2. Stocks and Bonds (Schedule B) (2) .OD
3. Closely Heltl Stock/Partnership Interest (Schedule C) (3) .00
4. Mortgages/Notes Receivable (Schedule 0) (4) .00
5. Lash/Bank Deposits/Misc. P¢rso nal Property (Schedule E) (5) 861.03
6. Jointly Owned Praparty (S<hetlule F] (6) .DO
7. Transfers (Schedule G) (7) .00
NOTE: To ensure proper
cretlit ko your account,
submit the upper portion
of this form with your
ta% Payment.
e. Total Assets C8) 861.03
APPROV ED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Lusts/Misc. Expanses (Schedule H) (9) 286.50
10. Debts/Mortgage LiabillYies/Liens (SChetlule I) C10) .OD
11. Total Deeuctions (11) 286.50
12. Net Value of Tax Return (12) 574.53
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .DO
14. Net Value of Estate SubOeck to Tax C14) 574.53
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
16. Amount of Line 14 kaxable at Lineal/Class A rate
17. Amount of Line 14 at Siblln9 rate
18. Amount of Line 14 taxable at Collateral/Class B rate
19. Principal lax Due
TAX CREDITS:
ns) 574.53 X 00 = .00
t16) "nD X D45 ° .00
(v) an X 12 = .00
ue) .00 X 15 = .00
n9)= .00
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT (+)
INTEREST/PEN PAID (-) AMOUNT PAID
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .DO
TOTAL DUE .00
* IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLE CT'EO AS A "CREDIT" (CR), VOU MAV B E
FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTION