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BUREAU OF INDIVIDUAL TAXE~SlI ~'°'
INHERITANCE TAX DIVISION ~~
PO BOX 280601 ' '~-!~ _ ~ICE OF INHERITANCE TAX
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~~ "OF',;13~~UCTIONS AND ASSESSMENT OF TAX
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DEPARTMENT OF REVENUE
REV-1547 EX AFP (12-11) r~
HARRISBURG PA 17128-0601
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WEAVER FO X ClJIv1~ERL~!a) Ctn., PA.
622 CHESTNUT HILL RD
DENVER PA 17517-8968
DATE 05-07-2012
ESTATE OF FOX EVA S
DATE OF DEATH 05-17-2011
FILE NUMBER 21 11-1252
COUNTY CUMBERLAND
ACN 101
APPEAL DATE: 07-06-2012
(See rei~erse side under Objections)
Amount Remitted C
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 F--
REV-1547 EX AFP (12-11) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: FOX EVA SFILE N0.:21 11-1252 ACN: 101 DATE: 05-07-2012
TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) .00 NOTE: T o ensure proper
2. Stocks and Bonds (Schedule B) (2) ,00 credit to your account,
3. Closely Held Stock/Partnership Interest (Schedule C) C3) .00 submit the upper portion
4.
Mortgages/Notes Receivable (Schedule D)
(4)
.00 of this
tax pay form with your
ment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 29, 331.00
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) .00
B. Total Assets (8) 29.331.00
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9)- 1.0.826.00
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 5.655.0 0
11. Total Deductions C11) 16,481.OU
12. Net Value of Tax Return (12) 12,850.00
13. Charitable/Governmental Bequests; Non-elected 9113 Tr usts (Schedule J) (13) .OU
14. Net Value of Estate Subject to Tax (14) 12,850.00
NOTE: If an assessment was issued previously, li nes 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 (15) .00 X 00 - ,QO
16. Amount of Line 14 taxable at Lineal/Class A rate (16) 1 . R D - 00 x 045 = 578.25
17. Amount of Line 14 at Sibling rate (17) .DO X 12 = .00
18. Amount of Line 14 taxable at Collateral/Class B rate (18) .0 0 X 15 - .00
19. Principal Tax Due (19)=
578.25
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
11-21-2011 (0015239 .00 578.25
TOTAL TAX PAYMENT 578.25
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" (CR), YOU MAY BE DUE
FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.
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