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BUREAU OF INDIVIDUAL TAXES -, F,.` C
INHERITANCE TAX DIVISION "~ J j "~ !~i ~ dr-l 'J
PO BOX 280601 ~~'
HARRISBURG PA 17128-0601
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ROBERT R BLACK
36 S HANOVER ST
CARLISLE PA 17013-3306
Pennsylvania ~
DEPARTMENT OF REVENUE
REV-1593 EX AFP C12-I1)
DATE 06-14-2012
ESTATE OF GLENN SAMUEL R
DATE OF DEATH 02-21-2011
FILE NUMBER 21 11-0295
COUNTY CUMBERLAND
ACN 101
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE _______ ~ RETAIN LOWER PORTION FOR YOUR RECORDS E~
------------------------ ------------------------------------------------------------------------------
REV-1593 EX AFP C12-11) ** INHERITANCE TAX RECORD ADJUSTMENT ~~
ESTATE OF: GLENN SAMUEL R FILE N0.:21 11-0295 ACN: 101 DATE: 06-14-2012
ADJUSTMENT BASED oN: ADMINISTRATIVE CORRECTION
VALUE OF ESTATE:
1. Real Estate (Schedule A) C1) 174 843 16
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
DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Administrative Costs/
Miscellaneous Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
cz) . 00
C3) .00
c4) .00
c5) 100 , 832.73
C6) .00
C7) i nn one zo
(8)
C9)
Clo)
17,171.18
738.99
375,881.27
C11) 17,910.17
C12) 357,971.10
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C13) .00
14. Net Value of Estate Subject to Tax C14) 357,971.10
TAX:
15. Amount of Line 14 at Spousal rate (15) .00X.00 = .00
16. Amount of Line 14 taxable at Lineal/Class A r ate C16)
357,971.10x.045= 16,108.70
17. Amount of Line 14 at Sibling rate (17) =
.00x.12 .00
18. Amount of Line 14 taxable at Collateral/Class B rate C18)
.00 x.15 .00
19. Principal Tax Due
C19) 16, 108.70
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+)
DATE
NUMBER
INTEREST/PEN
PAID C-) AMOUNT PAID
05-04-2011 CD014407 526.32 10,000.00
11-01-2011 CD015151 .00 6,489.46
TOTAL TAX PAYMENT 17,015.78
ALANCE OF TAX DUE 907.08CR
INTEREST AND PEN. .00
TOTAL DUE 907.08CR
* 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.) ~ll.J~l`Jl
REV-1470 EX (P?~10)
r
~` ` pennsylvania
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO Box 280601
Samuel R. Glenn
Steven James
INHERITANCE TAX
EXPLANATION
OF CHANGES
21 11-0295
101
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
A 1 The value of the real estate has been adjusted to reflect the sale value as indicated on the
HUD-1 Settlement Sheet provided by the estate. A request to refund the resulting
overpayment has been submitted.
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