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NARRI B R66PA ~ 128y 060/N ~ ~f/r !A~''~~Pj~~MENIT E OF INHERI T
ECaI~ I C, , u~s ~ U AL qND NCE oRNCE TAX
{d}pryry ~+ t. ~y ~ DUCTIpNS ASSESSMENT pFOWANCE pennSy(lr_
1, ~ i L ~EP 2 ~1 ~t7 ~ ~ J ~ TAX pARTMENT OF RE.
R~'1547 p( AFP (12-
- DATE
'~/Lt.. i Yj', ~,,, '.
E SIN M~p~•` ~~~~i~ DATETE D 09-24-2012
GLENN HERSHEY
1531 ~ BERl.A1yp CO., ~ FILE OF EATH 06'05-2006 CARRIE
CRANES GAP RD NUMBER 21
CARLISLE COUNTY 06-0562
PA 17013-9677 ACN CUMBERLAND
101
(S ePEAL DATE:
everse side 11- 23' 2012
Amount Rewitted underObfections~
MAKE CHECK P
REG A1'ABLE
REV 15476-THIS LIWE 1 COURT OUS WILA SD REMIT PAYMENT T0;
EX AFP C12- "- ~ RET CARLISLE E SQUARE
11) NOT-- _-AIN LOWS PA 17p
ESTATE OF: HERSHEY DISALLOWANCINHERITgNCERTION FOR YOUR 13
CARRIE E OF DEDUCTI NS APPRAISEMERECORDS E.
APPRAISED VALUE OF RETU TAX RETURN was; ~ X FALE N0.: 21 p6D0562ESS ENTAOF O AXCE pR - - - - ~ - - -
Real Estate RN BASED CCEPTEO ACN:
2. Stocks [Schedule A) pN: AS FILED 101 DATE 09-24-2012
and pRIGINAI RETURN ~ ) CHANGED
3' Closely B°nds [Schedule B
Held Stock/p )
4.
Mortgages/Note artnership In C1)
6, Josh/Bank DepOSits/Mis able CScheduleeD) [Schedule C) C2) .00 NOTE; To ens
~• TransfersaCSch dul ertycCS hedule F) roperty [Schedule C4) • 00 submit theyuureaccount,
PPRp Total Assets a G) E) C5) 7,29 '00 t xtpas fOrmmWithportion
C6) 7.10 yment. Y°ur
ED DEDUCTIpNS 636.75
9• Funeral C7)
Expenses/gdmD EXEMPTIpNS: • 00
lo.
Debts/Mortgage ~iabi COSts/Misc. Expe
11. Total lities/dens nses CSch C8)
Deductions [Schedule I) edule H) 7
12. Net Value of C9) 933.85
13. Char Tax Retur C10)
14. Net ltable/Government n 2 414.24
E: If Va~u ass Estate SubJect to Tax Nonelected y113 Trusts C11)
SSMENT fOF ct f19u ~es tth as Issued preylo [Schedule ~) C13) 1 ~g 95.24
at us1Y, 1~ ~ 61.3p-
5• Amount °fTAX: include the
dine total of nes c14) • 00
14, 15 a~d,or 1 9
6' AmOUnt of Line 14 us 16, 61 • 30-
14 at spo A~ returns 17,
~• AmOUnt of al rate
taxable at Lineal/ essed 18 and
~1ne 14 aS5
at Sib Class A rate C15) to date • 19 Wil j
=E~iT ~ipal Tax Due taxable at Collater C1 6) ~ 00 X Op =
~) X
MENT al/Class B rate 045 = • 00
.TE RECEIPT C18) X 12 = • 00
NUMBER DISC ~ 00 X 15 = • 00
INTE OUNT C+) C19)= •O 0
REST/pEN PAID C_)
AMOU ' 00
NT PAID
TOTAL TAX PAYMENT
BALANCE OF TAX DUE
AFTER DATE INDICATED, INTEREST • 00
ELATION OF gDDITIONq~ AND PEN.
SEE REVERSE TOTAL DUE • 00
INTEREST. IF 70T • 00
A REFUND. DSEEIREVERSEC IDEAOFA •~CREDIT•~ CCR) • 00
THIS FORM p YOU MAY DUE
OR INSTRUCTIONS. n
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