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NOTICE OF INHERITANCE TAX pennsylvania
[ l~%~ R'Jt~t€ E(fNT, ALLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE ,
BUREAU OF INDIVIDUAL TAXE
INHERITANCE TAX DIVISION ]-t;~ ~QF",~1 4ROCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP (12-11)
PO BOX 280601 ---J
HARRISBURG PA 17128-0601
21112 AUG 13 Ph 12: 22 DATE 08-06-2012
ESTATE OF SHEIBLEY RUTH E
DATE OF DEATH 02-10-2011
FILE NUMBER 21 11 - 0220
~~,Aq~ CO I COUNTY CUMBERLAND
KEITH 0 BREN ACN 101
44 W MAIN ST APPEAL DATE: 10-05-2012
MECHANICSBURG PA 17055-6249 (See reverse side under Objections)
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT-ALONG-THIS-LINE RETAIN-LOWER-PORTION FOR YOUR RECORDS
REV-1547 EX AFP (12-11) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: SHEIBLEY RUTH EFILE NO.:21 11-0220 ACN: 101 DATE: 08-06-2012
TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED
APPRAISED VALUE OF RETURN BASED ON. SUPPLEMENTAL RETURN NO. 01
1. Real Estate (Schedule A) (1) .0 NOTE: To ensure proper
.00 credit to your account,
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3) 00 submit the upper portion
of this form with your
4. Mortgages/Notes Receivable (Schedule D) (4) .00tax payment.
5. Cash/Bank Deposits/Misc. Personal Property CSchedule E) (5) 1,602.53
6. Jointly Owned Property CSchedule F) (6) .00
7. Transfers (Schedule G) (7) .00
8. Total Assets (8) 1,602.53
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 15.00
10. Debts/Mortgage Liabilities/Liens CSchedule I) (10) 00
11. Total Deductions (11) 15.00
12. Net Value of Tax Return (12) 1,587.53
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00
14. Net Value of Estate Subject to Tax (14) 8,771.01
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) 8.771 Al x 045 = 394.70
17. Amount of Line 14 at Sibling rate (17) An x 12 = .00
18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 = .00
19. Principal Tax Due C19)= 394.70
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT
DATE NUMBER INTEREST/PEN PAID AMOUNT PAID
04-26-2011 CDO14359 19.74 390.00
11-21-2011 REFUND .00 82.90-
03-15-2012 CDO15705 .64- 72.22
07-30-2012 REFUND .00 3.72-
TOTAL TAX PAYMENT 394.70
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 DU
FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.