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T~NOTICE OF INHERITANCE TAX pennsyLvania 4'
BUREAU OF INDIVIDUAL TAXES FR ^r LENT, ALLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE'
INHERITANCE TAX DIVISION L~ E90NS S AND ASSESSMENT OF TAX REV-1547 EX AFP (12-11)
PO BOX 280601r~-/ t' t
HARRISBURG PA 17128-0601 ` 11 IQ
DATE 0
70 12 AUG r 13 b3~ ir2` Gry2 8-06-2012
PR ESTATE OF HAWKINS DAISY R
DATE OF DEATH 04-05-2011
FILE NUMBER 21 11-0457
ow-IM, - COUNTY CUMBERLAND
WILLIAM L GRUBBERI D CO„ ACN 101
3803 GETTYSBURG RD APPEAL DATE: 10-05-2012
CAMP H I L L PA 17011-6809 (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 E-
REV-1547 EX AFP (12-11) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: HAWKINS DAISY RFILE NO.:21 11-0457 ACN: 101 DATE: 08-06-2012
TAX RETURN WAS: Cx) ACCEPTED AS FILED C ) CHANGED
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) Cl) .00 NOTE: To ensure proper
00 credit to your account,
2. Stocks and Bonds (Schedule B) (2)
submit the upper portion
3. Closely Held Stock/Partnership Interest (Schedule C) (3) 00 of this form with your
4. Mortgages/Notes Receivable (Schedule D) (4) .00 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property CSchedule E) C5) 9,747.56
6. Jointly Owned Property (Schedule F) C6) 193,560.95
7. Transfers (Schedule G) (7) 147, 000.00
8. Total Assets (8) 350,308.51
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses CSchedule H) C9) 5.549.94
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 24,066.94
11. Total Deductions (11) 29,616.88
12. Net Value of Tax Return (12) 320,691.63
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00
14. Net Value of Estate Subject to Tax C14) 320,691.63
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 (15) .00 X 00 = .00
16. Amount of Line 14 taxable at Lineal/Class A rate (16) 320.691.63 x 045 = 14,431.12
17. Amount of Line 14 at Sibling rate (17) nn X 12 = .00
18. Amount of Line 14 taxable at Collateral/Class B rate C18) .00 X 15 = .00
19. Principal Tax Due C19)= 14,431.12
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT
DATE NUMBER INTEREST/PEN PAID AMOUNT PAID
04-20-2012 CDO15874 .00 14,431.12
BALANCE OF UNPAID INTEREST/PENALTY AS OF 04-21-2012 TOTAL TAX PAYMENT 14,431.12
BALANCE OF TAX DUE .00
INTEREST AND PEN. 125.44
TOTAL DUE 125.44
* IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DU
FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.