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COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 016900
ANDES SAMUEL L
525 NORTH 12TH STREET
PO BOX 168
LEMOYNE, PA 17043
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
fold
101 $133.19
ESTATE INFORMATION: SSN: 345-10-3170
FILE NUMBER: 2111-1048
DECEDENT NAME: DICK MARY SUE
DATE OF PAYMENT: 12/11/2012
POSTMARK DATE: 12/11/2012
COUNTY: CUMBERLAND
DATE OF DEATH: 09/ 26/ 201 1
TOTAL AMOUNT PAID: $133.19
REMARKS:
CHECK# 8949
INITIALS: CJ
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
NOTICE OF INHERITANCE TAX 9) pennsytvania
BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION OF DEDUCTIONS AND ASSESSMENT OF TAX
REV-1547 IX AFP (09-12)
PO BOX 280601
HARRISBURG PA 17128-0601 RECOF~ fz
RGL0 OF
REOIS i z--, t Or `_u DATE 11-26-2012
ESTATE OF DICK MARY S
if? DEC r, DATE OF DEATH 09-26-2011
tL`j? DEC 11 2`1 FILE NUMBER 21 11-1048
SAMUEL L ANDES CLERK ` COUNTY CUMBERLAND
ACN 101
525 N 12TH ST ORPHANS' C.CU! APPEAL DATE: 01-25-2013
L E M O Y N E P g g~15y (See reverse side under Objections)
Fi L! CO., z 3
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: DICK MARY SFILE NO-:21 11-1048 ACN: 101 DATE: 11-26-2012
TAX RETURN WAS: ( X) ACCEPTED AS FILED ( ) CHANGED
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) .01) NOTE: To ensure proper
2. Stocks and Bonds (Schedule B) (2) 1,834,620.77 credit to your account,
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) .00 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 46,351.26
6. Jointly Owned Property (Schedule F) (6) 15,564.14
7. Transfers (Schedule G) (7) 1,431,708.99
8. Total Assets (8) 3,328,245.16
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 148,186.74
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 2,012.23
11. Total Deductions (11) 150, 198.97
12. Net Value of Tax Return (12) 3, 178, 046.19
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00
14. Net Value of Estate Subject to Tax (14) 3, 178, 046.19
NOTE: If an assessment was issued previously, Lines 14, 15, 16, 17, 18 and/or 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 rate (16) -n(I x 045 = .00
17. Amount of Line 14 at sibling rate (17) -nn X 12 = .00
18. Amount of Line 14 taxable at collateral rate (18) 3, 178, 046.19 X 15 = 476, 706.93
19. Principal Tax Due (19)= 476,706.93
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT
AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID
10-31-2011 CDO15145 18,421.05 350,000.00
07-11-2012 CDO16239 .00 108,285.88
BALANCE OF UNPAID INTEREST/PENALTY AS OF 07-12-2012 TOTAL TAX PAYMENT 476,706.93
BALANCE OF TAX DUE .00
INTEREST AND PEN. 133.19
TOTAL DUE 133.19
* 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 FOR INSTRUCTIONS.