HomeMy WebLinkAbout08-24-12.,~ ,_
l~ ILC1C~ OF INHERITANCE TAX Pennsylvania ~
BUREAU OF INDIVIDUAL rnxss ~FL'r~~~OC ALLOWANCE OR DISALLOWANCE
INHERITANCE TAX DIVISION DEPARTMENT OF REVENUE
PO BOX 280601 I[~'f ~V __, ~ ~~
P~ ' ` OE TIEUy~IOfitONS AND ASSESSMENT OF TAX REV-154] EX AFP (12-ill
HARRISBURG PA ]712g-0601
2~l2 AUG 24 Ali il~ 35 DATE 08-20-2012
ESTATE OF TEZAK JR FRANK J
DATE OF DEATH 11-16-2011
(~ORPH;IIU~ C~JRT FILE NUMBER 21 11-1333
CRAIG A HATCH ES@"~MBERLPNO CO., PA COUNTY CUMBERLAND
STE 100 ACN 101
APPEAL DATE: 10-19-2012
1013 MUMMA RD (See reverse side under Objections)
L EMOYNE PA 17043-1144 Amount Remittedr-----~
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALON6 THIS LINE ~-- RETAIN LOWER PORTION FOR YOUR RECORDS ('~
REV-1547 EX AFP C12-11) NOTICE OF INHERITANCE TAX APPRAISEME NT, ALLOWANCE
--------------
OR
DISALLOWANCE OF DEDUCTIONS AND ASSESS MENT OF TAX
ESTATE OF: TEZAK JR FRANK JFILE N0.:21 11-1333 ACN
: 101 DATE: OS-20-2012
TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Sehetlule A) O) 155,965
03
2. Stocks and Bonds (Sehetlule B) (y .
4,311
97 NOTE: To ensure proper
cretlit to
3. Closely Heltl Stock/Partnership Interest (Schetlule C7 (3) .
.00 your account,
submit the upper portion
4. Mortgages/Notes Receivable (Schetlule D)
C4)
.00 of this form with your
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (57
.00 tax payment.
6. Jointly Ownetl Property (Schedule F) (6) 23,884,90
7. Transfers (Schedule G)
(7) .00
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS: (8) _ 184.161 90
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schetlule H) 90
9
(q)
10. Debts/MOrt9age Liabilities/Liens (Schetlule I) (10) .
74 09
9 2 26
11. Total Oeduckions
12. Net Value of Tax R¢turn (11) 21,926.35
13. Charitable/Governmental Bequests; Non-elect¢tl 9113 Trusts (Sehetlule (12)
J) 162,235.55
14. Nat Valu¢ of Estate Subieck to Tax (13)
.00
u4) _ 162.235.55
N07E: If an assessment was issued previously, lines 14, 15 and/or 16
17 18
reflect fi8ures that include the total of ALL returns ,
,
a and 19 will
ASSESSMENT OF TAX: ssessed to date.
15. Ampunt of Line 14 at Spousal rate C15) 00
00 =
16. Amount of Line 14 taxable at Lin¢al/Class A rate (16) 1(
7 .
x
7;r
S .00
,
,
17. Amount of Line 14 at Sibling rate ,
~ x 045 =
7.300.60
(v) nn x 12 =
00
18. Ampunt of Line 14 taxable at Collateral/Class B rate (18) 00
15 .
=
19. Principal Tax Due .
x .00
TAX CREDITS: (19)' 7.300.60
PAYMENT RECEIPT DISCOUNT (+)
GATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
01-21-2012 CD015495 365
03
08-13-2012
REFUND . 7,000.00
.00 64.43-
~ IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
TOTAL TAX PAYMENT 7,300.60
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
70 TAL DUE .00
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE ~1~
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.