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NOTICE OF INHERITANCE TAX pennsylvania i
R{A(i4'IPPM;~TG LOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES },p
INHERITANCE TAX DIVISION )-'~.'QF rD'Ebu ,4,F1 S AND ASSESSMENT OF TAX REV-1547 EX AFP (12-11)
PO BOX 280601 ,
HARRISBURG PA 17128-0601
?J:Z OCT _9 PV3: 34 DATE 10-01-2012
ESTATE OF MARTIN MATTHEW D
DATE OF DEATH 11-08-2011
FILE NUMBER 21 12-0378
rtt~~aR~ COUNTY CUMBERLAND
CRAIG A DIEHL ESQ ~Q1aO~SERLAND CO„ PA ACN 101
3464 TRINDLE RD APPEAL DATE: 11-30-2012
CAMP HILL PA 17011-4436 (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--4 -
REV-1547 EX AFP (12-11) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: MARTIN MATTHEW DFILE NO.:21 12-0378 ACN: 101 DATE: 10-01-2012
TAX RETURN WAS: CX) ACCEPTED AS FILED ( ) CHANGED
APPRAISED VALUE OF RETURN BASED ON.. ORIGINAL RETURN
1. Real Estate (Schedule A) (1) .00 NOTE: To ensure proper
2. Stocks and Bonds (Schedule B) (2) .00 credit to your account,
submit the upper portion
3. Closely Held Stock/Partnership Interest (Schedule C) C3) 00 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) 11000 . 00
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) 100,000 . 00
8. Total Assets (8) 101 1000 . 00
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses CSchedule H) (9) 481.25
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .00
11. Total Deductions C11) 481.25
12. Net Value of Tax Return C12) 100,518.75
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts CSchedule J) (13) .00
14. Net Value of Estate Subject to Tax C14) 100,518.75
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) 100,518.75 X 00 = .00
16. Amount of Line 14 taxable at Lineal/Class A rate (16) 00 x 045 = .00
17. Amount of Line 14 at Sibling rate (17) .00 X 12 = .00
18. Amount of Line 14 taxable at Collateral/Class B rate C18) .00 X 15 = .00
19. Principal Tax Due C19)= .00
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT C+)
AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID
TOTAL TAX PAYMENT .00
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 DUE
FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.