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INHERITANCE TAX DIVISION"~.F f1:ED1J(~!'fjQNS AND ASSESSMENT OF TAX REV-1547 EX AFP (12-11)
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HARRISBURG PA 17128-0601 O CT OCT `9 PM 3; 34 DATE 10-01-2012
ESTATE OF COOK MARGARET E
DATE OF DEATH 03-23-2012
()RP FILE NUMBER 21 12-0400
CUMBERLAND Co. PA COUNTY CUMBERLAND
KEITH 0 BRENNEMAN ACN 101
44 W MAIN ST APPEAL DATE: 11-30-2012
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
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REV-1547 EX AFP (12-11) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: COOK MARGARET EFILE NO.:21 12-0400 ACN: 101 DATE: 10-01-2012
TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate CSchedule A) (1) •00 NOTE: To ensure proper
2. Stocks and Bonds (Schedule B) (2) 4,770.39 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 CSchedule D) (4) 00 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property CSchedule E) (5) 402,752. 95
6. Jointly Owned Property CSchedule F) (6) .00
7. Transfers (Schedule G) (7) 324,407.19
8. Total Assets (8) 731,930.53
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses CSchedule H) (9) 11,077.41
10. Debts/Mortgage Liabilities/Liens CSchedule I) (10) 3,343. 94
11. Total Deductions (11) 14,421.35
12. Net Value of Tax Return C12) 717,509.18
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C13) .00
14. Net Value of Estate Subject to Tax C14) 717,509.18
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) 717.509.18 x 045 = 32,287.91
17. Amount of Line 14 at Sibling rate C17) .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)= 32,287.91
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT C+)
DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID
06-19-2012 CDO16134 1,614.40 30,673.52
TOTAL TAX PAYMENT 32,287.92
BALANCE OF TAX DUE .01CR
INTEREST AND PEN. .00
TOTAL DUE .01C
* IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE
FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.