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R .i`(l~J(i X44 ICE OF INHERITANCE TAX Pennsylvania
BUREAU OF INDIVIDUAL TAXE V~ OW-A' E NT, ALLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE r
INHERITANCE TAX DIVISION Of ',d„ JJCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP (12-11)
PO BOX 280601
HARRISBURG PA 17128-0601
...314 OCT -9 FM 3: 34
DATE 10-01-2012
ESTATE OF LEFEVRE HELEN L
DATE OF DEATH 05-14-2012
d RiVN" ' G 1`~l'`1- FILE NUMBER 21 12-0608
TIMOTHY J LEFEWBERLMD CO., PA COUNTY CUMBERLAND
ACN 101
FL 2 APPEAL DATE: 11-30-2012
122 S 7TH ST (See reverse side under Objections)
LEMOYNE PA 17043-1809 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: LEFEVRE HELEN LFILE NO.:21 12-0608 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 CSchedule A) (1) .00 NOTE: To ensure proper
2. Stocks and Bonds (Schedule B) (2) .00 credit to your account,
.00 submit the upper portion
3. Closely Held Stock/Partnership Interest (Schedule C) (3) of this form with your
4. Mortgages/Notes Receivable (Schedule D) C4) .00 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 8,8 05.66
6. Jointly Owned Property (Schedule F) C6) .00
7. Transfers CSchedule G) C7) .00
8. Total Assets (8) 8,805.66
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses CSchedule H) (9) 1.131.19
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 00
11. Total Deductions (11) 11131.19
12. Net Value of Tax Return (12) 7,674.47
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00
14. Net Value of Estate Subject to Tax (14) 7,674.47
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) 7,674.47 X 045 = 345.35
17. Amount of Line 14 at Sibling rate C17) 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)= 345.35
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT
AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)
07-02-2012 CDO16204 17.22 327.18
09-24-2012 SBADJUST .00 .95
TOTAL TAX PAYMENT 345.35
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.