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NOTICE OF INHERITANCE TAX -A,
pennsylvania
BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP (12-12)
PO BOX 280601
HARRISBURG PA 17128-0601
DATE 12-24-2012
RrEG S ESTATE OF PETRY ROBERT H
DATE OF DEATH 01-06-2012
Lul PEc 21 Fif 2 t FILE NUMBER 21 12-0044
COUNTY CUMBERLAND
HOWELL C METTE ESQ ~ ACN 101
E, K, ,i
3401 N FRONT ST ORPHANS' n n,< 1 APPEAL DATE: 02-22-2013
PO BOX 5950 j' . ' (See reverse side under Objections)
HARRISBURG
G J--% 5`0 " 'zAmount 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 (12-12) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: PETRY ROBERT HFILE NO.:21 12-0044 ACN: 101 DATE: 12-24-2012
TAX RETURN WAS: C X) ACCEPTED AS FILED C ) CHANGED
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate CSchedule A) (1) 168, 000.00 NOTE: To ensure proper
2. Stocks and Bonds (Schedule B) (2) 1,084,780.71 credit to your account,
. submit the upper portion
3. Closely Held Stock/Partnership Interest (Schedule C) (3) 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) 122,862.63
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) 71,241.71
8. Total Assets C8) 1,446,885.05
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 51,015.94
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 21,421.58
11. Total Deductions (11) 72,437.52
12. Net Value of Tax Return (12) 1,374,447.53
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00-
14. Net Value of Estate Subject to Tax (14) 1,374,447.53
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) 1,374,447.52 x 045 = 61,850.14
17. Amount of Line 14 at Sibling rate C17) -001 X 12 = .00
18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 = .00
19. Principal Tax Due C19)= 61,850.14
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)
03-29-2012 CDO15765 3,052.63 58,000.00
10-04-2012 CDO16606 .00 797.51
TOTAL TAX PAYMENT 61,850.14
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 ~r
FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.