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NOTICE OF INHERITANCE TAX pennsy vania
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
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. E DATE 12-24-2012
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o 01 ' =aa ESTATE OF SHEAFFER BEULAH M
DATE OF DEATH 01-08-2012
iri;l_ 21 j FILE NUMBER 21 12-0119
COUNTY CUMBERLAND
EDMUND G MYERS E -1 X 1 F ACN 101
301 MARKET APPEAL DATE: 02-22-2013
PO BOX 109 fiPHANS1, V 0 ~ IR ' (See reverse side under Objections
LEMOYNE CUMBERWD/t 19 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 (12-12) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: SHEAFFER BEULAH MFILE NO.:21 12-0119 ACN: 101 DATE: 12-24-2012
TAX RETURN WAS: ( X) ACCEPTED AS FILED ( ) CHANGED
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) 292,000 . 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) (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) 190,534.03
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) .00
8. Total Assets (8) 482,534.03
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) C9) 23,006.29
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 5,130. 29
11. Total Deductions (11) 28, 136.58
12. Net Value of Tax Return (12) 454,397.45
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) 1,000. 00
14. Net Value of Estate Subject to Tax (14) 453, 397 .45
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) 453 , 397.45 X 045 = 20,402.89
17. Amount of Line 14 at Sibling rate C17) .0 0 X 12 = .00
18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 = .00
19. Principal Tax Due (19)= 20,402.89
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT C+)
DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID
04-09-2012 CDO15813 .00 17,000.00
10-04-2012 CDO16603 .00 2,508.15
INTEREST IS CHARGED THROUGH 01-08-2013 TOTAL TAX PAYMENT 19,508.15
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 894.74
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 6.75
TOTAL DUE 901.49
IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DU
FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.