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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 pp ;
DATE 12-24-2012
REG S- y + ESTATE OF PLEVA ROGER J
DATE OF DEATH 07-04-2012
[ { FILE NUMBER 21 12-0812
COUNTY CUMBERLAND
RICHARD C PLEVA_ ~ C' ACN 101
965 MAGOTHY AV(~.~tt (LIE + APPEAL DATE: 02-22-2013
AR NO L D 'M~ 12 1 ?'l 0 (See reverse side under Objections)
CUMBERLAND,
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: PLEVA ROGER JFILE NO.:21 12-0812 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) 174,000.00 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) 1,58 1.73 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 220,530.58
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) 758,210.38
8. Total Assets (8) 1,154,322.60
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 15,139.22
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 78,066.02
11. Total Deductions (11) 93,205.24
12. Net Value of Tax Return (12) 1,061,117.40
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .0 0
14. Net Value of Estate Subject to Tax (14) 1,061,117.40
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 .061 .117.40 x 045 = 47,750.28
17. Amount of Line 14 at Sibling rate (17) _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)= 47,750.28
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)
10-01-2012 CDO16576 2,387.51 45,362.77
TOTAL TAX PAYMENT 47,750.28
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" (CR), YOU MAY BE
FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.