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NOTICE OF INHERITANCE TAX L ~ - pennsylvania
- T, ALLOWANCE OR DISALLOWANCE
BUREAU OF INDIVIDUAL TUE9 DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION i1171~ 11 O-F'- DEI TCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP (12-12)
PO BOX 280601 RGl7 IZ)
HARRISBURG PA 17128-0601
21 DATE 12-17-2012
C Dec
~
ESTATE OF KOONCE MARY R
CLEF1. `n DATE OF DEATH 01-15-2012
ORPHANS' COURT FILE NUMBER 21 12-0149
rr ~~~A Fs COUNTY CUMBERLAND
ADAM R DELUC~1 ESQ ACN 101
61 W LOUTHER ST APPEAL DATE: 02-15-2013
CARLISLE PA 17013-2987 (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- 4-
REV-1547 EX AFP (12-12) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: KOONCE MARY RFILE NO.:21 12-0149 ACN: 101 DATE: 12-17-2012
TAX RETURN WAS: ( X) ACCEPTED AS FILED ( ) CHANGED
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) 28,500.00 NOTE: To ensure proper
2. Stocks and Bonds (Schedule B) C2) .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) 1,8 41.2 5
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) .00
8. Total Assets (8) 30,341.25
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 2,142.83
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 206.86
11. Total Deductions C11) 2,349.69
12. Net Value of Tax Return (12) 27, 991.56
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C13) .0 0
14. Net Value of Estate Subject to Tax (14) 27,991.56
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) 27 , 991. 56 X 045 = 1,259.62
17. Amount of Line 14 at Sibling rate (17) .001x 12 = .00
18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 = .00
19. Principal Tax Due (19)= 1,259.62
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT C+} AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID
04-11-2012 CDO15828 62.98 1,282.50
12-10-2012 REFUND .00 85.86-
TOTAL TAX PAYMENT 1,259.62
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 UE
FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.