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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
RE CO RID E DATE 12-17-2012
REG. ESTATE OF HOWAQRD EDNA M
DATE OF DEATH 01-16-2012
t;;.( L! t FILE NUMBER 21 12-0248
COUNTY CUMBERLAND
JOHN C OSZUSTOWICZGL F. ACN 101
104 S HANOVER T~ „ , APPEAL DATE: 02-15-2013
CARLISLE ' P ` - 3 4 2 0- (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- E-
REV-1547 EX AFP (12-12) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: HOWAQRD EDNA MFILE NO.:21 12-0248 ACN: 101 DATE: 12-17-2012
TAX RETURN WAS: ( X) ACCEPTED AS FILED C ) CHANGED
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) .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) C4) .00 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 22,445.89
6. Jointly Owned Property (Schedule F) (6) 5,031.12
7. Transfers (Schedule G) (7) 295, 054.79
8. Total Assets (8) 322,531.80
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) C9) 8,445.93
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 2,130. 12
11. Total Deductions (11) 10,576.05
12. Net Value of Tax Return (12) 311,955.75
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) 52,867.87
14. Net Value of Estate Subject to Tax (14) 259, 087.88
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) 5,031.12 X 00 = .00
16. Amount of Line 14 taxable at Lineal/Class A rate C16) .0 0 X 045 = .00
17. Amount of Line 14 at Sibling rate C17) 134 .51 9.80 X 12 = 16, 142.38
18. Amount of Line 14 taxable at Collateral/Class B rate (18) 119,536.96 X 15 = 17,930.54
19. Principal Tax Due (19)= 34,072.92
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)
04-16-2012 CDO15853 421.05 81000.00
09-11-2012 CDO16487 .00 25,651.92
TOTAL TAX PAYMENT 34,072.97
BALANCE OF TAX DUE .05CR
INTEREST AND PEN. .00
TOTAL DUE .05C
* 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.