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NOTICE OF INHERITANCE TAX � pennsylvania
APPRAISEMENT, ALLOWANCE DR DISALLOWANCE , DEPARTMENTOFREVENUE
BUREAU oF INDIVIDUAL TAXES OF DEDUCTIONS AND ASSESSMENT OF TAX
INHERITANCE TAX DIVISION � � REV-1547 DC AFP (09-12)
PO BOX 28060] "-
HARRISBURG F�i 171'28-0601
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.�._ �i! : . .:,:t G.' ',. . ,_;_'�>. DATE 12-03-2012
� ESTATE OF SIMMONS CAROLINE R
! � ;� DATE OF DEATH 10-16-2011
t��'`� ',�'�� �ti E-���� � �U FILE NUMBER 21 11-1140
COUNTY CUMBERLAND
DAVID H STONE ESQ (,;3 ;���;,'_�; ;;, ACN 101
414 BRIDGE ST ��` � ;,�;a�� ., �+��a° APPEAL DATE: 02-01-2013
NEW CUMBERLAN x 7 7 (SeereversesideunderObjections)
���������t � �j �� ' ,� A�ount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE � RETAIN LOWER PORTION FOR YOUR RECORDS � ______________
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REV-1547 EX AFP C12-11� NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: SIMMONS CAROLINE RFILE N0. :21 11-1140 ACN: 101 DATE: 12-03-2012
TAX RETURN WAS: C ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate CSchedule A) C1) •�0 NOTE: To ensure proper
2. Stocks and Bonds (Schedule B) (2)
106.34 credit to your account,
.00 submit the upper portion
3. Closely Held Stock/Partnership Interest (Schedule C) C3) of this form with your
4. Mortgages/Notes Receivable (Schedule D) (4) •�� tax payment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 30.22
6. Jointly Owned Property (Schedule F) �6� .0 0
7. Transfers (Schedule G) ��� 17,105.85
8. Total Assets c8) 17.242.41
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) �q� 13.22 0.07
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .00
11. Total Deductions (11) 13,220.07
12. Net Value of Tax Return �12� 4,022.34
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts CSchedule J) �lg� .00
14. Net Value of Estate Subject to Tax C14� 4,02 2.34
NOTE: If an assessment was issued previously, Lines 14, 15, 16, 17, 18 and/or 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) 4,022.34 X 00 - .00
16. Amount of Line 14 taxable at lineal rate C16) -�� x 04 5 = .00
17. Amount of Line 14 at sibling rate C17) -�0 X 12 = .00
18. Amount of Line 14 taxable at collateral rate (18) .00 X 15 = .00
19. Principal Tax Due C19�- .00
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT C+)
AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX PAYMENT .00
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
FDR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE FOR INSTRUCTIONS.
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REV4470 Ex(01-10)
. pennsylvania INHERITANCE TAX
DEPARTMENT OF REVENUE
EXPLANATION
BUREAU OFINOIVIDUALTAXES OF CHANGES
PO Box 280601
0
DECEDENT'S NAME
Simmons, Caroline FILE NUMBER
REVIEWED BY 2111-1140
Justin R. Gilmore AcN
101
ITEM
SCHEDULE NO EXPLANATION OF CHANGES
F Per request,joint accounts have been billed separately.
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