HomeMy WebLinkAbout04-1182COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVrDUAL TAXES
DEPT 280601
HARRISI]U RG, PA 17128-O60~
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 004771
HEDDEN HENRY A
635 OBSERVATORY DRIVE
LEWlSBERRY, PA 17339
........ fold
ESTATE INFORMATION: SSN: 077-01-3682
FILE NUMBER: 2104- 1182
DECEDENT NAME: HEDDEN DOROTHY A
DATE OF PAYMENT: 12/28/2004
POSTMARK DATE: 1 2/28/2004
COUNTY: CUM BERLAN D
DATE OF DEATH: 11/03/2004
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $11,000.00
REMARKS:
TOTAL AMOUNT PAID:
$11,000.00
SEAL
CHECK#348
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT 280601
HARRISBURG, PA 17128-0601
REV-' 162 EX(1 '-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
HEDDEN HENRY A
635 OBSERVATORY DRIVE
lEWISBERRY, PA 17339
__nnn told
ESTATE INFORMATION: SSN, 077-01-3682
FILE NUMBER: 2104-1182
DECEDENT NAME: HEDDEN DOROTHY A
DATE OF PAYMENT: 07/19/2005
POSTMARK DATE: 07/19/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 11/03/2004
NO. CD 005590
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $563.65
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$563.65
REMARKS: HENRY A HEDDEN
CHECK# 354
SEAL
INITIALS: SK
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
Rb'5C:'EXI6-GOI
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG, PA 17128-0601
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DECEDENTS ~A~E (LAST, FIRST AND MIDDLE INITIAL)
-Ie.dde /'I Dcro f1, ,
DATE OF DEATH (MM-DD-YEAR)
REV-1500
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FILE NUMBER
d2 L - ..eL .i
COU-.rv::;ODE YEAR
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Real Estate (Schedule A)
2 Stocks and Bonds (Schedule B)
3 Ciosely Held Corporation, Partnership or Sole-Proprietorship
4 Mortgages & Notes Receivable (Scneciule OJ
5 Cash. Bank Deposits & Miscellaneous Personal Property
Z (Schedule E)
0 6, Jointly Owned Property (Schedule F)
~ D Separate Billing Requested
...J
:::::l 7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property
I- (Schedule G or L)
C.
<I: 8, Total Gross Assets (total Lines 1-7)
U 9 Funeral Expenses & Administrative Costs I,Schedule H)
W
0:::
10, Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11 Total Deductions (total Lines 9 & 10)
12 Net Value of Estate (Line 8 minus Line 11)
L8J 1. Original Return
D4.LirnitedEstate
D 6. Decedent Died Testate :Attach copy of Will)
D 9. Litigation Proceeds Received
TELEPHONE NUMBER
I 7 - 938 - 7 S's 'I
1!LLg~
NUMBE?
4
SOCIAL SECURITY NUMBER
o 7-Di
"3,[,,3'2.
DATE OF BIRTH (MM-DD-YEAR)
IC-i-I?/?
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
1/-03-0'-1
(IF APPLICABLE) SURVIVING SPOUSE'S NA,ME (LAST. FIRST. AND \1100LE INITIAL;
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D 2. Supplemental Return
D 4a. Future Interest Compromise ,,8ate J: cealh a~er 12-12-82)
D 7. Decedent Maintained a Living Trusl,:AtlachcopyofTrusl!
D 10. Spousal Poverty Credit '.dme of deat~ between 12-31-91 and 1-H5!
SOC:Al SECURITY NUMBER
~ 3, Remainder Return ;~ate of death pr.or:o :2 ',3-82)
5 Federal Estate Tax Return Reouired
8, Total Number of Safe Deposit Boxes
LJ 11. Election to tax under Sec. 9113(A) IAttach Sc~ 0)
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THIS'SECTION'IIIlUST BE COMP ETEO. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME J, / COMPLETE MAILING ADDRESS
-e ee/,l b3S Oh5erva.I-c;7 0"III-<?-
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- wed/ h}-571 3Yc I
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(4) i :'LQ i""'-
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(5) -::J ~o
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;2 9 7. u c I, '"1'0 ~:~ -~I~-;
(6) <::- --l~j
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(7) - 0-
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"). 91, 0 0 1- ~o
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(9) ), .:J '
/ b21. 33
(10) -
(11) ;:;:-;, /10 '-I, ~
(12) :;2109,g]b.77.
,
13 Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (SChedule J)
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14 Net Value Subject to Tax (line 12 minus Line 13)
(13)
:2 b 9 1f3 b , '7.]
-
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
15 Amount of line 14 taxable at the spousal tax
rate, or transfers under Sec_ 9116 (a)(1_2)
16 Amount of Line 14 taxable at lineal rale
17 Amount of Line 14 taxable at sibling rate
xO_ (15)
x 0 'is. (16) 12 1'-12, ~~
x 12 (17)
x .15 (18) b5
D .IZ- $63,
'i19) -7~
..)GCJ, 830, 1:1
I
18. Amount of Line 14 taxable at collateral rate I J
.1' II 000, <<;: pJ'l :wlo'! /of' dt"S ~o'''1 r
19. TaxDu. J IV,zS n1.J2J II S79.Cr~j,r
200
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
~
Decedent's Complete Address:
STREET.DDRES~ .;I
f) ~
CITY
)) - 7/DJ...
STATE P If
ZIP_~. II'
1/,-,
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
J), N2,,~
I
1/, rJ!lCO~ ~f..
'S7'1, ",...u
Total Credits ( .A + 8 + C )
(2)
II, 571 ~.
I.>;>
3. InteresVPenalty if applicable
D. Interest
E. Penalty
TotallnteresVPenalty ( D + E )
4 If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the DVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
8. Enter the totai of Line 5 + 5A. This is the 8ALANCE DUE.
(3)
(4)
(5) .5~3. b,~
(5A)
(58) 50,3. ~
5. If Une 1 + Une 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
D I2SJ
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred: ...,.......... ..... . ....,.,.,_..... ..... ........ ...... .. ............... . . .... i'l
b. retain the right to designate who shall use the property ':-3:lS7erred or ;ts Incorre ._. .... ..... 'i
c. retain a reversionary interest: or...-----,
d. receive the promise for life of either payments, benefits or care? ,. ... .... D
2. if death occurred after Decemoer 12. 1982, aid decedent transfer property 'Nlthln one year of death
without receiving adequate consideration? ,.
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? . ... . ..... 0
4. Did decedent own an Individual Retirement Account, annUity, or other non-orobate property which
contains a beneficiary designation? .
No
'8J
:x;
;-."
t3':
L
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iXl
Jnder :Jenalties of _Jer)ury, I declare !hat I have examined this return. including accomoanying schedules and S[8[ements, ana to the best of my knowledge and belief. it IS :rue, correct anc complete
Jeciaraiion of preparer other than the personal representative is based on allnformation of'Nhic:l pleparer~as arv knowledge
SIGNATURE 9f PERSON RESPONSI E FOR F,llING RETURN
,7 fiv
9';TE
/If" /O,j-
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.~DDRESS.7 ,
(y -;;;5 Ob5</'.N/...;?'/ Dr ~ wish., <'ry
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE /
?//i /-5 3 '1- 9S'/9
DATE
ADDRESS
-:1:s.:;J.'~;::ii:C'];;::;;"":::(~f:l;'~h';:-';-~31X;;.~-c;'~\<:;,;:,;;r~;2';;-;;;'1":Jii&-~~-:4~Li^:~r"~~;:~~~i..~:3k\i.~~~U,ii;"_:i'~iti0,i;~-'
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 PS 99116 (a) (1.1) (ill.
For dales of death on or after January 1. 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)l.
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent. an adoptive parent.
or a stepparent of the chiid is 0% [72 P.S. 99116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's ilneal benefiCiaries is 4.5%, except as noted In 72 P.S. 99116(1.2) [72 PS. 99116(a)(1)1.
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as an
ndividual who has at least one parent in common with the decedent, whether by blood or adoption.
''''''''EX_I','"' ~
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Do/' 0 -J1"
SCHEDULE F
JOINTL Y.OWNED PROPERTY
FILE NUMBER
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A ;-!~ /11ft Ii
b 35 obset' 1/(110..'( D,"
''-I-...uu /~ j,,,, i' 1" fll1 173; '1
SVJ'!
B, 5.:.-L e i9 8 (.4 c.... 0 10
8? oi l-f" 11 hi eJ<>,-<'A: Dr ,1/<" S..-:rL
To- ex 5 c)7 , ; / / "'- P L 3.2 '2 '$ 0
D, ''J -14".
c.
fila rj 01';", ;-I f{J tH t s
737 S''3tJ! Sr Oce~'1
if? ~ !' 0. fful7i) F L 3 3 0.5' i:J
p'LcAJ.4kr
JOINTLY.OWNED PROPERTY
LETTER DATE DESCRIPTION OF PROPERTY
ITEM FOR JOINT MADE InClud,e name offlnancial ~nstitution anc bank account numoeror similar identifying number ,;t:a h '10 OF OATEOFDEATH
NUMBER TENANT JOINT deed ,orjolnlly held realeslale. c, :lATE OF DEATH DECO'S VALUE OF
VALUE OF ASSE, iNTEREST DECEDENTS INTERE:::
1, 3 A. C. f'n~,-uA.. tJ, ,r/2; s: ~ )1 I.V ~ t 70 ~7J97b32.... ;/ c3 - 1.00'1
2 ()c.-t' 1'1 J.. 6 :2.4.& i J ';'A: /'"I'2;6J'I.hY
;.... /1 .f'" 11 I C c /J'1rl1-.'re-eg,." A:: ~3~/o/()g'1 I -~ If, 5 ?(),;< 9
1. i...:{) 2- r{;;o /0'/;');' ,lY'L..e. t3 M I\' 1>..2(/> o'i/~b3 'V 'ie. ~ 7 jV
'- J-- S;S,..2 '1b ;-;b 'J-O :2'Z hJ 3 :;9
J 11- 5/'1kJ C.:mm iJni f yI.J,'YIK, 'i8"O(1,g'11J30 ;1.0, 03't,~s- _'V 10,0)7, 0_3
tJ /1 lefl//' ' L v /;1 111..? r t:-<! f~ {J-'/1 k: i;J. () "0 .:>.'f / 13,7S~'L If'! ~-c b) g 7/,,::JS
/ ,.~
m,J ~ 7;0 'l-tJ 0 Ib7 'I 35 o~b ,II?
5 A 6 ;big f-€t1/f , ,SO I7,S/3.of
- ff i). .I,Yc'<! 3/,850,. ,"to 'cJ""'V J S, OJ 2.S."-
0 ~ ;::rsJ,t'r7jCre.ekSje7J1 /.lme #170
/). - id' 17
--. Ie .Jj 7 /.; ::2,-
1 B lCi~{):J CD h'/ In....:- to.. <' 6.:--)/,/\ 12.000 ;;ZlfL /375 ';l.. ",-0
. -
eMf/C j).. 0 (JO .2-53 .., -b - I.b - --.-
S 13 IJ -If'02 eu YY(rJ;..?/c-/ ,;);)0 5",." ::>:...-' /7 53?, ~c
!3 o-rJl: !j'j oD!l '1'1230 .
1 !?, ''-''''OJ t ' VYI Y/1 ,-,11. f1 20,(;J3'{.OS 51; }o, 1>(7, co]
,
;O,I/;>-C. e JYr11r7 < t' ("'- 8...",1<,' }2&oO/VJ /3 , '751. f 7 SQ 6/,976,2.3'
/0 c.....
I,/;Y/o..2.. e<T'l'?1'i1 ~;- ~. -(' 6t-;tK. i:2 "'0 0 ';2,";' y 35) cl".S. /0 !2b 17/~3< sg
1/ c "-
C ~13 ~ /JJ t'YZ 1 'I;/' 8~-<- c;y~() '?'I733u ? 0, 03'1.0S- ~U )0017.0;
I~
TOTAL (Also enter on line 6, Recapitulation) $ 29~ 001, LjO
(If more s ace is needed ins
p
ert additional sheets of the same size)
REV-1511 EX-\'.- (12-99) .
, ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF D
)('0 f-A
f)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
eel/P N
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES / //;"'1-< I J '-10. tV ~31i.f. 30
1. .c (,i Yl<-'/~ II'> V-< / 3 <.'iJ.'.S
I
/~)v/,;,/- ;J J 7. 30 P If, //7-' //
3'1,)' <fV
c: 10, ~
m~JJ,Jl:J I e At"'.1... '5 ov, ~
~-o?rvl'C...R~~ 7/'''''/Y//)/Y - P'/-'-" ~u,""
P/'~" c"-'/ g) ,~
<;x ('v'vC-<! ...........-1 ~IIN:; 1"4 -;'d/~U.rn.c:.. -;;;::, .-
''';0 .w
f?('~u ll?~_/' _4 Or:),' f1~Jf- I ...",
R e c. f?f' t/..),'\.- r u c-,)(. ilC
-fh ~'" /tc"l'- e",,,/i ./ <;f"""f!s$1 3 7
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions 'Jt/J/'Y J!e ,/ cI" /,1
Name of Personal Representative(s) Il
( -3'1'51/:'1
Social Security Number(s)/EIN Number of Personal Aepresentative(s) /33
Street Address b 3 S 0& e (' Ja..k-'l' 7 Dr
City -i! c' u.J ,.s 60ft y Slate .J?I1. Zip /133 '1
,
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not lhe same as claimant's. attach explanation)
Claimant
Street Address
City State _ Zip
I
Relationship of Claimant to Decedent
4 Probate Fees
5.
Accountant's Fees
6.
Tax Return Preparer's Fees
7.
.,l---Y
~ .~
(iP'p
if 5 CO 'v
II) ~s3 ,.v
;2.;5 ~ 1:0
_.., LV
~o___
/JJp53~
I ,-v
::z) 5;2(.>-
TOTAL (Also enter on line 9, Recapitulation) $ 1 3) 57'3. ~
(If more space is needed. insert additional sheets of the same size)
pl-r7
P/l jo-y
REV-1512 EX+ \12-03)
, ,
'*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF DolO 'f/;y f) },,,,o/h/l
Report debts incur;ed by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
FILE NUMBER
ITEM
NUMBER
VALUE AT DATE
OF DEATH
2--
2,
vi
5"
(;}
I
'5
'7
/'-'
iJ
IA
DESCRIPTION
/'OW01' liJI.'"r: fJJ1.5
V;S- tc- !3, 'II
S(;,~
;;./8 d
(2,72.
}/O )1
SU-R
C;jJ,;" I-
;-/Jj P /
3' t. ,~
-r" b, ~ s J '1-",.,)' .,0 r d" r
sCl/dl, K-f~"b
/b'~
50 ~
/1." ! /---J,
'J X ;.I
/1>3,SY
/(' c 1
ba h... St<- f
r 'I
J--ynJ / Y
C i!-.s.~
fA ,;S /'C'/ iff
I ~./O
,;;-.'tZ
;2 D,~
Co /y/ C-a.) j-
,;} '1' ;20
il )6
No /y S?,Jo,f jj,s/,
YI/c // " r ]-1-<:.,,/' r (;; /'c vI'
0:J/.-!1.
TOTAL (Also enler on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
10-03-2005
HEDDEN
11-03-2004
21 04-1182
CUMBERLAND
101
APPEAL DATE: 12-02-2005
( See reverse side under Objections)
Amount Remitted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
~Y!_~~9~~_!~!~-~!~~------~---~~!~!~_k9~~~_~9~!!9~_~9~_Y9~~_~~~9~~~__~____________________
REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
DOROTHY A FILE NO. 21 04-1182 ACN 101
BUREAU OF INOIVIDUAL
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NDTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
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,,",
.i). ') ;.,.....
,:"J
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
HENRY A HEDDEN
635 OBSERVATORY
LEWISBERRY
DR
PA 17339
ESTATE OF
HEDDEN
REV-I547 EX AFP 106-05)
DOROTHY
A
TAX RETURN WAS: (X) ACCEPTED AS FILED
CHANGED
DATE 10-03-2005
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate ISchedule A)
2. Stocks and Bonds ISchedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable ISchedule D)
5. Cash/Bank Deposits/Misc. Personal Property ISchedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
.00
294.001. 40
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Dabts/Mortgage Liabilities/Liens ISchedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
110)
23,543.30
621.33
(11)
(12)
(13)
(14)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
294,001.40
74 164 63
269,836.77
.00
269,836.77
NOTE: IT an assessment was issued previously, lines 14, 15 and/or 16. 17. 18 and 19 will
reTlect Tigures that include the total oT ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
.00 X 00 = .00
269,836.77 X 045 = 12,142.65
.00 X 12 = .00
.00 X 15 = .00
(19)= 12,142.65
rlun"... ICI:~E.l1'1 (+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
12-28-2004 '-: CD004771 578.95 11,000.00
07-19-2005 CD005590 .00 563.65
TOTAL TAX CREDIT 12,142.60
BALANCE OF TAX DUE .05
INTEREST AND PEN. .00
TOTAL DUE .05
· IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
pt
I IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)