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Ap1'ICAT�N�����IQrylICETOR�QISALLOWANCE "� Pennsylvania
BUREAU OF INDIVIDUAL TAXES ��ep�y�T$�HS � _NA, ASSESSMENT OF TAX DEPARTMENT6FR£VENUE
INXERITANCE TAX DZYISStiN rt '}'j �� J REY-154) Df AFP (03-13)
PO BOX 280601
HARR258UR6 PA 1?128-G681 ��'� ��� � �� 1
i �t DATE 66-10-2013
CLEy1'IS (}r ESTATE OF 4BRZ£N ROBERT F
DATE OF DEATH 02-24-2011
�RPHAN,�i� �Q�f(�'� fSIE NUMBEB 21 11-q455
CUMB�RLtiND GD„ p� COUNTV CUMBER4AND
RICHARO L PLACEV ESp p�N lpl
3621 N FRONT ST APPEAL DATE: pg-04-2013
HARRISBURG PA 17116 (SeereversesidetuiderObjutions}
A�ount Ra�ittrtl��u----�
MAKE CH£CK PAYABi.f AND REMIT PAYMENT TOz
REGISTER OF WILLS
1 COURTNOUSE SqUARE
CARLISLE PA 17413
CUT ALON6 iNIS LINE �i RETAIH �OWER PORTION FOR YOUR REC4RDS !-�
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REY-1547 EX AFP C62-13� NOTIGE 4F INNERITANCE TAX APPRAISEMENT, ALIOWANCE 4R
OISALCOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX .
ESTATE OFs OBRIEN ROBERT FFILE N0. :21 11-0455 ACN: LO1 DA7E: 06-10-2613
TAX RETURN WAS: C ) ACCEP7Ep AS FILED CJ(> CHANGED SEE ATTACHED NOTICE
APPRAZSED YAIUE OF RETURN BASED QNs ORIGINAL RETURN
1. Rea3 Estate CSChedule A) U7 �0� NU7E; To ensul`e propeP
2. Stocks antl Bonds CSChetlule B7 �27 220�414.51 credit to your account>
�0 sUbmit th• uppar pO�t10n
8. Closaly Held Stoek/Partners�ip Interest CSChatlul• C3 t3) oP this form wltA your
k. Mortga9os�Natax Receivabl• CSchpdule D3 t4} •�� t&x paY�ent.
5. Gash/Bank OeOOSits/Xisc. Personai Property tSChadula E} f5} 141r709.58
6. Jointiv OxnaE Property CSCfiaCUla F) t6} .00
7. Tronsfers fSchedule C,} f77 28r4b2.89
8. Total Assets C87 �90. 91 .48
APPROYED DEDUGTSONS AND EXEMPTION5:
4. Funoral Expenses/Adm. Costs/Misc. Exponsos CSChetlule H) �g� 26•I E6.92
10. Debts/Mortyage LSabllikies/Liens CS<hetlule I) �107 1 .449.34
71. Total Daductions �11� 27.5$8.31
12. Net Valu¢ oP Tax Return tyy� 363�003.67
13. C�ari#able/Governmental BeQUasts; Non-electad 9113 Trusts CSChptlula J) tx;} .�4
ik. 17st vaiue at Estate Sub3�ct to Tsx f141 363.003,67
NOTE: If an assessaent was issued previousiy, Lines 14, 15. 16, 17, 18 andlor 14 will
reflect fiauras that include the total af all returns assessad ta dats.
ASSESSNENT QF TAXz _
15. Amount of Line 14 at spousal rate C15) 167.270.39 X 00 = .06
16. Amount ot Line 14 t0xahl• at 11�eaY Pat9 (16) 14�'-�;x- '�R X �45 = 8r$0$.4Q
17. Amoun# of LSne 14 at s3613np rate C17) -��1 X 12 .00
18. Amount of Line 14 taxahle at eollateral rate t78} .00 X� 15 = .DO
14. Principal Tax Due �ig�= $�&OS.QO
TAX CREDITS:
PAYMENT RECEIP7 DISCOUNT C+) AM�UNT PASD
DATE NUMBER INTERES7/PEN PAID C-)
1- 4-2011 CD01526 . 0 , 5.6
04-04-2013 C4017408 .00 2,392.58
04-04-2013 WRITEDFF .00 123.60
INTEREST IS CHARGED THROUGH 06-25^2013 TOTAI TAX PAYMENT S,1S7.58
AT THE RATES APPLICABLE AS OUTLINED ON THE B1tlANCE dF TAX DUE 640.42
REVERSE SIDE OF THIS FORM INT£REST AND PEN. 4.32
TOTA� DUE � b44.74
• IF PAID AFTER DA7E TNDICATEp, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A CREDIT (CR3, YOU NAY BE OUE �
FqR C0.LCULATION qF pDDITIONAL INTEKEST. A REFUN➢. SEE REYERSE SIDE FQR INSTRUtTIONS. �f
'V1
RESERVATION: Eatates of decedents dyu��p on or bafore Dec. i2,1982-if any fuWra intergat in the eetate is fr�tened in ' or
enjayment m coHa�al be�neficiariea of iiie decederrt atter 1Me expiretlon of�.any.esta�tor Nf9 pr years:tlie Commcup�waeNh
� here6y exW'esslY ra&erv�N1e right�a{�raise aru!assess trunator mher(tance�es aE tlie bwEut r�aYpral rata on any such
fufure intereat.
PAYMENT: Datach tha top portlon of qus notice and submit with your payment�the Aegistsr of WiNS Indicat�on ihe front of tfie rwtice.
Make check or money ordpr payabie tp:REGISTEH OF WILL,AGENT.
pEFUND(CR): A retund of a terc credit rwt requested on the tex reWm may be requested by completir�p an AppNCSpon br RefurW of
Pennsyivartia tnhe�ita�ce arrd Estabe Ta�c(REV-1313}. AppGcaBons aro avallaWe from ihe dep8rkmeirt's wab site at
www.reven K.�;anY Rapi9ter of WiUS or Revenue 0(suicFOtfice;or from� � � 2#-hbur ttsrtns orderfng
servica:t-804-362-2q50;services for taxpgyers wdh spedel haar'up anNpr speaWnp needs:i-800d47-3020(TT ony).
Please albw 4-S weeks han itre�te a rehmd was grartteci fi artive.
OS,IECTfOtdS: Arry party in interest rwt satisfied with the appraisement,albw�r�ce or tFselbwance of daductions,or assessmenk of tax
{includir�g discount or irtterest}as strown on lMis rrotice may object within 80 days ot the date of receipt of this rroMce by:
A} Filing a�appeai onHne at on or before ihe appeai tlate idgndfied pn the froM of this rwtioe.
Qr sen�Ing a wriiten prqtest to:PA 17epahment of�Aevenue,Board af Appeais,Pb BOX 2612Qi,Harcisburg PA 1712&1021;
8} Mavirg Me madet datermmed at auc�t of tl�e eecouirt of tlre pereaial reKxeaentadve;or
C) CjAppealinp to the dryhaas'C�rt.
ADMlPIISTRATiVE Errrns discovsred on itris arsessrnent shouid be addreased in wriNnp io:PA Depsrtment of Revenue,8ureau of Individual
COFiRECT10N5: Taues.ATTN:Po&AasBSament RaWew Unit,�pQ 60X 2806Q1,Harrisburg PA,47'128�1021,FFWne(71Z)787-6505. Sea page 4
Instruc6ons for Inherffa�e Tau Reium fur a Residern Decedent(REV-1501)for an explanation of administraNvely correclable
ettors.
LYlSC4UNT: tf any tax due i5 paid within three caiendar moMhs after the decedeM's death,a five pBrcent discount pf the t8z paid is allowable.
iNTEREST: iMerest is charged bepinning with first day of delinquenCy,or nine months and one date trom date ot death,to the date of
y�apmaM. Anrxi�ai intereat rates are availabie on Form REV-5611,avaitabFe at www.rey,gpue.state p�,or upon rquest by
calling 7-888-728-2937.
lrMergst is cakx�la�!as folbws:
INTEREST m BALANCE OF TAX UNPAtD X NUMOER OF DAYS DELINQUENT X DAILY INTEREST FACTpR
Any No6ce issued aker the tax becomes delinquent will reflect an interest ca�ulation ta 75 days beyorid the date of the
assessment. M paymerd is made atter the irderest caicutation date staw on the Notice,adcG6onai iinerest must be caiculated. �
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nEV.taayGZ�(ai-WI♦
� pennsylvania lNHERITANCE TAX
� DEPARTMENT 6F REVENUE EXPLANATION
BUREAU OFINDIVIDUALTAXES OF CHANGES
PO Box 280901
DECE6ENTS NAME FILE NUMBER
Rabert F. O'Brien 2171-0455
REVIEWED BY ACN
Joseph Coilinx 101
SCHEDUIE �Np EXPLANATION OF CHANGES
G 1 The ncn-probate asset 4s taxable autright to the beneficiary before determining residue.
{nterest is abatsd in the amaunt of$iZ3.60 from the delinquent date 11-24-2011 to 44
2013, the date af receipt of the pro+�eeds af litigatian.
�tow Pa4e 1