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���r�,�i.�►1���ANCE TAX � pennsylvania
ApPRAIS�F�(pCMy,TJ,t,.;A. LdG'AI� �E OBFDISALLOWANCE
BUREAU OF INDIVIDUAL TAXES OF DELUCI't9N�I� '-/�S�SES�MENT OF TAX DEPARTMENTOFREVENl1E
INHERITANCE TAX DIYISION � oa L( REV-15W EX AFP (�3-13)
PO 90X 280601
HARRISBUBG PA 17128-0601 ����� 11.�1 � �
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t�ar�3 o�-oa-zois
C�ERK OF ESTATE OF SOUTNER PAULINE B
�RpH��s• C�U��LE NUMBERTH 21 13-0058
CUM@ERL�Np GO.�c�rv CUMBERLAND
CHARLES E PETRIE
ACN 101
3528 BRISBAN ST APPEAL DATE: 09-06-2013
HARRISBURG PA 17111-1803 (Seereversesideund¢rObjections)
. Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALON6 TNIS LINE -� RETAIN LOWER PORTION FOR YDUR RECORDS (-�
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REY-1547 EX AFP CO2-13� NOTICE DF INHERITANCE 7AX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: SOUTNER PAULINE BFILE N0. :21 13-0058 ACN: 101 DATE: 07-08-2013
TAX RETURN WAS: C x) ACCEPTED AS FILED O CHANGEO
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A7 (1) •�� NOTE: To ensure proper
2. Stocks and Bonds (SChetlule BJ �Z� .D� credit to your account,
.QO SUb101t the upp¢1' p01't1o11
3. Llosely Held Stock/Partnership LnF¢rest (SChetlule C) (3), of this form with your
4. Mortgages/NOtes Receivable (SChetlule D) (4) •00 tax oayment.
5. CashBank Deposits/Misc. Personal ProperYY (Schedule E) �5) 34,748.64
b. Jointly Ownetl Property (SChetlule F) �6� .00
7. Transfers (SCheCule G) C7� .00
e. Total Assets Ce) 34.748.64
APPROVED DE�UCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Atlm. Costs/Misc. Expenses (Schedule H) �9� 6.308.27
10. Debts/Mortgage Liabilities/Liens CSchedule I) (lOJ 2.781 .36
11. Total Detluctions C11) 9.089.63
12. Net Value ot Tax Retur� �lZ� 25.659.01
13. Charitable/GOVernmental Bequests; Non-electetl 9113 Trusts (SChedule J) �13� . 00
14. NeY Value of Estate Subject to Tax �lG� 25.659. 01
NUTE: If an ass¢ssment was issued previouslv. Lines 14, 15, 16, 17, 18 and/or 19 will
reflect figures that include the total of all returns assessed to date.
ASSESSMEN7 OF TAX:
15. Amount of LSne 14 at sPOUSal rete C15J •DO X 00 .00
16. Amount of Line 14 taxa6le at lineal rate (16) �F•��`q� �� X 04rJ ° 1,154.66
17. Amount of Line 14 at siblin9 rate (17) - �� X 12 - . 00
18, Amount of l3ne 14 taxable at collateral rate (18) . 00 X 15 - . 00
14. vrinciaal Tax Due (19�= 1 .154.66
TAX CREDITS:
PAYMENT RECEIPT DISCOl/NT C+) pMOUNT PAIO
DATE NUMBER INTEREST/PEN PAID C-)
05-03-2013 CD017540 .00 1, 154.66
T�TAL TAX PAYMENT 1,154,66
BALANCE OF TAX DUE ,00
INTEREST AND PEN. ,OD
TOTAL DUE .00
* IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A CREDIT (CR). YOU MAY BE DUE ,('�V
FOR CALWLATION OF ADDITIONAL INTEREST. A REFONO. SEE REVE2SE SIDE fOR INSTRUCTIONS. r�1��P
�UJ
. . _ . _ . . . . . . . . ..
RESERVATION: enjoymeM�to collateral b'enef c ar esfof thDe de edent afte the exp iat oneof any estate forl fe�oayefarse he Commonlwealth
hereby expressly reserves the right to appraise and assess transfer inheritance iaxes at the lawful collateral rate on any such
future interest.
PAYMENT: Detach the top portion of this notice and submit with your payment to the Register of Wills Indicated on the front of[he notice.
Make check or money order payable to:REGISTER OF W ILL,AGENT. .
REFUND(CR): Penns y an a�lnher tance and Estate Tar(REV-1313). Appb at oQ seare availab e�l otm9he depalrtmenCs web sRe atf
www revenue staLe.p��,any Register of Wills or Revenue Dis[rid Office,or from the departmenYs 24-hour forms ordering
service:1-800-362-2050;services for taxpayers with special hearing and/or speaking needs:1-500-447-3020(TT only).
Please allow 4-6 weeks from the date a refund was granted to arrive.
OBJECTIONS: Any party in interest not satisfied with the appraisement,allowance or disallowance of deductions,or assessment of tax
(including discount or interest)as shown on this notice may object within 60 days of the date of receipt of this notice by:
A) Or se di g a wrttelnnprotes PA Depart elnt of Reve�n�u�e�Boa d of AppealsPPO BOX1281201tlHarr sburg PA 17�128 1�021;
B) Having the matler determined at audit of the account of the personal representative;or
C) C)Appealing to the Orphans'Court.
ADMINISTRATIVE Errors discovered on this assessment should be addressed in wriiing to:PA Department of Revenue,Bureau ot Individual
CORRECTIONS: Taxes,ATTN:Post Assessment Review Unit,PO BOX 280601, Harrisburg PA,17128-1021,Phone(717)787-6505. See page 4 .
Instructions for Inheritance Taz Return for a Resident IJecedent(REV-1501)for an ezplanation of administratively correctable
errors.
DISCOUNT: If any taz due is paid within ihree calendar months after the decedenYs death,a five percent discount of the taz paid is allowable.
INTEREST: PaYment Annrual�'�nbte9estl a9es ere avaiaab�e onl�Form REV 1611e available ad o�deVenue state oa usator upon rquest by
calling 1-888-728-2937.
Interest is calculated as follows:
INTEREST=BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
Any Notice issued aker the taz becomes delinquent will reflect an interest calculation to 15 days beyond the date of the
� assessment. If payment is made atter the interest calculation date show on the Notice,additional interest must be calculated.