HomeMy WebLinkAbout09-03-13 NOTICE OF INHERITANCE TAX � pennsylvan�a
APPRAiSEMENT, ALLOWANCE OR DiSALLOWANCE D E P A R T M E N T O F R E V E N U E
BUREAU oF INDIVI D U A L T A X E S O F D E D U C T I O N S A N D A S S E S S M E N T O F T A X
INHERITANCE TAX DIVISION REV-1547 IX AFP CO3-13)
PO BOX 280601
HARRISBURG PA 17128-0601
���;���}�� ����.�� ,�t�,. DATE 09-02-2013
��'��� =r ��l � �t' ESTATE OF COOVER CLARK C
}'�� ��' Y�f�.�.j DATE OF DEATH 12-31-2012
`?��f� �F FIL"E NUMBER 21 13-0014
P � t � �2 �� COUNTY CUMBERLAND
CONFAIR SUSAN H . ACN 101
2331 MARKET ST (;��-��� �� APPEAL DATE: 11-01-2013
C A M P H I L L P A 17���i��2t, ��� . (See reverse side under Objections)
�i����� 5 �T
���� � A�ount Rewitted
�'� F� MAKE CHECK PAYABLE AND REMIT PAYMENT T�:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALON6 THIS LINE ____ �! RETAIN LOWER PORTION FOR �YUUR RECORDS E�
REV-1547 EX AFP CO2-13? NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: COOVER CLARK CFILE N0. :21 13-0014 ACN: 101 DATE: 09-02-2013
_TAX RETURN WAS: C X) ACCEPTED AS FILED C ) CHANGED
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate CSchedule A) C1� .0 0 NOTE: To ensure proper
2. Stocks and Bonds CSchedule B) C2� .0 0 credit to your account,
.0 0 submit the upper portion
3. Closely Held Stock/Partnership Interest CSchedule C) C3) of this fo�m with your
4. Mortgages/Notes Receivable CSchedule D) C4� 242,650.00 tax payment.
5. Cash/Bank Deposits/Misc. Personal P�operty CSchedule E) (5) .0 0
6. Jointly Owned Property CSchedule F� C6� .0 0
7. Transfers CSchedule G) ��� .0 0
8. Total Assets C8) 242,650.00
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. FunQral ExpQnsa�s/Adm. Costs/Misc. Expenses CSchedule H) �g� 3,000.00
10. Debts/Mortgage Liabilities/Liens CSchedule I) �lp� .0 0
11. Total Deductions �li� 3,000.00
12. Net Yalue of Tax Return C12� 239,650.00
13. Charitable/6overnmental Bequests; Non-elected 9113 Trusts CSchedule J) C13� .0 0
14. Net Yalue of Estate Sub3ect to Tax C14� 239,b50.00
NOTE: If an assess�ent was issued previously, tines 14, 15, 16, 17, 18 and/o•r 19 will
reflect fiaures that include the total af all returns assessed to date.
ASSESSMENT OF TAX:
15. Aaoount of Line 14 at spousal rate C15� 239,650.00 X 00 = .00
16:' Amount of Line 14 taxable at lineal rate C16) -�� X 045 = .00
17. Amount of Line 14 at sibling rate C17? .00 X 12 = .00
18. Amount of Line 14 taxable at collateral rate C18) .0 0 X 1 5 = .0 0
19. Princfpal Tax Due C19�= .0 0
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT C+)
AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)
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 D
FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE FOR INSTRUCTIONS.