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REC%QjtCNDi'1'` C 6�F)F INHERITANCE TAX pennsylVanla
BUREAU OF INDIVIDUAL TAXES REGIS ;AJ M�Ff1�,,,ALLgWANCE OR DISALLOWANCE �Clll►`7t DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION DUCiT.lDNS AND ASSESSMENT OF TAX REV-1547 EX AFP (08-13)
PO BOX 280401 )
HARRISBURG PA 17128-0601 L"13 3 PM 3 L 4
U DEC l.11 II 1 DATE 12-16-2013
CLERK OF ESTATE OF SHAUB GEORGIA A
ORPHANS' COURT DATE OF DEATH 12-04-2012
CUMBERLAND CO., PA FILE NUMBER 21 12-1296
COUNTY CUMBERLAND
CHEREWKA ESQ MICHAEL ACN 101
624 N FRONT ST APPEAL DATE: 02-14-2014
WORMLEYSBURG PA 17043 (See reverse side under Objections)
Amount Remitted]
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
I COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE ---- --i RETAIN LOWER PORTION FOR YOUR RECORDS (--
`-""---"`-`-"`--"--""-"-----"-""""`-`--------------
REY-1547 EX AFP C08-13) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: SHAUB GEORGIA AFILE NO. :21 12-1296 ACN: 101 DATE: 12-16-2013
TAX RETURN WAS: C ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) •00 NOTE: To ensure proper
2. Stocks and Bonds (Schedule B) (2) 29,441 .00 credit to your account,
DO submit the upper portion
3. Closely Held Stock/Partnership Interest (Schedule C} (3) of this form with your
4. Mortgages/Notes Receivable (Schedule D) (4} •00 tax payment.
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 1,057,148.00
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) 298'282.00
B. Total Assets (B) 1 ,384.871 .62
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm, Costs/Misc. Expenses (Schedule H) (9) 97.129.00
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 51 ,793.00
11. Total Deductions (11) 148,922.00
12. Net Value of Tax Return C12) "1,235,949.00
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) 187.533,4D
14. Net Value of Estate Subject to Tax (14) 1,048,415.60
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) •00 X 00 = .00
16. Amount of Line 14 taxable at lineal rate (16) -nn X 045 = 100
17. Amount of Line 14 at sibling rate (17) .-00 X 12 = .00
18. Amount of Line 14 taxable at collateral rate (18) 1 ,048,415.60 X 15 = 157,262.34
19. Principal Tax Due (19)= 157,262.34
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-05-2013 CDO1726 .00 181,156.00
TOTAL TAX PAYMENT 181,156.00
BALANCE OF TAX DUE 23,893.66CR
INTEREST AND PEN. .OD
- _ TOTAL DUE 23,893.66CR
* IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A CREDIT (CR), VDU MAY BE DUE
FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE FOR INSTRUCTIONS.
RM1470 Ex(01.1
I pEnnsytVania INHERITANCE TAX
I DEPARTMENT OF REVENUE EXPLANATION
BUREAU OF INDIVIDUAL TAXES OF CHANGES
PO Box 280801
HARRISBURG PA 17128-0601
DECEDENTS NAME FILE NUMBER
Georgia Shaub 2112-1296
REVIEWED BY ACN
Alan —Agent ID: 99 101
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
G Accounts are taxable outright to the beneficiary/ies before determining residue.
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