HomeMy WebLinkAbout05-23-14 INHERITANCE TAX 17pennsyLvania
RECORD ADJUSTMENT
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION REV-1593 EX AFP (12-13)
PD BOX 280601
HARRISBURG PA 17128-0601
DATE 05-14-2014
ESTATE OF BLOSER BENJAMIN P
DATE OF DEATH 09-21-2011
FILE NUMBER 21 11-1219
COUNTY CUMBERLAND
ACN 101
DOUGLAS WILLIAM Amount Remitted
43 W SOUTH ST
CARLISLE PA 17013-3432 MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
NOTE: To ensure proper credit to your account, submit the upper portion of this form with
Your tax payment.
CUT ALONG THIS LINE --► RETAIN LOWER PORTION FOR YOUR RECORDS 4-
REV-1593 EX AFP C12-133 x* INHERITANCE TAX RECORD ADJUSTMENT ■■
ESTATE OF: BLOSER BENJAMIN P FILE NO. :21 11-1219 ACN: 101 DATE: 05-14-201,4
ADJUSTMENT BASED ON: PROTEST BOARD DECISION _G
VALUE OF ESTATE: C7
1. Real Estate (Schedule A) Cll . 00
2. Stocks and Bonds (Schedule B) (2) . 00 M n ;0 rJ
3. Closely Held Stock/Partnership Interest (Schedule C) (3) 00 ��
r) rn
4. Mortgages/Notes Receivable (Schedule D) (4) .00 y (A W C1
T n
5. Lash/Bank Deposits/Mist. Personal Property (Schedule E) O
(5) 401 ,933.60 �:-% n -n -n
6. Jointly Owned Property (Schedule F) (6) . 00 C"J O O 21
7. Transfers (Schedule G) (7) 00 'o ~+ (- (TI
B. Total Assets (8) 'O �401.9,3.3.60n o
DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Administrative Costs/
Miscellaneous Expenses (Schedule H) (9) 10,062.92
18. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .00
11. Total Deductions (11) 10,062.92
12. Net Value of Tax Return (12) 391,870.68
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00
14. Net Value of Estate Subject to Tax (14) 391 ,870.68
TAX:
15. Amount of Line 14 at Spousal rate (15) 391,870.68X.00 = . 00
16. Amount of Line 14 taxable at Lineal/Class A rate (16) .00 X.045= . 00
17. Amount of Line 14 at Sibling rate (17) .00X. 12 = .00
18. Amount of Line 14 taxable at Collateral/Class B rate (18) .001. 15 = .00
19. Principal Tax Due
TAX CREDITS: (19) .00
PAYMENT RECEIPT DISCOUNT (+] 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" (CR), YOU MAY BE DUE
FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)