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BUREAU OF INDIVIDUAL TAXES RECORD ADJUSTMENT Iff,
DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION REV-1593 EX AFP (12-13)
PO BOX 280601
HARRISBURG PA 17128-0601
DATE 11-10-2014
ESTATE OF HESS A A
DATE OF DEATH 08-31-2013
FILE NUMBER 21 13-1014
COUNTY CUMBERLAND
ACN 101
BOGAR JAMES D Amount Remitted
1 W MAIN ST 11 3 a . W
SHIREMANSTOWN PA 17011-6327 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 (12-13) ** INHERITANCE TAX RECORD ADJUSTMENT **
ESTATE OF: HESS A A FILE NO. :21 13-1014 ACN: 101 DATE: 11-10-2014
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
VALUE OF ESTATE: o
1. Real Estate (Schedule A) (1) .00
2. Stocks and Bonds (Schedule B) (2) 312,918. 18
3. Closely Held Stock/Partnership Interest (Schedule C) (3) 00 ZZ [j C 01)
4. Mortgages/Notes Receivable (Schedule D) (4) 00 r C N --{ C7
_. rT, _ -71
5. Cash/Bank Deposits/Mist. Personal Property (Schedule E) (5) 132,627.46
� �
6. Jointly Owned Property (Schedule F) (6) 00 r J
7. Transfers (Schedule G) (7)
39.755.33 C
B. Total Assets (8). 4856-3'00.-97 C7
DEDUCTIONS AND EXEMPTIONS: FTt
N
9. Funeral Expenses/Administrative Costs/ cf) c>CTS "rT
Miscellaneous Expenses (Schedule H) (9) 52,816.30
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) Go
11. Total Deductions (11) 52,816.30
12. Net Value of Tax Return (12). 432,484.67
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00
14. Net Value of Estate Subject to Tax (14) 432,484.67
TAX:
15. Amount of Line 14 at Spousal rate (15) .00X.00 = .00
16. Amount of Line 14 taxable at Lineal/Class A rate (16) 31,418.34 X. 045= 1,413.83
17. Amount of Line 14 at Sibling rate (17) 15,709.17Y. 12 = 1,885.10
18. Amount of Line 14 taxable at Collateral/Class B rate (18) 385,357.16Y. 15 = 57,803.57
19. Principal Tax Due
(19) 61,102.50
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID
11-21-2013 CDO18437 3,055.13 59,248.46
02-14-2014 CDO18757 .00 701 .22
09-16-2014 REFUND .00 6,231.72-
INTEREST IS CHARGED THROUGH 11-25-2014* TOTAL TAX PAYMENT 56,773.09
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 4,329.41
REVERSE SIDE OF THIS FORM INTEREST AND PEN. LUq,ve
TOTAL DUE —4;
* 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.)