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BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE
ECORD£D 0 �'QE ��pUCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP (11-14)
INHERITANCE TAX DIVIS t�t tt''
PO BOX 280601
HARRISBURG PA 17128-06(RECISTE^ OF V!1LLS
t1 DATE 12-29-2014
2014 DEC 29 FM
12 C5 ESTATE OF NEBROSKI PATRICIA A
DATE OF DEATH 11-30-2013
CHF;;, OF FILE NUMBER 21 14-0814
MOYA ORPHAA4'S' ^i ^M COUNTY CUMBERLAND
Jnr F 1 , a; . I ACN 101
5011 LOC �W"L` t_ 11 . % APPEAL DATE: 02-27-2015
HARRISBURG PA 17109-4522 (See reverse side under Objections)
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS 4--
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REV-1547 EX AFP C11-14) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: NEBROSKI PATRICIA AFILE NO. :21 14-0814 ACN: 101 DATE: 12-29-2014
TAX RETURN WAS: ( X) ACCEPTED AS FILED ( ) CHANGED
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) Cl) •00 NOTE: To ensure proper
2. Stocks and Bonds (Schedule B) (2) .00 credit to your account,
3. Closely Held Stock/Partnership Interest (Schedule C) (3) 00 submit the upper portionof this form with your
4. Mortgages/Notes Receivable (Schedule D) (4) .00 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) .00
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) 82,964.79
B. Total Assets c8) 82,964.79
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 4,84 7.54
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 00
11. Total Deductions (11) 4,847.54
12. Net Value of Tax Return (12) 78,117.25
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00
14. Net Value of Estate Subject to Tax (14) 78,117.25
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) 78,117.25 X 00 = .00
16. Amount of Line 14 taxable at lineal rate (16) -nn x 045 = .00
17. Amount of Line 14 at sibling rate (17) .00 X 12 = .00
18. Amount of Line 14 taxable at collateral rate C18) .00 X 15 = .00
19. Principal Tax Due (19)= 00
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+)
AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
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 FOR INSTRUCTIONS.