HomeMy WebLinkAbout04-15-15 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBUFiG,PA 1 7 1 28-0 601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 020506
SHEAFFER PATRICIA D
8 LONGWOOD DRIVE
MECHANICSBURG, PA 17050
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
_______' fold '_____"" __""__
101 � 51 ,153.15
ESTATE INFORMATION: ssrv: �
FILE NUMBER: 2114-O3H5 I
DECEDENT NAME: DEVORE BEVERLY LOU �
DATE OF PAYMENT: 04/1 5/201 5 �
POSTMARK DATE: 04/15/2015 �
couNTv: CUMBERLAND �
DATE OF DEATH: 04/01/201 4 �
�
TOTAL AMOUNT PAID: S 1 ,153.15
REMARKS:
CHECK# 1017
INITIALS: HMW
SEAL RECEIVED BY: LISA M. GRAYSON, ESQ.
REGISTER OF WILLS
REGISTER OF WILLS
'"""1 II I Il" I 1 II 11111 '
� � �,
NOTICE OF INHERITANCE TA�; t'� � pennsylvania
APPRAISEMENT, ALLOWANCE OR DISAL.L04JY�NCE �' DEPARTMENTOFREVENUE
BUREAU OF INDIVIDUAL TAXES OF DEDUCTIONS AND ASSESSMENT rJF� fAeX. '� REV-1547 EX AFP (11-14)
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
DATE (14-06-2015
ESTATE OF LIEVORE BEVERLY L
DATE OF DEATNI [�4-01-2014
FILE NUMBER `e'1 14-0385
COUNTY C:UMBERLAND
ZIELONIS HEATHER L ACN 1.01
6 ASH DR APPEAL. :pATE: 06-05-2015
MECHANICSBURG PA 17050 (See ra>nc���s�c side under Objectioris)
Amount Rem�.t�te�dl �. /,�j
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTf_R Uf= WILLS
1 COUR'rHOUSE SQUARE
CARLISLE f'A 17013
CUT ALON6 THIS LINE � RETAIN L�WER PORTION_FOR YOUR RECORDS_ (-� ___________________
REV-1547 EX AFP C11-14� NpTICE OF INHERII�ANCE TAX APPRAISEhiENT�, ALLOWANCE OR
DISALLOWANCE UF DEDUCTIONS AND ASSESSMEFdT OF TAX
ESTATE OF: DEVORE BEVERLY LFILE N0. :21 14-0385 ACN: 101 DATE: 04-06-2015
TAX RETURN WAS: C ) ACCEPTED AS FILED C yO CHANGED SEE ATTACHED NOTICE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) .00 NOTE: To ensure proper
�Z� 2U0,339.72 credit to vour account,
2. Stocks and Bonds (Schedule B) submit the upper portion
3. Closely Held Stock/Partnership Interest CSchedule C) (3J '�� of this form with your
4. Mortgages/Notes Receivable (Schedule D) (G) •00 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5)-.--
22,121 .62
6. Jointly Owned Property (Schedule F) {6) .00
��� 25,396.49
7. Transfers (Schedule G)
8. Total Assets c8) 247,857.83
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) �9� 40,741. 18
10. Debts/Mortgage Liabilities/Liens CSchedule I) C10) 84,613.06
cll� 125,354.24
11. Total Deductions 122�503.59
12. Net Value of Tax Return �12�
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts CSchedule J) (13) .00
14. Net Value of Estate Subject to Tax C14� 122,503.59
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: ,pp X 00 - .00
15. Amount of Line 14 at spousal rate C15) -
16. Amount of Line 14 taxable at lineal rate (16) �??•�i�3-52 X 045 = 5,512.66
17. Amount of Line 14 at sibling rate (17) .00 X 12 = .00
18. Amount of Line 14 taxable at collateral rate (18) .00 X 15 = .00
ci9�= 5,512.66
19. Principal Tax Due
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)
11-24-2014 CD019957 .00 4,369.82
INTEREST IS CHARGED THROUGH 04-21-2015 TOTAL TAX PAYMENT 4,369.82
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 1 , 142.84
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 10.31
TOTAL DUE 1 ,153. 15
� 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.
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