HomeMy WebLinkAbout04-20-15 RECORDED OFFICE OF' NOTICE
OF INHERITANCEOWANCE OR TAX DISALLOWANCE � � Pennsylvania
BUREAU OFpp�� V BUA�. TADEES OF DEDUCTIONS AND ASSESSMENT OF TAX DEPARTMENT OF REVENUE
INHERITANCE(T �ON� 41 L L S REV-1547 EX AFP (11-14)
PO BOX 280601
HARRISBURG PA 17128-0601 �
HIS PPR
DATE 04-20-2015
ESTATE OF CLARK JESSE R
CRP �k".�, r,i4,- DATE OF DEATH 10-28-2012
_ FILE NUMBER 21 12-1183
CJMW�;?Lt•` _ . ti
COUNTY CUMBERLAND
SHAW ANDREW H ACN 101
STE 11 APPEAL DATE: 06-19-2015
200 S SPRING GARDEN S (See reverse side under Objections)
CARLISLE PA 17013-2578 Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT-ALONG-THISLINE ---) RETAIN-LOWER-PORTION-FOR-YOUR-RECORDS- E-
--- ----- -------------------------- ----- ------- --- ---- ------- -----------------------
REV-1547 EX AFP (11-14) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: CLARK JESSE RFILE NO. :21 12-1183 ACN: 101 DATE: 04-20-2015
TAX RETURN WAS: C X) ACCEPTED AS FILED C ) CHANGED
APPRAISED VALUE OF RETURN BASED ON- ORIGINAL RETURN IN
1. Real Estate (Schedule A) (1) 195,000.00 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.
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 50,516.91
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) C7) .00
S. Total Assets (8) 245,516.91
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 11 ,030.92
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 217,994.27
11. Total Deductions C11) 229,025.19
12. Net Value of Tax Return C12) 16,491.72
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00
14. Net Value of Estate Subject to Tax (14) 16,491 .72
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) 16,491 -77 x 045 = 742. 13
17. Amount of Line 14 at sibling rate (17) .0 0 , X 12 = .00
18. Amount of Line 14 taxable at collateral rate (18) .00 X 15 = .00
19. Principal Tax Due C19)= 742.13
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT C+)
AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
12-05-2014 CDO19994 30.12- 772.25
TOTAL TAX PAYMENT 742.13
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. ,*��\