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NOTICE OF INHERITANCE TAX p � pennsyLvania
DEPARTMENT OF REVENUE
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE jj�
PO '/
BUREAU OF INDIVIDUAL TAXES OF DEDUCTIONS AND ASSESSMENT OF TAX
INHERIBOXTANCE280601 TAX AVM DED REV-1547 EX AFP (11-14)
OFFICE OF
HARRISBURG PA 17128-0 O1
REGISTER "I-)-F WILLS
DATE 05-04-2015
19 Pn- 12 20 ESTATE OF MOORE JOSEPH P
DATE OF DEATH 09-05-2013
C LE: 0 F FILE NUMBER 21 13-0992
COUNTY CUMBERLAND
ROGERS L•YSE E ACN 101
S A I D UJ
3VANtTt 400A APPEAL DATE: 07-03-2015
635 N 12TH ST (See reverse side under Objections)
LEMOYNE PA 17043-1247 Amount Remittedl
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 +-
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DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: MOORE JOSEPH OFILE N0. :21 13-0992 ACN: 101 DATE: 05-04-2015
TAX RETURN WAS: ( X) ACCEPTED AS FILED C CHANGED
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) Cl) 374,000.00 NOTE; To ensure proper
2. Stocks and Bonds (Schedule D) (2) 3,813.81 credit to your account,
00 submit the upper portion
S. Closely Held Stock/Partnership Interest (Schedule C) (3) .
of this form with your
4. Mortgages/Notes Receivable (Schedule D) (4) .00 tax payment.
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 536,838. 13
6. Jointly Owned Property (Schedule F) (6) 188.39
7. Transfers (Schedule G) (7) 55,646.51
8. Total Assets 970,486.84
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 66,348.63
10. Debts/Mortgage Liabilities/Liens (Schedule 1) C10) 2,0 62.05
11. Total Deductions (11) 68,410.68
12. Net Value of Tax Return (12) 902,076.16
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (15) .00
14. Net Value of Estate Subject to Tax (14) 902,076.16
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 C16) RF19;,976,- I A x 045 = 39,850.93
17. Amount of Line 14 at sibling rate (17) -0f) x 12 = .00
18. Amount of Line 14 taxable at collateral rate (18) 16,500.00 x 15 = 2,475.00
19. Principal Tax Due (19)= 42,325.93
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID
12-02-2013 CDO18473 2,042.11 38,800.00
06-05-2014 CDO19266 .00 1,500.00
TOTAL TAX PAYMENT 42,342.11
BALANCE OF TAX DUE 16. 18CR
INTEREST AND PEN. .00
TOTAL DUE 16. 18CR
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.