HomeMy WebLinkAbout06-17-15 NOTICE OF INHERITANCE TAX pennsyLvania
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP (11-14)
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-060FICE OF
RECORDL' U OF `:TILLS DATE 06-15-2015
ESTATE OF MENTZER KIMBERLY
DATE OF DEATH 02-05-2014
JUN 17 FILE NUMBER 21 14-0165
COUNTY CUMBERLAND
GENT E§4_Er"N' OFDOUGLAS H ACN 101
STEL�
,pHkt1S,' COURT APPEAL DATE: 08-14-2015
1� 7,gJ-C�HELBE-RqE-R, VA (See reverse side under Objections)
H PA 17331-1372 Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE 1� 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: MENTZER KIMBERLY FILE N0- :21 14-0165 ACN: 101 DATE: 06-15-2015
TAX RETURN WAS: C X) ACCEPTED AS FILED CHANGED
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) 89,790.41 NOTE: To ensure proper
2. Stocks and Bonds (Schedule B) (2) .00 credit to your account,
00 submit the upper portion
3. Closely Held Stock/Partnership Interest (Schedule C) (3) .
of this form with your
4. Mortgages/Notes Receivable (Schedule D) (4) .00 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 17,445.43
6. Jointly Owned Property CSchedule F) (6) .00
7. Transfers (Schedule G) (7) .00
8. Total Assets 107,235.84
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 33,951 .43
10. Debts/Mortgage Liabilities/Liens (Schedule 1) (10) 52,675.88
11. Total Deductions (11) 86,627.31
12. Net Value of Tax Return C12) 20,608.53
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00
14. Net Value of Estate Subject to Tax (14) 20,608.53
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 (is) .00 X 00 = .00
16. Amount of Line 14 taxable at lineal rate (16) 20,608-153 x 045 = 927.38
17. Amount of Line 14 at sibling rate (17) nO x 12 = .00
18. Amount of Line 14 taxable at collateral rate (18) .00 X 15 = .00
19. Principal Tax Due (19)= 927.38
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID
01-23-2015 CD020167 4.26- 931.64
06-08-2015 SBADJUST .00 1 .75
TOTAL TAX PAYMENT 927.38
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.