HomeMy WebLinkAbout07-06-15 NOTICE OF INHERITANCE TAX pennsyLvania
BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE
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INHERITANCE TAX DIVISION OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP (11-14)
PO BOX 280601
17128 nr'^ RDED OFFICE OF
HARRISBURG PA
REGISTER OF WILLS DATE 07-06-2015
?015 JUL ESTATE OF CLOUSER DAVID H
6 PM 3 10 DATE OF DEATH 02-20-2009
FILE NUMBER 21 09-0204
CLERK OF COUNTY CUMBERLAND
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,.AtiS,M6HAEL 0 ACN 101
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CAMP HIP IffRD APPEAL DATE: 09-04-2015
- PA 170 11-4432 (See reverse side under Objecfions
Amount Remitted I
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- CLOUSER DAVID HFILE NO. :21 09-0204 ACN: 101 DATE: 07-06-2015
TAX RETURN WAS: ( X) ACCEPTED AS FILED C CHANGED
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) 151,000.00 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) (S) 22,955.80
6. Jointly Owned Property (Schedule F) C6) .00
7. Transfers (Schedule G) (7) .00
B. Total Assets (8) 173,955.80
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) C9) 22,251.36
10. Debts/Mortgage Liabilities/Liens (Schedule 1) (10) .00
11. Total Deductions (11) 22,251.36
12. Net Value of Tax Return (12) 151,704.44
13. Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (13) .00
14. Net Value of Estate Subject to Tax (14) 151,704.44
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) 1 9;A.49iA-44 X 045 = 7,040.54
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)= 7,040.54
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID
05-15-2009 CD011247 352.03 7,000.00
TOTAL TAX PAYMENT 7,352.03
BALANCE OF TAX DUE 311.49CR
INTEREST AND PEN. .00
TOTAL DUE 311 .49CR
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. 01�\