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NOTICE OF INHERITANCE TAX 1pennsytvania
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES OF DEDUCTIONS AND ASSESSMENT OF TAX
INHERITANCE TAX 'IVORDED OFFICE OF
REV-1547 EX AFP (11-14)
PO BOX 280601
HARRISBURG PA 17128-06
MISTER. OF WILLS
DATE 07-20-2015
?015 JUL 27 Pin 2 11 ESTATE OF GROSS ARLENE M
DATE OF DEATH 07-13-2014
C L E FILE NUMBER 21 14-0983
OTTO III ORPHATV'6 i -V COUNTY CUMBERLAND
ACN 101
L
10 E HI&HW3E R1 A APPEAL DATE: 09-18-2015
CARLISLE PA 17013-3015 (See reverse side under Objections)
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
I COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE 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: GROSS ARLENE MFILE N0- :21 14-0983 ACN: 101 DATE: 07-20-2015
TAX RETURN WAS: ( X) ACCEPTED AS FILED C J CHANGED
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) Cl) 227,304.00 NOTE: To ensure proper
2. Stocks and Bonds (Schedule B) (2) 46,282.02 credit to your account,
3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion
of this form with your
4. Mortgages/Notes Receivable CSchedule D) (4) .00 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) CS) .00
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) .00
8. Total Assets 273,586.02
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 420.50
10. Debts/Mortgage Liabilities/Liens (Schedule 1) (10) 00
11. Total Deductions (11) 420.50
12. Net Value of Tax Return (12) 273,165.52
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00
14. Not Value of Estate Subject to Tax (14) 273,165.52
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) 273,165.52 X 00 = .00
16. Amount of Line 14 taxable at lineal rate (16) -nn x 045 = .00
17. Amount of Line 14 at sibling rate C17) .00 x 12 = .00
18. Amount of Line 14 taxable at collateral rate (18) .00 X 15 = .00
19. Principal Tax Due (19)= 00
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID
TOTAL TAX PAYMENT .00
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.