HomeMy WebLinkAbout04-29-05
, .'~-'-'-'~--'--'",""--
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
IIlTICE DF INHERITANCE TAX
BUREAU DF INDIVIDUAl;:lfI;~;:n (}rf:!Cr:: n,.OlPPRAISEHENT, ALLDIIANCE DR DISALLlIIIAIlCE
INHERITANCE TAX DIVISIDIf .,_,JI...._. """.,,U '.I! f, rL ,.tr OF DEDUCTIONS AND ASSESS"ENT OF TAX
PO 10)( 288611 , I J"
IWIRISBlIlG PA 17128-0601
'*
REV-I541 EX AFP (03-05)
CLEFI<
CHARLES ~}ri'R.i(~S\
6 CLOUSE.t'RD
MECHANICSBURG PA 17055
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
04-25-2005
GOAS
04-19-2004
21 05-0117
CUMBERLAND
101
_t _lttecl
THOMAS
S
ZfiU5 29 Pi! i2: 03
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
li!r-"1!4,."ft.m.m~'.'H'I"m...!Rft"fIM!l!'.'IW.I'll\flI'YftWllf~.Ytr.WI_.Mr.............. ...
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF GOAS THOMAS S FILE NO. 21 05-0117 ACN 101 DATE :04-25-2005
TAX RETURN "AS: (X I ACCEPTED AS FILED
( I C_ED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..l Est.t. (Schsdul. AI
2. Stock. _ Bond. (Schsdul. BI
3. CloseJ.y IWld Stoc:k/Psrtnorship Int.rost (Sc:hsdlll. CI
'I. IIort_sIIIot.. _hsbl. (Schsdul. DI
5. es_ IIsposJt./IU.... P.,.-.l Praperty ($ch.....l. EI
6. Jointly DNhsd Property (Schsdul. FI
7. T~sf.rs (Sch.dul. 8)
B. Tot.l As..ts
(11
121
(31
I'll
151
(6)
(71
.00
.00
.00
.00
10.050.00
.00
333,385.44
(BI
NOTE. TI> in...... pr_r
credit !to your'SCCOUht,
......i t Ih ......r porUon
of thi~ fora with your
t.x ...~nt.
343,435.44
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. F....rol E_..s/_. Co.tsllllac. ExPSh"s (Schsdul. HI 191
10. Dsbtslllort_ UsbiliU.slUsn. ISchsdul. II (101 .00 I
11. Totsl hducUons 111l ' 3.988 90
12. IWt V.l... of T_ Rsturn 1121 ~39, 446.54
13. Chsritsbls/80v.nnsant.l Bsqus.ts; Non-.l...tecl 9113 Trusts (Schsdul. JI (131 ; .00
1'1. IWt V.I... of Est.t. SubJsct to T_ 11'11 ,39,446.54
NOTE: I~ an .......ent wa. is.ued previou.ly, lines 14, 15 and/or 16, 17, 18 'and 19 will
rWl.C't ~igures t:hat: inclUde t:he t:at:al ~ ALL ret:urn. .....s.d 1:0 da1:..!
- ,
ASSESSMENT OF TAX: ,
IS. _t of Uno 1'1 .t Spou..l rot. (ISI 339.446 . 54 x 00 =
16. _t of Uno 1'1 t_l. .t U....l/Cl..s A rot. (161 .00 X 045 =
17. _t of Uno 1'1 .t Sibling rats 1171 .00 X 12 =
lB. _t of Uno 1'1 ~l. .t Coll.t.r.l/Cl.s. B rot. (181 .00 X 15 =
19. Princi...l T_ Du. 1191=
3,988.90
.00
.00
.00
.00
.00
DATE
IUIIlER
INTEREST/PEN PAID I-I
AIIDUNT PAID
~
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.00
.00
.00
.00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FDR CALCUlATION DF ADDITIONAL INTEREST.
( IF TDTAL DUE IS LESS THAN t1, NO PAYIlENT IS RElIC/IRED.
IF TDTAL DUE IS REFLECTED AS A "CREDIT'" ICII, YOU MY BE DUE
A REFUND. SEE REVEIlSE SIDE OF TlUS FDRM FDR INSTRUCTIONS. I