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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISIQN..
PO BOX 280601
HARRISBURQ PA 17128-0601--'
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LilC;},I;..} c..' 'ii [. 4
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
riLERK OF
WILLIAM , ,~~OURT
DOUGLASfi.~,,:OFI1~(l:E P;\
PO BOX 2'61
CARLISLE PA 17013
05-16-2005
COULSON
11-14-2004
21 05-0007
CUMBERLAND
101
*'
REY-1547 EX AFP (03-05)
MILDRED
M
A.aunt R..i tted
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 ....
nV-"MC,."ft.~.'l"ft~'1l!'.Wtm.!ft!'.!wtA'rt'lFlW.m.~'IlI'It~TftMM1'~.ycr.WlAtY.ll?r.............. ...
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF COULSON MILDRED M FILE NO. 21 05-0007 ACN 101 DATE 05-16-2005
TAX RETURN WAS: (X I ACCEPTED AS FILED
I CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estat. (Schedule A)
2. Stocks end Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule DJ
5. Cash/Bank Deposits/Misc. Personal Property (Schedul. E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(II
(2J
(31
(~I
(SI
(61
(71
80,000.00
13.474.89
.00
.00
2.932.69
74.193.00
3,533.76
(81
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral ExPenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Totall Deductions
12. N.t Value of Tax Return
13. Charitable/Govern..ntal Bequestsj Non-elected 9113 Trusts (Schedule ~)
l~. Net Value of Estat. Subject to Tax
(91
1101
14,244.16
I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
IS. Amo...t of Line 1~ at Spousal rata (lSJ
16. A.ount of Line 14 taxable at lineal/Class A rete (16)
17. ""ount of Line 1~ at Sibling rat. 117l
18. A~unt of Line 14 taxable at Collaterel/Class B rate (18)
19. Principal Tax Due
T .
NOTE:
.
INTEREST/PEN PAID (-I
.00
DATE
02-18-2005
1U18ER
CD004969
.00
(Ill
1121
1131
1l~1
.00 X
159,890.18 X
.00 X
.00 X
AMOUNT PAID
6,840.00
~
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
PAYMENT MUST BE MADE BY 08-14-2005*.
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
00 =
045 =
12 =
15 =
1191=
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax PIIyaent.
174,134.34
14.::'44 lit.
159,890.18
.00
159,890.18
.00
7,195.06
.00
.00
7,195.06
6,840.00
355.06
.00
355.06
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I