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BUREAU OF INDIVIOUAL;f~€~
INIERITANCE TAX DIYISIOH--~-
PO BDX 280601
HARRISBURG PA 11128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
'~.PPRAISEHEHT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHEHT OF TAX
zoos tU'r 20 Pri 12: 42
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
05-16-2005
BRECKELS
01-18-2005
21 05-0077
CUMBERLAND
101
AIlount R.'1i tt.d
CLERK OF
ORP"^N'" "0' lOT
. 1"11-1,\ 0 \j .lli-\
DIANE S Bm~'D);;'
525 GREASON RD
CARLISLE PA 17013
*'
REV-1541 EX AFP (03-05)
ANNE
S
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
If~V-"M~,."ft.'lIW.m!'1I!'.W't'l:'l!\!.!II!'.!Ml'ftW~M!!.mr.l'WlflTft"':.'lrCtW~m:y.8Tr.............. ...
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BRECKELS ANNE S FILE NO. 21 05-0077 ACN 101 DATE 05-16-2005
TAX RETURN WAS: I X) ACCEPTED AS FILED
) CHANGED
I~ an assessment was issued previousLy, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total ~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 .t Spousal rat. (15)
16. Aaount of Line 14 taxable at Lineal/Class A rat. (16)
17. A.ount of Line 14 at Sibling rat. (17)
18. Amount of Line 14 taxable at Collateral/Class Brat. (18)
19. Principal Tax Due
A CIS:
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estat. ISchedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held stock/Partnership Int.rest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. c.sh/Bank Deposlts/Hlsc. Personal Property (Schedule EJ
6. Jointly Owned Property ISchedule F)
7. Transfers (Schedule GJ
8. Total Assets
11)
121
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
82.08
10.095.68
5,095.53
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral ExPanses/Ad.. Costs/Misc. ExPenses (Schedule Hl
10. Debts/Mortgage Liabilities/Liens (Schedule Il
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
1~. Net Value of Estate Subject to Tax
(9)
(10)
1,855.84
.00
Ill)
(12)
(13)
(14)
NOTE:
.00
.00
.00
13,417 .45
X 00 =
X 045 =
X 12 =
X 15 =
AHOUHT PAID
2,012.62
DATE
02-22-2005
INTEREST/PEN PAID (-)
100.63
NUHIIER
CD004971
~
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
NOTE: To insure proper
cradl t to your -.ccCKInt,
sub.l t the upper portion
of this form with your
tax pa.."t.
15,273.29
1 .Rlii:; R4
13,417 .45
.00
13,417.45
1191=
.00
.00
.00
2,012.62
2,012.62
2,113.25
100.63CR
.00
100.63CR
I IF TOTAL DUE IS LESS THAN $1, NO PAYHEHT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FOHN FOR INSTRUCTIONS.)