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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
CAPPRAISEMENT, ALLOWANCE OR DISALLDIIANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
BUREAU OF INDIVIDUAL 'TAXiS
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
"~'o P" IF 1.3
i L t"''I L: 4
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
CLERK OF
~flVk"M,''',C1,~,lURT
ROBERT G ,~C~C ~~
107 LOCU ' "51 ,., "
HARRISBURG PA 17101
05-16-2005
MOYER
06-06-2004
21 05-0167
CUMBERLAND
101
AlIOW'lt R_i tted
*'
REY-1541 EX AFP (03-05)
RICHARD
L
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 ~
Itn.-"M4,."tf.'XlW'l"ft~'tr!1.mtWt.!II!'.!wtA'l"t'lFlW.M.~'Wlt~TftMMl'~."tJ:r.WlFlW.lITr.............. ...
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF MOYER RICHARD L FILE NO. 21 05-0167 ACN 101 DATE 05-16-2005
TAX RETURN liAS: (X I ACCEPTED AS FILED
I CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..l Estate (Schedule A)
2. Stocks .nd Bonds (Schedul. BI
3. Closely Held stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Depos-its/Hi.sc. Personal Property (Schedule EJ
6. Jointly Owned Property (Schedule fl
7. Transfers (Schedule GJ
8. Total Assets
(11
(21
(31
(41
(SI
(61
(71
,00
12,410,37
,00
,00
,00
,00
85,847,22
(81
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expens.s/A~. Costs/Hisc. Expenses (Sch.dul. H)
10. Debts/Mortgage Liabilities/Liens (Schedule Il
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governnental Bequests; Non-elected 9113 T~sts (Schedule J)
14. Net Value of Estate Subject to Tax
I~ an assessment was issued previously, lines 14, lS and'Dr 16, 17, 18 and 19 will
reflect ~igures that include the tDtal Df ALL returns assessed tD date.
ASSESSMENT OF TAX:
IS. boun,t of Line 14 ai Spousal rate US)
16. A~unt of Line 14 taxable at lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. A.ount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
A C I :
(91
1101
NOTE:
DATE
NlII1BER
INTEREST/PEN PAID (-I
7,245.00
.00
(111
1121
1131
1141
91,012,59 X
,00 X
.00 X
,00 X
AHOUNT PAID
~
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
credit to your account,
sub.it the upper po~tion
of this for. with your
tax pay...nt.
98,257,59
7.:;t41i nn
91,012.59
.00
91,012.59
00 =
045 =
12 =
15 =
.00
.00
.00
.00
.00
1191=
,00
.00
.00
,00
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS RElIlIIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR I, YOU HAY BE DUE
A REFUND, SEE REVERSE SIDE OF THIS FORtI FOR INSTRUCTIONS. I