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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
11-28-2005
BASKIN
01-02-2005
21 05-0204
CUMBERLAND
101
APPEAL DATE: 01-27-2006
( See reverse side under Objections)
Amount Remitted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
9~!_~~9~~_!~~~_~~~~______~___~~!~!~_~9~~~_~~~!!9~_~~~-!~~~-~~~~~~~--~--------------------
REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
DORIS D FILE NO. 21 05-0204 ACN 101
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
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BUREAU OF INDIVIDIiJ<<C,ir"XEtU U-fi',,: "
INHERITANCE TAX DIYISION
PO BOX 280601
HARRISBURG PA 17128-0601
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MI CHAE CLBANGS
429 S 18TH ST
CAMP HILL
PA 17011
ESTATE OF
BASKI N
REY-1547 EX AFP (06-05)
DORIS
D
TAX RETURN WAS: (X) ACCEPTED AS FILED
DATE 11-28-2005
CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Hortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
50.855.83
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Hisc. Expenses (Schedule H)
10. Debts/Hortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
11,829.35
12.668.94
(11)
(12)
(13)
(14)
(9)
(10)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
50,855.83
24.498 29
26,357.54
.00
26,357.54
NOTE: IT an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reTlect Tigures that include the total oT ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
.00 X 00 = .00
26,357.54 X 045 = L 186.09
.00 X 12 = .00
.00 X 15 = .00
(19)= L 186.09
In:"c~1" l+J AHOUNT PAID
DATE NUHBER INTEREST/PEN PAID (-)
09-22-2005 CD005831 .00 L186.09
TOTAL TAX CREDIT L186.09
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE- ,
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)