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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 2B0601
HARRISBURG PA 1712B-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF DETERMINATION AND
__A~~S$MENT OF PENNSYLVANIA
ESTATE TAX BASED ON FEDERAL
ESTATE TAX RETURN
*'
REV-4B3 EX AFP (06-05)
JO ANNE GORDON
3619 GOLFVIEW DR
MECHANICSBURG PA 17050
DATE 08-07-2006
ESTATE OF HOLLASH ALBERT J
DATE OF DEATH 09-09-2005
FILE NUMBER 21 05-1024
COUNTY CUMBERLAND
ACN 201
APPEAL DATE: 10-06-2006
(See reverse side under Objections)
Amount Remitted I ~
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
NOTE: To insure proper credit to your account. submit the upper portion of this form with your tax payment.
~~!_~~~~~_!~~~_~~~~________~__~~J~J~_~9~~~_!9~JJ9~_f9~_J99~_fJ~~~__~_____________________
REV-483 EX AFP (03-05) .. NOTICE OF DETERMINATION AND ASSESSMENT
OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN ..
ESTATE OF HOLLASH
ALBERT
J FILE NO.21 05-1024
ACN 201
DATE 08-07-2006
ESTATE TAX DETERMINATION
1. Credit For State Death Taxes as Verified
.00
2. Pennsylvania Inheritance Tax Assessed
(Excluding Discount and/or Interest)
46,189.20
3. Inheritance Tax Assessed by Other States
or Territories of the United States
(Excluding Discount and/or Interest)
.00
4. Total Inheritance Tax Assessed
46,189.20
5. Pennsylvania Estate Tax Due
.00
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
-IF PAID AFTER THIS DATE. SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU MAY BE
DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
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