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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXE~r::('(',Q[p\ 0Ff:V"'~ C~
INHERITANCE TAX DIVISION . I..V'.;! , I..U V I u_., NOTICE OF INHERITANCE TAX
PO BOX 280601 . 'AIt~ISEIlENT ALLONANCE OR DISALLONANCE
HARRISBURG. PA 11128-0601 _J bIl" DEDUCTION'f AND ASSESSMENT OF TAX ON
SECURI Y ACCOUNTS HELD IN
BENEFICIARY FORM
'*
2006 DEe -4 PM 3: 25
REV-1548A AFP CO'-D51
CLERK OF
ORPH.A~\l'S COURT
KATHLEEN GA~Y~'Kf~" ."'(~'.. Pi\
34 BRIDGEPORT DRIVE
MECHANICSBURG PA 17050
DATE 12-04-2006
ESTATE OF LARNEY ANNE C
DATE OF DEATH 08-17-2006
FILE NUMBER 21 06-0747
COUNTY CUMBERLAND
SSN/DC 176-32-2941
ACN 06500467
APPEAL DATE: 02-02-2007
(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
CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR RECORDS ~
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NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS
AND ASSESSMENT OF TAX ON SECURITY ACCOUNTS HELD IN BENEFICIARY FORM
DATE 12-04-2006
ESTATE OF LARNEY
ANNE
C DATE OF DEATH 08-17-2006
COUNTY
CUMBERLAND
FILE NO. 21 06-0747
TAX RETURN WAS:
S.S/D.C. NO. 176-32-2941
(X) ACCEPTED AS FILED () CHANGED
BENEFICIARY FORM OF ASSET INFORMATION
ACN
06500467
NAME OF SECURITY:
MERRILL LYNCH
ACCOUNT NO.
872-47339
TYPE OF ASSET:
( ) SECURITIES (Xl SECURITY ACC ( ) STOCK () BONDS
DOD Valuation
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
276~782.o0
0.200
55~356.40
.00
55.356.40
.15
8.303.46
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT. SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS. AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
10-30-2006 CD007367 415.17 7.889.29
TOTAL TAX CREDIT 8.304.46
BALANCE OF TAX DUE 1. ooCR
- INTEREST AND PEN. .00
TOTAL DUE l.o0CR
· IF PAID AFTER THIS DATE. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED.
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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