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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 2B0601
HARRISBURG PA 1712B-0601
NOTICE OF INHERITANCE TAX
APPR~~SEMENT,ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS.. AND ASSESSMENT OF TAX ON
~OINTLY HELD OR TRUST ASSETS
REV-154B EX AFP (06-05)
I, '~J
DATE 04-23-2007
. ES;{ATE OF STAIVISKY JACK A
i j j =rlA1'E OF DEATH 06-29-2006
FILE NUMBER 21 07-0235
COUNTY CUMBERLAND
SSN/DC 193-30-1145
; i ACN 06147901
APPEAL DATE: 06-22-2007
(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
ELIZABETH A STAIVISKY
100 CARDINAL DR
HUGHESVILLE PA 17737
CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REY=is4i-EX-AFP-C03=OSj--------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE o4-23-~007
I
ESTATE OF STAIVISKY
JACK
A DATE OF DEATH 06-29-2006
COUNTY
CUMBERLAND
FILE NO. 21 07-0235
TAX RETURN WAS:
S.S/D.C. NO. 193-30-1145
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
06147901
FINANCIAL INSTITUTION: THE MUNCY BANK & TRUST CO
ACCOUNT NO.
2205004815
TYPE OF ACCOUNT:
DATE ESTABLISHED
~ )SAVINGS () CHECKING ()TRUST ()TIME CERTIFICATE
06-13-2005
X
5,274.07
0.166
879.03
.00
879.03
.00
.00
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF T~IS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. M~KE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS" AGENT."
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
x
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE I .00
INTEREST AND PEN. .00
TOTAL DUE .00
* 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.
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