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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0'01
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS, AND ASSESSMENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
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DENNIS R SHELl':i'tilI~R~E'R
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PO BOX 394
LEWISBERRY PA 17339
REV-1548 EX AFP (0'-05)
DATE 05-28-2007
ESTATE OF SHELLENBERGER SHIRLEY D
DATE OF DEATH 04-17-2006
FILE NUMBER 21 06-0363
COUNTY CUMBERLAND
SSN/DC 180-26-6686
ACN 06129127
APPEAL DATE: 07-27-2007
(See reverse side under Objections)
A.ount Re.lttedl 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 +--
REY=is4i-EX-iFP-C03=Os5--------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 05-28-2007
ESTATE OF SHELLENBERGER
SHIRLEY
COUNTY
CUMBERLAND
D DATE OF DEATH 04-17-2006
FILE NO. 21 06-0363
TAX RETURN WAS:
S.S/D.C. NO. 180-26-6686
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: SOVEREIGN BANK
TYPE OF ACCOUNT:
DATE ESTABLISHED
ACN
06129127
ACCOUNT NO.
1685540138
()SAVINGS () CHECKING (>TRUST oc: )TIME CERTIFICATE
08-11-2005
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
5,125.11
1. 000
5,125.11
.00
5,125.11
.15
768.77
x
x
TAX CREDITS:
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."
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 06-05-2007 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 768.77
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 23.40
TOTAL DUE 792.17_
* IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. * Lb
{ 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. )