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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*'
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
: _...(':""', -::-,:jN,01~~~('\lf)',NHERIT ANCE TAX
, 'AIiPRAIs'eM'Ellfr,!,..~LL.oWANCE OR DISALLOWANCE
iGF-DEDUCTlONS\ AND ASSESSMENT OF TAX ON
JOINTLYHELb OR TRUST ASSETS
REV-1548 EX AFP (06-05)
2007.JAN 16 PH 12: 02
DATE 01-15-2007
ESTATE OF PETERSON RICHARD N
DATE OF DEATH 07-17-2006
FILE NUMBER 21 06-1101
COUNTY CUMBERLAND
SSN/DC 086-20-0896
ACN 06153190
APPEAL DATE: 03-16-2007
(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
l~-LFr'" r,--
" ._:I'o;r\ 1....),'-
ORPHlJrS r:(;! !RT
KAREN J MARCH CUI',:_m - . - ,
3755 MOUNTAIN VIEW RD
MECHANICSBURG PA 17050
CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR RECORDS +-
REY=is4i-EX-AFP-C03=Os5--------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 01-15-2007
ESTATE OF PETERSON
RICHARD
N DATE OF DEATH 07-17-2006
COUNTY
CUMBERLAND
FILE NO. 21 06-1101
TAX RETURN WAS:
S.S/D.C. NO. 086-20-0896
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
06153190
FINANCIAL INSTITUTION: MEMBERS 1ST FCU
ACCOUNT NO.
118029-46
TYPE OF ACCOUNT:
DATE ESTABLISHED
()SAVINGS () CHECKING ()TRUST OC )TIME CERTIFICATE
02-04-2005
x
21,094.91
0.166
3,515.89
.00
3,515.89
.45
158.22
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."
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 (-)
11-30-2006 CD007558 .00 158.22
TOTAL TAX CREDIT 158.22
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE Ii
.oor-.
" IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. " /J
( 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. )