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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
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BUREAU OF INDIVIDUAL TA~:~JJ'S'l.;::')
INHERITANCE TAX DIVISION "
PO BOX 2B0601
HARRISBURG PA 17128-0601
NOTICE OF INHERITANCE TAX
A~P~AtSEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS, AND ASSESSMENT OF TAX ON
, . JO~TL Y HELD OR TRUST ASSETS
Pr\ \2.. 0 DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
REV-1548 EX AFP (06-05)
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ETHEL J PET~('rN'
1520 SELTZER CT
MECHANICSBURG
PA 17050
01-15-2007
PETERSON
07-17-2006
21 06-1101
CUMBERLAND
086-20-0896
06153199
APPEAL DATE: 03 -16 - 20 07
(See reverse side under Objections)
Amount Remitted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
RICHARD
N
TO:
CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REY=is4S-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
06153199
FINANCIAL INSTITUTION: MEMBERS 1ST FCU
ACCOUNT NO.
118029-00
TYPE OF ACCOUNT:
DATE ESTABLISHED
~ )SAVINGS () CHECKING ()TRUST ()TIME CERTIFICATE
01-29-1993
x
6,452.29
0.166
1,075.40
.00
1,075.40
.00
.00
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 (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE . DO)
* 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. )