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COMMONWEALTH OF ~ENNSYLVANIA
DEPARTMENT OF REVENUE
*
U F I DIVIDUAL TAXES-"r, ,--,'1"", (,r:::i(',~-NOTICE OF INHERITANCE TAX
~~H~~:TAN~E T~ DIVISION ,. \ rh, ,~-) '--'~"PRA:I$EMENT, ALLOWANCE OR DISALLOWANCE
PO BOX 280601 ' " . - rliFDEDUCTIONS, AND ASSESSMENT OF TAX ON
HARRISBURG PA 17128-0601 JOINTL Y HELD OR TRUST ASSETS
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MECHANICSBURG PA 17050
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 06153181
APPEAL DATE: 03-16-2007
(See reverse side under Objections)
A.ount Re.1ttedl 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=is4S-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 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
06153181
FINANCIAL INSTITUTION: MEMBERS 1ST FCU
ACCOUNT NO.
118029-59
TYPE OF ACCOUNT:
DATE ESTABLISHED
()SAVINGS () CHECKING (>TRUST OC )TIME CERTIFICATE
01-29-1993
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
X
10,579.59
0.166
1,763.30
.00
1,763.30
.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."
X
TAX CREDITS:
PAYMENT
DATE
RECEIPT
NUMBER
DISCOUNT (+)
INTEREST/PEN PAID (-)
AMOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
* 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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