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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
~;;:r,c'",: (IlofT@ "OF INHERITANCE TAX
'I.;~P~~ISEMI;:N,T . ALLOWANCE OR DISALLOWANCE
<..Dt : O.tDLlCTION s.., AND ASSESSMENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
2U01 JUL 30 P;i! I: 22
CLERK OF
ORPH;\N'S C()URT
SANDRA K ROBERTS CUr'!'"""" I p,',
203 POTATO RD
CARLISLE PA 17013
REV-1548 EX AFP (06-05)
DATE 07-30-2007
ESTATE OF FITE DONALD L
DATE OF DEATH 04-28-2007
FILE NUMBER 21 07-0595
COUNTY CUMBERLAND
SSN/DC 167-40-1756
ACN 07125511
APPEAL DATE: 09-28-2007
(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
CUT ALONG THIS LINE ..... RETAIN LOWER PORTION FOR YOUR RECORDS +-
REY=is4S-EX-AFP-coi=os5--------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 07-30-2007
ESTATE OF FITE
DONALD
L DATE OF DEATH 04-28-2007
COUNTY
CUMBERLAND
FILE NO. 21 07-0595
TAX RETURN WAS:
S.S/D.C. NO. 167-40-1756
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MEMBERS 1ST FCU
TYPE OF ACCOUNT:
DATE ESTABLISHED
ACN
07125511
ACCOUNT NO.
223010-00
~ )SAVINGS () CHECKING ()TRUST ()TIME CERTIFICATE
01-16-2004
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
X
422.64
0.500
211. 32
.00
211.32
.15
31.70
X
TAX CREDITS:
PAYMENT
DATE
06-20-2007
RECEIPT
NUMBER
CD008309
DISCOUNT (+)
INTEREST/PEN PAID (-)
1.59
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."
AMOUNT PAID
31.70
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. >
33.29
1.59CR
.00
1.59CR
Ci