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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
r;p-:'nD'[r~;[~r-O~,_~NHERITANCE TAX
,..: ;~:~RA~EtfEN1",CAobl-oWANCE OR DI SALLOWANCE
':::Qf..;DEDUCT10I\lS "AND ASSESSMENT OF TAX ON
"'jO'INTL y. H&LD OR TRUST ASSETS
*'
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 2B0601
HARRISBURG PA 17128-0601
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CHRISTOPH DAVIS C' '
3929 BROOKRIDGE DR
MECHANICSBURG PA 17050
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REV-1548 EX AFP (06-05)
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
09-03-2007
DAVIS
04-12-2007
21 07-0594
CUMBERLAND
040-42-3539
07123129
APPEAL DATE: 11-02-2007
(See reverse side "nder Objections)
A.ount Re.ltted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CYNTHIA
TO:
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 09-03-2007
ESTATE OF DAVIS
CYNTHIA
DATE OF DEATH 04-12-2007
COUNTY
CUMBERLAND
FILE NO. 21 07-0594
TAX RETURN WAS:
S.S/D.C. NO. 040-42-3539
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MEMBERS 1ST FCU
TYPE OF ACCOUNT:
DATE ESTABLISHED
ACN
07123129
ACCOUNT NO.
181555-00
~ )SAVINGS () CHECKING ()TRUST ()TIME CERTIFICATE
02-01-1999
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. >
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
x
1,121.93
0.166
186.99
.00
186.99
.45
8.41
x
TAX CREDITS:
PAYMENT
DATE
RECEIPT
NUMBER
DISCOUNT (+)
INTEREST/PEN PAID (-)
PAYMENT MUST BE MADE BY 01-13-2008*.
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
.00
8.41
.00
8.41
C--J