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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
,
N~TICE OF INHERITANCE TAX
ARPRAISE"ENT, ALLOWANCE OR DISALLOWANCE
OPDEnUCTIONS, AND ASSESSMENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
1 f;, ~\;\. \ \: 2.5 DATE
T 1 S-J\ - t\
L(\U :. ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
MATTHEW K WAGNER
13 HOMESTEAD LN
CAMP HILL
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PA 17011
REV-1548 EX AFP (06-05)
09-11-2007
POWELL
08-12-2006
21 06-0730
CUMBERLAND
174-20-6085
06152631
APPEAL DATE: 11-10-2007
(See reverse side under Objections)
A.ount Re.1ttedl I
MAKE CHECK PAYABLE AND REMIT PAYMENT
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
JEAN
D
TO:
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS +-
REY=is4i-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 09-11-2007
ESTATE OF POWELL
JEAN
D DATE OF DEATH 08-12-2006
COUNTY
CUMBERLAND
FILE NO. 21 06-0730
TAX RETURN WAS:
S.S/D.C. NO. 174-20-6085
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MEMBERS 1ST FCU
ACN
06152631
ACCOUNT NO.
261572-46
TYPE OF ACCOUNT: ()SAVINGS () CHECKING OC >TRUST ()TIME CERTIFICATE
DATE ESTABLISHED 02-03-2006
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" ( CRl, YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
5,007.52
1. 000
5,0 D7 . 52
.00
5,007.52
.45
225.34
X
x
TAX CREDITS:
PAYMENT
DATE
RECEIPT
NUMBER
DISCOUNT (+)
INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 09-19-2007
AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORM
*
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
225.34
6.42
231.76
. ~........
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