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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280'01
HARRISBURG PA 17128-0'01
~;rr,,'-'.r'
, ,', ..... l'(QT~CE OF INHERITANCE TAX
'A~PRA~SEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS, AND ASSESSMENT OF TAX ON
' J~INTLY HELD OR TRUST ASSETS
*'
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CARLISLE PA 17013
--
REV-1548 EX AFP (0'-05)
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
10-16-2007
ROBERTS
~1/--b7~{/~:Jtf
CUMBE~LA~
184-03-2419
07111274
APPEAL DATE: 12-15-2007
(See reverse side IInder Objections)
A.ount Re.1 tted [ J
MAKE CHECK PAYABLE AND REMIT PAYMENT
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
JOHN
R
TO:
CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR RECORDS +-
REV:is4i-EX-AFP-C03:0Sj-----------_________________________________________________________
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 10-16-2007
ESTATE OF ROBERTS
JOHN
R DATE OF DEATH 01-21-2007
FILE NO. S.S/D.C. NO. 184-03-2419
TAX RETURN WAS: (X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MEMBERS 1ST FCU
TYPE OF ACCOUNT:
DATE ESTABLISHED
COUNTY
CUMBERLAND
ACN
07111274
ACCOUNT NO.
36012-05
~ )SAVINGS () CHECKING ()TRUST ()TIME CERTIFICATE
10-17-1997
Account Balance
Percent Taxable
Amount SUbject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
x
19,099.28
0.166 =
3,183.28
3,183.28
.00
.45
.00
X
TAX CREDITS:
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."
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 .00
* 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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