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CRYSTAL KERNS
1830 F HEISHMAN GRDN DR
CARLISLE PA 17013
COMMONWEALTH OF PENNSYLVANIA
.. ,.~EPARTMENT OF REVENUE
. NOTICE OF INHERITANCE TAX
APPRAISEI'lENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS, AND ASSESSMENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
20D7 OCT /2 Pi'l12:' 0 DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
'*
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 1712B-0601
REV-1548 EX AFP (06-05)
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10-16-2007
ROBERTS
01-21-2007
1.\ -0 1 {)~'l4
C6HBERLAND
184-03-2419
07111281
APPEAL DATE: 12-15-2007
(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
JOHN
R
TO:
CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR RECORDS +-
Riy=is4i-ix-AFP-C03=os5---------------------------------___________________________________
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
COUNTY
CUMBERLAND
FILE NO. S.S/D.C. NO. 184-03-2419
TAX RETURN WAS: (X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
07111281
FINANCIAL INSTITUTION: MEMBERS 1ST FCU
ACCOUNT NO.
36012-11
TYPE OF ACCOUNT:
DATE ESTABLISHED
()SAVINGS OC) CHECKING (>TRUST (>TIME CERTIFICATE
09-14-1992
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
x
12,354.27
0.166
2,059.09
2,059.09
.00
.45
.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 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 r\
II IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. II
( 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. )