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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRIS8URG PA 17128-0601
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,-:c:\_,U,-:;, !) rr;1!'OpPlt OF INHERITANCE TAX
:-r,-:!,..,:AJ!J!>~kSEt1eN~1 ALLOWANCE DR DISALLOWANCE
Iii:::!...:,::; :0,", rll:1'IdeiriD.dii....s. AND ASSESSMENT OF TAX ON
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JOINfLY HELD OR TRUST ASSETS
za07 DEe 10 PH I: 28
CLERK OF
ORPHAN'S COURT
JACQUELIN ANDER~V1[~EF?LANO CD.. PA
12045 GERALD AVE
GRANADA HILLS CA 91344
REV-1548 EX AFP <06-05)
DATE 12-10-2007
ESTATE OF WALLOWER EVA
DATE OF DEATH 02-28-2007
FILE NUMBER 21 07-0552
COUNTY CUMBERLAND
SSN/DC 160-16-8651
ACN 07119693
APPEAL DATE: 02-08-2008
(See reverse side under Objections)
A.ount 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-C03=Os5--------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 12-10-2007
ESTATE OF WALLOWER
EVA
DATE OF DEATH 02-28-2007
COUNTY
CUMBERLAND
FILE NO. 21 07-0552
TAX RETURN WAS:
S.S/D.C. NO. 160-16-8651
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MEMBERS 1ST FCU
TYPE OF ACCOUNT:
DATE ESTABLISHED
ACN
07119693
ACCOUNT NO.
6050-00
~ )SAVINGS () CHECKING ()TRUST ()TIME CERTIFICATE
03-15-2000
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
4,250.80
0.166
708.48
.00
708.48
.45
31. 88
X
X
TAX CREDITS:
PAYMENT
DATE
RECEIPT
NUMBER
DISCOUNT (+)
INTEREST/PEN PAID (-)
AMOUNT PAID
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 DF THIS FORM FOR INSTRUCTIONS. )
INTEREST IS CHARGED THROUGH 12-18-2007
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."
.00
31.88
.14
32.02
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