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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
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r)::r\f~:'-;r::;: (',"'iMTttE OF INHERITANCE TAX
," , ", j :-~APPR.AISE.,.jEIfT, ALLOWANCE OR DISALLOWANCE
'IOF; nEDUCT~HS, AND ASSESSMENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
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DENNIS RANGE ClJ,n:~- " ,~-' P!\
1007 CHARLES STREET
MECHANICSBURG PA 17055
REV-1548 EX AFP (06-05)
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
12-17-2007
RANGE
07-27-2007
21 07-0985
CUMBERLAND
162-48-0958
07002799
APPEAL DATE: 02-15-2008
(See reverse side under Objections)
A.aunt Remitted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
STEPHANIE A
TO:
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 12-17-2007
ESTATE OF RANGE
CUMBERLAND
STEPHANIE A DATE OF DEATH 07-27-2007
S.S/D.C. NO. 162-48-0958
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MEMBERS 1ST FED CREDIT UNION ACCOUNT NO.
FILE NO. 21 07-0985
TAX RETURN WAS:
TYPE OF ACCOUNT:
DATE ESTABLISHED
COUNTY
ACN
07002799
204497-00
~ )SAVINGS () CHECKING ()TRUST ()TIME CERTIFICATE
04-26-2001
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
X
18,994.00
0.166
3,165.73
.00
3,165.73
.00
.00
X
TAX CREDITS:
PAYMENT
DATE
RECEIPT
NUMBER
DISCOUNT (+)
INTEREST/PEN PAID (-)
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
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. }
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