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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAIS~~ ALLONANCE OR DISALLONANCE
OF DEDUCTIOn:), AND ASSESSIIENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
RE\I-lS4' EX AFP 112-D8)
DENISE L HOUSE
1222 N 16TH ST
HBG PA 17~~:3
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
.~ SSN/DC
ACN
08-06-2001
HOUSE EMMA
01-12-2000
~';Rt[JA'; ? ~ ~
209-12-9017
00138202
AiIount R_itt.d
J
" 'C
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 ~
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NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 08-06-2001
ESTATE OF HOUSE
EMMA
J DATE OF DEATH 01-12-2000
COUNTY
CUMBERLAND
FILE NO. S.S/D.C. NO. 209-12-9017
TAX RETURN WAS: (X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
00138202
FINANCIAL INSTITUTION: ALLFIRST BANK
ACCOUNT NO.
0044307551
TYPE OF ACCOUNT: () SAVINGS (x> CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 08-28-1964
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
1,336.73
0.500
668.37
.00
668.37
.06
40.10
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."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 08-14-2001 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 40.10
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 2.94
TOTAL DUE 43.04
* 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 HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. 1