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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
NOTICE OF INHERITANCE TAX
A~PRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF D!:buCTIONS. AND ASSESSMENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
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DONALD L SMITij~
APT 19
660 GREGS DR
HBG PA 17111
REV-1548 EX AFP (06-05)
DATE 01-14-2008
ESTATE OF SHAY SARA E
DATE OF DEATH 07-24-2007
FILE NUMBER 21 07-0737
COUNTY CUMBERLAND
SSN/DC 185-03-3704
ACN 07145644
APPEAL DATE: 03-14-2008
(See reverse side under Objections)
Amount 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 01-14-2008
ESTATE OF SHAY
SARA
E DATE OF DEATH 07-24-2007
COUNTY
CUMBERLAND
FILE NO. 21 07-0737
TAX RETURN WAS:
S.S/D.C. NO. 185-03-3704
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: PNC BANK
TYPE OF ACCOUNT:
DATE ESTABLISHED
ACN
07145644
ACCOUNT NO.
5004050155
()SAVINGS ~) CHECKING ()TRUST ()TIME CERTIFICATE
01-05-2004
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
X
3,109.27
0.500
1,554.64
.00
1,554.64
.45
69.96
X
TAX CREDITS:
PAYMENT
DATE
11-02-2007
RECEIPT
NUMBER
CD008913
DISCOUNT (+)
INTEREST/PEN PAID (-)
.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."
AMOUNT PAID
69.96
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 tl, 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. )
69.96
.00
.00
.00
~
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