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• .. COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
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,TNHffRITANCE TAX
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION ,i
AP~',RAISEMENT, gt,4QWANCE OR DISALLOWANCE
PO BOX 280601 OF DEDUCT'ION'S, '/IND ASSESSMENT OF TAX ON
HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS REV-1548 EX AFP (06-05)
2Q0~'0~ P 4 AM f l: ~ ATE 10-13-2008
STATE OF CALDWELL OLGA C
v~~~\ (J4+^ DATE OF DEATH 04-19-2008
FILE NUMBER
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MICHAEL A CALDWELL I,
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', r SSN/DC 137-14-7519
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ACN 08126360
302 LEWISBERRY RD APPEAL DATE: 12-12-'2008
NEW CUMBERLAND PA 17070 (See reverse side under Objections)
Amount Remitted ~~LJ/'„ ~~7
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~""~ RETAIN LOWER PORTION FOR YOUR RECORDS •~
REV-1548-EX AFP C03-05~--------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 10-13-2008
ESTATE OF CALDWELL OLGA C DATE OF DEATH 04-19-2008 COUNTY CUMBERLAND
FILE N0. S.S/D.C. N0. 137-14-7519 ACN 08126360
TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED
JOINT OR TRUST ASS
FINANCIAL INSTITUTION: FULTON BANK
TION
ACCOUNT N0. 1068-30389
TYPE OF ACCOUNT: C )SAVINGS 4C) CHECKING C )TRUST C )TIME CERTIFICATE
DATE ESTABLISHED 01-03-2005
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
4,381.00 NOTE:
X 0.500
2,190.50
2. [~
x ~ - o ys-
-~e-~- iy, 77
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 T0:
"REGISTER OF WILLS, AGENT."
PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)
5~~~ ITT c~~~ FcaR/'-c
PAYMENT MUST BE MADE BY 01-20-2009*. TOTAL TAX CREDIT .00
BALANCE OF TAX DUE 98.57
INTEREST AND PEN. .00
TOTAL DUE 98.57
* IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST
^
C IF TOTAL DUE IS LESS THAN B1, NO PAYMENT .
IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR), YOU MAY BE DUE A REFUND.
Debts a~
Olga C. Caldwell
SSN 137-14-7519
DOD 4/19/2008
Date Paid Check # Payee
5/30/08 1094 Green Memorial Hospital Medical Exp. $ 375.00
5/31/08 1.095 Church of Latter Day Saints Funeral Exp. 250.00
6/27/08 1096 Cardiologists of C&CC Medical Exp. 210.00
6/27/08 l 097 City of Fairborn (Ambulance) Medical Exp. 100.00
7/7/08 1098 Primed Physicians Medical Exp. 10.00
7/7/08 1099 Fairborn Vision Center Medical Exp. 30.00
7/15/08 1100 Medical Imaging Physicians Medical Exp. 293.00
8/21/08 1101 Musselman Funeral Home Funeral Exp. 584.22
9/27/08 1102 Primed Physicians Medical Exp. 10.00
TOTAL EXPENSE: $ 1,862.22