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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
LCE,.~f~F INHERITANCE TAX 1
BUREAU OF INDIVIDUAL TAXES t~~"~'~~ ~' ~, ,+ ICI
r ~~,( ~L
INHERITANCE TAX DIVISION ~l.~ifl~6N~ (,JILLDWANCE OR DISALLOWANCE
PD BOX 280601 ~~ :~"'~'.(9~'vP,EpllD~~1~1$,. AND ASSESSMENT OF TAX ON
HARRISBURG PA 17128-0601 +-~~t% ~1'E tw1bINT~L~Y-HELD OR TRUST ASSETS- REV-1548 EX AFP C06-05)
DATE 11-17-2008
G~fl$ ~EC ~ ~ pM [{: ~7 ESTATE OF HIPPS CARRIE E
DATE OF DEATH 02-01-2008
FILE NUMBER `L~- 0$- ~l $
(;(„~~~( Q~ COUNTY CUMBERLAND
ORP~,A;~I~, ~OiJRT SSN/DC
GOYA GODA C~J~ -;, ~ ;~r~ pA ACN 08140520
400 MAPLE ST ~J' APPEAL DATE: 01-16-2009
WRIGHTSVILLE PA 17368-1640 (See reverse side under Objections)
A~eount Remitted p
MAKE CHECK PAYABLE AND REMIT PAYM T T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG- THIS LINE "'~ RETAtN LOWER PORTION FOR YOUR RECORDS ~
PURPOSE OF
NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S.
Section 9140).
PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the
reverse side.
-- Make check or money order payable to: REGISTER OF WII.LS, AGENT.
Failure to pay the tax, interest, and penalty due may result in the filing of a lien of record in the
appropriate county, or the issuance of an Orphan's Court citation.