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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
~„ , , ._ ,
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BUREAU OF INDIVIDUAL TAXES ~~~cEr ~3F~~'~?~.~RITANCE TAX
INHERITANCE TAX DIVISION AP.}~R ~i~~~[@N'~r ALLOWANCE OR DISALLOWANCE
PO BOX 280601 OF D~DbCf40kS,'AMA `ASSESSMENT OF TAX ON REV-1548 EX AFP CO1-o9)
HARRISBURG PA 17128-0601 JOINTLY HELD bR TRUST ASSETS
~~~~ APR ~~ P~ +2` ~ STATE OF ADAMS .2009 BETTY
G,LE~K ~'F DATE OF DEATH 01-23-2008
FILE NUMBER 21 08-0107
DRPH4C~~'S r~~~T COUNTY CUMBERLAND
DAVID M ADAMS CU~~ ' r~ ~`~~~ r~n., ~~ ACN/DC 08113418658
423 CHESTNUT ST APPEAL DATE: 06-05-2009
MT HOLLY SPRGS PA 17065 (See reverse side under Objections)
Awount Reuitted ~~~~~ /,~
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 ~
PURPOSE OF
NOTICE: Ta fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 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 tos REGISTER OFWII.LS,AGENT.
Failure to pay the tax, interest, and penalty due may result in the filing of alien of record in the
appropriate county, or the issuance of an Orphan's Court citation.