HomeMy WebLinkAbout07-17-09COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES NOTICE OF INKER$TANCE TAX
-r. e ALiOWANGE DR DISALLOWANCE
INHERITANCE TAX DIVISION i ~, ~t1l~~~~
PO BO% 280601 -"BEBULLT~IO S, ~p'ND ASSESSMENT OF TAX ON
HARRISBURG PA 17128-0601 ~.j~a~J~~~pJ~l~,v~-116LD OR RUST ASSETS
REV-1548 EX AFP (01-097
7E 07-13-2009
2009JUL 17 PMl2137; TATS OF CLOUSER DAVID H
TE OF DEATH 02-20-2009
RILE NUMBER 21 D9-0204
CLERK /O~7F~ COUNTY CUMBERLAND
DONNA WEST ~RPHAN~SiiUVRI SSNfDC 184-26-5048
7152 COUNTY ROAD #56 CUN!RF4L~UD C~-~PA ACN APPEAL DATE9117509611-2009
MT GILEAD OH 43338 (See reverse side under Objections)
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE 1 RETAIN LOWER PORTION FOR YOUR RECORDS t-
REV-1548 EX AFP CO1-09)
NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE OR DISALLOWANCEOF
DEDUCTIONS. AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 07-13-2009
ESTATE OF CLOUSER DAVID H DATE OF DEATH 02-20-2009 COUNTY CUMBERLAND
FILE N0. 21 09-0204 S.S/D.C. N0. 184-26-5048 ACN 09117546
TAX RETURN WAS: IX) ACCEPTED AS FILED C ) CHANGED
JOINT OR TRUST ASSET INFORMATION
^
FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT N0. 113054-40
TYPE OF ACCOUNT: C )SAVINGS C ) CHECKING C )TRUST 6()TIME CERTIFICATE
DATE ESTABLISHED 12-14-2005
Account Balance
Percent Taxable
Amount SubJect to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
85,622.33
X 0.083
7,134.91
.oD
7,134.91
X .45
321.07
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 T0:
"REGISTER OF WILLS, AGENT."
PAYMENT
GATE RECEIPT
NUMBER DISCOUNT C+)
INTEREST/PEN PAID I-) AMOUNT PAID
05-15-2009 CD011243 16.05 321.07
TOTAL TAX CREDIT 337.12
BALANCE OF TAX DUE 16.05CR
INTEREST AND PEN. .00
TOTAL DUE 16.05CR --
IF PAID AFTER THIS DATE, SEE
REVERSE FOR CALCULATION OF
ADDIT
IONAL INTEREST. ~ //
~~
( IF TOTAL DUE IS LESS THAN il, ND PAYMENT IS REpUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CRT, YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ]