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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
.+;~; ~, ,r °•, ,710T`I"CE , OF INHERITANCE TAX
' ~'., AP~RRAI~EMENT; ALLOWANCE OR DISALLOWANCE
~~_ (~~ DEDIVCTIOMS AND ASSESSMENT OF TAX
. _ . I i i ..
2~~9 JUL - ~ PM 12.~ 38
ORPC~E~ ~~ ~0~'~~T~
KEITH 0 BRENNEMAN (~~'~^ '~.'_~~ ~.-~ 'A'
SNELBAKER >3< BRENNEMAN
PO BOX 318
MECHANICSBURG PA 17055
REV-1547 EX AFP CO1-09)
DATE 07-06-2009
ESTATE OF TURNER GEORGE M
DATE OF DEATH 02-11-2008
FILE NUMBER 21 08-0161
COUNTY CUMBERLAND
ACN 101
APPEAL DATE: 09-04-2009
(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 ---) RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP CO1-09) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF TURNER GEORGE M FILE N0. 21 08-0161 ACN 101 DATE 07-06-2009
TAX RETURN WAS: ( ) ACCEPTED AS FILED C X) CHANGED SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
I1) 210,000.00 NOTE: To insure proper
C2) •00 credit to your account,
.00 submit the upper portion
C3) of this form with your
C4) .00 tax payment.
c5) 4, 198.89
c6) .00
I7) 71,836.89
c8) 286,035.78
APPROVED DEDUCTIONS AND EXEMPTIONS:
16,943.43
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) C9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) C10) 8.638.42
11. Total Deductions C11) ~~'•r'g) •gr'
260,453.93
12. Net Value of Tax Return (12)
.00
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule .I) (13)
260,453.93
14. Net Value of Estate Subject to Tax C14)
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate C15) 74,411.89 X 00 = .00
16. Amount of Line 14 taxable at Lineal/Class A rate (16) 186,041?. 04 X 045= 8,371.89
17. Amount of Line 14 at Sibling rate (17) .00 X 12 = .00
18. Amount of Line 14 taxable at Collateral/Class B rate (18) •00 X 15 = .00
19. Principal Tax Due C19)= 8,371.89
Twv rrrnrrc.
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT (+)
INTEREST/PEN PAID (-) AMOUNT PAID
02-20-2009 CD010928 .00 8,321.32
INTEREST IS CHARGED THROUGH 07-21-2009 TOTAL TAX CREDIT 8,321.32
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF T'AX DUE 50.57
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 139.91
TOTAL DUE 190.48
* IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN ~il, NO PAYMENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
REV-1470 EX (6-88) r
INHERITANCE TAX
EXPLANATION
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
PO Box 280601
HARRISBURG PA 17128-0601
DECEDENTS NAME FILE NUMBER
George M. Turner 2108-0161
REVIEWED BY ACN
Destiny S.R.Brown 101
ITEM EXPLANATION OF CHANGES
SCHEDULE NO.
The value of the estate has been adjusted as the result of the correction of an error in
arithmetic.
Row Page 1
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
„~';.;` ~'-` `•N1j7~I'CE~QF INHERITANCE TAX
BUREAU OF INDIVIDUAL TAXES _ _~Ap:PRAISEMFNT,`ALLOWANCE OR DISALLOWANCE
INHERITANCE TAX DIVISION y 0~',IfEpUGTIONS AND ASSESSMENT OF TAX
PO BOX 280601 -
HARRISBURG PA 17128-0601
JOEL R ZULLINGER
ZULLINGER DAVIS PC
14 N MAIN ST STE 200
CHAMBERSBURG PA
~~4 ~~L ( ~ ~~ {~~ ~~7
CLE~~4 C~=
~q:~l '~,\i'~ ~ i
I ~ i~, - L ,i~-~
two _.
17201
REY-1547 EX AFP (D1-09)
DATE 07-13-2009
ESTATE OF GOOHART GEORGE C
DATE OF DEATH 06-04-2008
FILE NUMBER 21 08-0685
COUNTY CUMBERLAND
ACN 101
APPEAL DATE: 09-11-2009
(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 ~ RETAIN LOWER PORTION FOR YOUR RECORDS E~
-------------------------------------------------------------------------------------------
REV-1547 EX AFP CO1-09) NOTICE OF INHERITANCE TAX APPRAISEMENT, .ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF GOOHART GEORGE C FILE N0. 21 08-0685 ACN 101 DATE 07-13-2009
TAX RETURN WAS: C X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL AND SUPPLEMEN TAL RETURN N0. O1
1. Real Estate (Schedule A) (1) 130,514.71 NOTE: To insure proper
2. Stocks and Bonds (Schedule B) (2) 3,22$,37 credit to your account,
submit the upper portion
3. Closely Held Stock/Partnership Interest (Schedule C) (3) •00 of this form with your
4. Mortgages/Notes Receivable (Schedule D) (4) .00 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) C5) 14 8,343.43
6. Jointly Owned Property (Schedule F) (6) 1,48 3.05
7. Transfers (Schedule G) (7) 48,878.08
s. Total Assets (g) 332,447.64
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11
12
13
14
Total Deductions
Net Value of Tax Return
25,582.61
(9)
(lo) 4.343.83
C11) 29.926.44
(12) 302,521.20
Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule .1) (13) .00
Net Value of Estate Subject to Tax (14) 302,521.20
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate C15)
16. Amount of Line 14 taxable at Lineal/Class A rate C16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAY CRFTITTS~
.00 x 00 _ .00
302,52:L.20 X 045_ 13,613.46
.00 X 12 _ .00
.00 x 15 _ .00
(19)= 13,613.46
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT C+)
INTEREST/PEN PAID (-)
AMOUNT PAID
08-14-2008 CD010146 607.50 11,542.50
02-10-2009 CD010897 .00 1,399.72
03-26-2009 CD011045 .00 63.74
07-06-2009 SBADJUST .00 .19
TOTAL TAX CREDIT 13,613.46
BALANCE OF l"AX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* IF PAID AFTER DATE INDICATED, SEE REVERSE C IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DU~
A REFUND. SEE REVERSE SIDE DF THIS FDRM FOR INSTRUCTIONS.)
COMMONWEALTH OF PENNSYLVANIA
' DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
BUREAU OF INDIVIDUAL TAXES APPRAISE'MCNT rX,LLO~,ICt~,£±'OR`'DISALLOWANCE
INHERITANCE TAX DIVISION OF DED11.,I.Q.T„TONS_~7\N~D'.AS~SE'SSMENT OF TAX
PO BOX 280601 rj,..., _ _, ~.} , ~~
HARRISBURG PA 17128-0601 ~-,- ~ _ ,_. ~ REV-1547 EX AFP (01-09)
DATE 07-20-2009
~~~~ `~~~ i / PI~i~,r~~ OF OIRTON ALLEN S
DATE OF DEATH 06-28-2008
~~~~~ ~ FILE NUMBER 21 08-0757
Q,"~„L`~--',L~'~f'~ r ~~}IQ dNTY CUMBERLAND
TAYLOR P ANDREWS ESQ Cl t~'.^ ~ -~ ;,,](~~, 101
ANDREWS ~ JOHNSON ~ ~ '~- "~• APPEAL DATE: 09-18-2009
78 W POMFRET ST (See reverses~ideunderObjections)
CARLISLE PA 17013 Amount Remitted
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 F-
-------------------------------------------------------------------------------------------
REV-1547 EX AFP CO1-09) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENI' OF TAX
ESTATE OF ORTON ALLEN S FILE N0. 21 08-0757 ACN 101 DATE 07-20-2009
TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHAPIGED SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
C1) .00
c2) 246 , 072.83
c3) .00
c4) .00
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
I5) 114_, 654.41
c6) 16, 152.82
C7) .00
cs) 376,880.06
APPROVED DEDUCTIONS AND EXEMPTIONS:
39,900.40
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) C9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) C10) 579.78
11. Total Deductions X11) 40.480.18
12. Net Value of Tax Return C12) 336,399.88
13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (Schedule J) (13) •0 0
14. Net Value of Estate Subject to Tax (14) 336,399.88
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate
16. Amount of Line 14 taxable at Lineal/Class A rate
17. Amount of Line 14 at Sibling rate
18. Amount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
rex r~rnrTC.
c15) 16, 152.82 X
C16) 320,24'7.06 X
(17) • 00 X
(18)
.00 X
00 _ .00
045_ 14,411.12
12 _ .00
15 = .00
c19)= 14,411.12
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT C+)
INTEREST/PEN PAID C-) AMOUNT PAID
09-24-2008 (0010307 651.32 12,375.00
11-23-2008 (0010930 .00 1,380.30
07-13-2009 SBADJUST .00 4.57
TOTAL TAX CREDIT 14,411.12
BALANCE OF T'AX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* IF PAID AFTER DATE INDICATED, SEE REVERSE C IF TOTAL DUE IS LESS THAN +>1, NO PAYMENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED /'\S A "CREDIT" (CR), YOU MAY BE DUFr., n~
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)\Y}'~
REV-1470 EX (6-8A~
` INHERITANCE TAX
COMMONWEALTH OF PENNSYLVANIA EXPLANATION
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
PO Box 280601
HARRISBURG PA 17128-0601
DECEDENTS NAME FILE NUMBER
Allen S. Orton 2108-0757
REVIEWED BY ACN
Sheila Megonnell 101
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
H B_3 Per Section 3121 of 1994 Act, effective January 30, 1995 the family exemption was
increased to $3,500.
Row Page 1
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
-. ;~Nf?TL6ErOf-.INHERITANCE TAX
BUREAU OF INDIVIDUAL TAXES APRRdI$EM£~IT'I1L(;OWANCE OR DISALLOWANCE
INHERITANCE TAX DIVISION %OF.D~DULfIONg:AND ASSESSMENT OF TAX
PO BOX 280601 ri., _, _
HARRISBURG PA 17128-0601 _ ~~ ~ `` REV-1547 EX AFP (01-09)
~~~~ ~~~' ~ ~ ~~ ~~~ 3~STATE OF TAYLOR2009 DOROTHY G
DATE OF DEATH 08-06-2008
C~~~ ~ ~i=
~ 1 ~, ~,n ~ FILE NUMBER 2:L 08-0996
Q~~` ~' ''~~~ COUNTY CUMBERLAND
HAROLD S IRWIN III G~i "_ ~ '~', N. ACN 101
64 S PITT ST APPEAL DATE: 09-11-2009
CARL I SL E PA 17 013 (See reverse side under Objections)
Amount Remitted)
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND (:0 COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE --1 RETAIN LOWER PORTION FOR YOUR RECORDS ~-
-------------------------------------------------------------------------------------------
REV-1547 EX AFP (01-09) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF TAYLOR DOROTHY G FILE N0. 21 08-0996 At;N 101 DATE 07-13-2009
TAX RETURN WAS: C X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper
2. Stocks and Bonds (Schedule B) C2) ,00 credit to your account,
3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion
of this form with your
4. Mortgages/Notes Receivable (Schedule D) (4) .00 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 1,50 0.00
6. Jointly Owned Property (Schedule F) (6) 45,500.00
7. Transfers (Schedule G) (7) .00
e. Total Assets (e) 47, 000.00
APPROVED DEDUCTIONS AND EXEMPTIONS:
12,069.38
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) C10) 999.10
11. Total Deductions (11) 1.068.48
12. Net Value of Tax Return (12) 33,931.52
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00
14. Net Value of Estate Subject to Tax (14) 33,931.52
NOTE: If an assessment was issued previously, lines 14, 15 and./or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15) .00 X 00 __ .00
16. Amount of Line 14 taxable at Lineal/Class A rate C16) •00 X 045 = .00
17. Amount of Line 14 at Sibling rate (17) .00 X 12 _ .00
18. Amount of Line 14 taxable at Collateral/Class B rate (18) 33, 931 .52 X 15 _ 5, 089.73
19. Principal Tax Due (19)= 5,089.73
Tex rornrTC.
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT C+)
INTEREST/PEN PAID (-)
AMOUNT PAID
02-09-2009 CD010876 .00 5,014.68
02-09-2009 CD010877 .00 75.05
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
TOTAL TAX CREDIT 5,089.73
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
C IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE D
A REFUND. SEE REVERSE SIDE OF THIS FDRM FOR INSTRUCTIONS.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
- ~ -,N OT LC, E, OF, INHERITANCE TAX
BUREAU OF INDIVIDUAL TAXES •AP~PRAIS£MI:N7,,,ALLOWANCE OR DISALLOWANCE
INHERITANCE TAX DIVISION '',`01=''I7~EAUGT,xONS AND ASSESSMENT OF TAX
PO BOX 280601 ~~_ : w, •
HARRISBURG PA 17128-0601 ~~ `~ `` REV-1547 EX AFP CO1-09)
~~~g J~~ ~ ~ ~~ ~~: ~~ DATE 07-13-2009
ESTATE OF HENSEL FRANCES M
DATE OF DEATH 0!~-25-2008
/~ G!~~~~v`- FILE NUMBER 2:L 08-1105
-.~E)Rr COUNTY CIMBERLAND
MARL I N D STEALER Cj ! _ _• ~;'^: ~Cr~ ACN 101
619 MOUNTAIN ST APPEAL DATE: 09-11-2009
ENOLA PA 17025 (See reverse side under Objections)
Amount Remittedl~
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 t'- __________________
-------------------------------------------------------------------------
REV-1547 EX AFP CO1-09) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT' OF TAX
ESTATE OF HENSEL FRANCES M FILE N0. 21 08-1105 ACN 101 DATE 07-13-2009
TAX RETURN WAS: C X) ACCEPTED AS FILED C ) CHAPIGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper
2. Stocks and Bonds (Schedule B) (2) .00 credit to your account,
submit the upper portion
3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 of this form with your
4. Mortgages/Notes Receivable (Schedule D) (4) .00 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) C5) .00
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) .00
8. Total Assets fig) .00
APPROVED DEDUCTIONS AND EXEMPTIONS:
•00
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9)
L0. Debts/Mortgage Liabilities/Liens (Schedule I) C10) .00
11. Total Deductions (11) -00
12. Net Value of Tax Return C12) .00
13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (Schedu le J) C13) .00
14. Net Value of Estate Subject to Tax C14) .00
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15) • 00 X 00 _ . 00
16. Amount of Line 14 taxable at Lineal/Class A rate C16) •00 X 04 5 = .00
17. Amount of Line 14 at Sibling rate C17) •0 0 X 12 _ .00
18. Amount of Line 14 taxable at Collateral/Class B rate C18) •0 0 X 15 _ .00
19. Principal Tax Due ~lq)= .00
TAY CRFTITTR
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT (+)
INTEREST/PEN PAID C-)
AMOUNT PAID
02-10-2009 CD010881 .00 158.70
~ IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
TOTAL TAX (:R EDIT 158.70
BALANCE OF 1-AX DUE 158.70CR
INTEREST AND PEN. .00
TOTAL DUE 158.70CR
C IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED ,AS A "CREDIT" CCR), YOU MAY BE DUfr ~D
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) \O~•