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HomeMy WebLinkAbout01-27-10 ~VN~~ ~ Pennsylvania DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES Telephone 717 787-3930 January 15, 2010 MS. PATSY GOCHENAUER REGISTER OF WILLS ADAMS COUNTY COURTHOUSE 111-117 BALTIMORE STREET, RM. 102 GETTYSBURG, PA. 17325-2398 n CJ O ~~ -o ~'~~~ _,~~ :=' ~ ~} h l7 ~'~ !"7 _,c~-„ ~~ Re: Estate of MATTHEW SHAFFER File Number: 2109-0744 County: Cumberland Date of Death: 12/11/2008 fV d q L >~ a' N -J s~• '"~ l °1 fT',:_~ ~; ~ r~,:_; _.<. ~: c -> _ .i1 Dear Register of Wills: Please contact me at the telephone number above if you have any questions. Sincerely, ,- _... _ ._.._.,rt -- _ --.. A ~ i l~~,Jl~. / ' . v FILED Claudia Maffei, Supervis r Document Processing Unit JAN 2 5 ~p Inheritance Tax Division ~~_ -. _ ,.::order .J; .> ', , _.. _. Department of Revenue I PO Box 2806011 Harrisburg, PA 17128 1717.787.8327 I www.revenue.state.pa.us All original Inheritance Tax documents for the subject decedent should be forvvarded to the Cumberland County Register of Wills; however, you may wish to retain a copy, including photocopies of all receipts for the collection of Inheritance Taxes in the subject estate which have been issued by your office. ~ I COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF gEVENUE BUREAU OF INDIVIDUALTAXE9 DEPT280801 HARF1138URG, PA 17128-0801 PENNSYLVANIA IN4'IEF~ITANCE AND ESTATE TAX 4F~ICIAt RECENT NO /~A ~~~~0~ REV-1182 EX (17.88) nelrew CU FRVM: B~CtOT~,• 11114t~i! ~ f#iil~ti>r{~i IIiO~ ~ttttli>r`1 ~`~ ~7g~ ACN ASSESSMEWT CONTROL AMOUNT NUMBER ^ -- FOLD HERE ESTATE INFORMATION: FILE NUMBER Q 109-0143 ~~ NAME OF DECEDENT (LAST) (FIRST) (MI) DATE OFPAYMENY a~,,,,~~~vv POSTMARK DATE `*~ ,# '• ~~~rr~yvk'; r', `: COUNTY ~ ~, *` r,., DATE OF DEATH 2 , ~ ~, REMARKS .-._.~c; .'r,-: ..:e SEAL TOTAL ~, ,, ~, , , ~ .,R{ffi9tiER OF WILLS FOLD HERE - T PAID ~;~' ~~ i. ~ 1lsiada >t. 2t ~ i l3apa~r art ~'llle ~ 4 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ®UpEAU Ok INDIVIDUAL TAXES DEPT.280801 HARRISBURG. PA 17128.0801 RECEIVED xtmoL~y L 8~i~~'1!t 64 QiliEllhlDq~AI >~~ Oardaare PA 17'324 MO..ee..~~r2,50~ qEV-1182 Ex (11.88) ACN ASSESSMENT CONTROL AMOUNT NUMBER 1 43 ~ I -• ERE ,....:.~ 1-`.. F~SATC IIJCA~\ SV1-i. I PENN$YLVANI~11 INHERITANCE AN1') E8~'ATE TA)~ OFFICIAL R~CEfiPT `FIL o=0 14s ~ NAME OF DECEDENT Bh M~°I ~ M ~ (LAST) ~~try1;~i~ ~MI) Y f ~ T~ Q ~ DA tR1/~~jZ{7i~Si ;~~i1n41iVj:y,~ ?ARK -~ coin `,. ~ *~ R` C . ~, ~ „~., ~ + DATE OF Q A~± 12/1~ at7QB l : ~ ~ / ecu w non ; _ ~} g. F;". SEAL TOTAL _" it ~a.48 FOLD HERE ':5 R~~ plus ~~ ~;, 4, (Page 1 of 7) PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE sBREAU of INDIYIDWI rAxES AND FILE N0. 0109- O/yam Po Bao( :Bactl TAXPAYER RESPONSE ACN 09110041 NIIRRISBNIR PA 17126-0601 DATE 02-20-2009 as-ua a err as•w, TYPE OF ACCOUNT `,~ ~ EST. OF 'MATTHEW D SNAPPER ® sAVINCs SSN ^ cHECKiws APR 15 2009 DATE OF DEATH 12-11-zoos ^ TRUST OtlNTY ADAMS ^ CERTIF. ENIT PAYMENT AND FORMS TD: ROWENA J SNAPPER REGISTER OF WILLS 64 GREENHOUSE RD ADAMS CO COURT HOUSE GARDNERS PA 17324 GETTYSBURG, PA 17325 ADAMS COUNTY NTNL BANK orovided the Dapartaent with the in}ersatian belor, rhich has bean wed in caloulatina tM aetential tex dw. Records indicab tMt at the daalh of the above-nwsd dwsdwt, you ran a SoinL arner/bawflclarY of this woount. If you fw1 the lnfonatiw is iworroct, sleass obtain written correction frog tM fiwnelal institution, ettacA s eoplr to this fore and return it is the •bev .aAdnas. This aeeowt is taxYl• in aeeordenca with the Inheritance TeX laws of th• Cagvnrealth of Pennsylvania- Piseaw call 1717) 7a7-8327 rlth auastiws. COMPLETE PART I BELDW R SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 9061789 Dat• 12-31-2D01 Established To wsuro prover credit to tlu account, two COales of this notice drat aeeeapally pArasnt to the Raylatar of NSlls. Make chock wlr+ble to "Reaiabr of Nills, Aaant". Aeoount Bslanea Poromt Tsxsbl• Amount Subiact to Tax Tax Ret• Potsntisl Tax Duo 0 864.12 X 16.667 _ 144:02 )( . 0 0 t .00 NOTE, If tax psywnts aro sada ritAln thrw aonths of the tleoeMnt's data of deathr deduot a 5 percent discount on tM tm[ dw. A,xl InMribnce Tax due rill bwoae dsll,wwnt n!w sonths attar the dab of death. A. ~ The above inforwtion wd tax due is correct. Rw1t paywant to the Resister of W111s rilh two eoptes of this notice to obtain r CHECK • diseaunt or avoid interest. or cheek bax "A" and return this noliee to the Resister of 1 ONE ~ Mille wd en official aaaauasnt will be issued by tM PA Daparteent of Rarenus. L BLDCK R. ~ ihs above wsst Ma bow or will ba nporbd end tax 9sid with tho PonnsYlrsnia Inhsritanw Taz return ONLY to bs tiled by tM Mate npnsmtatlvs. C. ~ Ths above info !on is ineorr et and/or debts antl deducts wa tars Paid. Cwaleb PART 2A wd/er PART ~ bslw. PART If SndieatSnY a different tax rata, plaas• atat• relationship to dacadont: TAX RETURN - CDMPUTATION LINE 1. pate Eatabliahad 2. Aocount Dalanc• S. Pa roast Taxable 4. Amount Subioet to Tez 5. Debts and Deduotions 6. A~aunt Taxablo 7. Tax Rst• 0. Tax Duo DF TAX ON JOINT/TRUST ACCOUNTS 1 2 $ 3 X 4 $ 5 6 $ 7 X 8 $ PART UG81S ANL 1f6LUt:lAUAS t.LAlP7GU DATE PAID PAYEE DESCRIPTION AMOUNT PAID ATE --'- FileN:010900000165 Under ponaltias of poriury, L daclsre thatth• facts I have repartod above era true, eorroet snd ao •to to tho bu(~t ofQmyQknev/i~odpo and baliof. HOME__ C ) ~ 1.-0- ~l ~~i.{iy_ WORK C ) (Page 2 of 7) PENNSYLVANIA INHERITANCE INFORMATION NOTICE DuREAU DF 1MrvIlRWI TAxES AND Po em(zncol TAXPAYER RESPONSE INRRISBUR6 PA 17120.-afal FILE N0. OlV 9•U~'y~ ACN 09110043 DATE 02-20-2009 9 ` ~ p EST. OF MATTHEW D SHAFFER SSN APR 271009 DATE OF DEATH 1z-11-2008 ~ COUNT7f ADAMS MIT PAYMENT 4ND FORNa TD, TIMOTHY L SHAFFE V REGISTER OF WILLS b4 GREENHOUSE RD ADAMS CO COURT HOUSE 6ARDNERS PA 17324 GETTYSBURG, PA 17325 TYPE OF ACCOUNT ® SAVINGS C)(ECK IN6 ^ TRUSr ^ CERTIF. ADAMS COUNTY NTNL BANK pnvidad the Daaartwnt Nfth tM )nforution baloNr which Ma bnn used in cateulmliM Ms potential ta: des. Records lndieata that at the death of the :boys-nomad Meadent. You Nara a ioint eNnor/MM*Scisy of this account. If you fool the intonation Ss ineerraot, please obtain Nrlttan oorraation frees tM fiMneial Snst1lution. attach + oopi. to this ton and Nturn 1! to !M above sddnu. This account is taxable in accoManw Nith tM Inharitsnca lax laws of the Ceronwalth et Pennrilvanfa. PLasa call [717) 7a7-Bi27 with weatSons. COMPLETE PART 1 BELOW B SEE REVERSE SIDE FOR FILING AHD PAYMENT INSTRUCTIONS Account No. 9061789 Dat• 12-31-2001 ie ensure proper endit to the aeaount, tNo Estmblieked eoPiea of this notice must ^ccompMy paynnt to the Resister of Wllls. Make check Account Balance 864.12 $ payable to "Resister of pi11a, Aaent^. Percent Taxablo X 16.667 NOTE. If tax parimts an mods NStMD thus Amount Subiect to Tax $ 144.02 months of the decedent's Oats of death, Tmx Rmt• X .045 deduct a 5 peraant tlisesunt on the tax due. Aro Inheritance Tax due will beoan delineuenf Potential Tax Dua 6.48 $ niM menthe ^fter the date of dwth. T P TAXPAYER RES S ~ 1 A. ~ TM above in}orewtion and Lax due is aernat. ' Resit payment to the Reeist.r of Mills rith Mo conies of this notioe'to obtain a discount or avoid Sntarest, or chock box "A" aed talon this notice to the Resister of CHECK WSlls and an official assessment Nill be issued by the PA Department of Revenue. DNE ~ BLOCK a. ~ Tha above asset has boon or Nill 0• resorted and tax paid N1th the Pennrilvenia Inheritance isx reSUrn DNLY to be filed by tM estate npnsentatiw. C. ~ the above fnfor~ion Ss lncorr~ and/or debts and tlsddctlone Nan paid. Coaplete PART 2 and/or PART E MloN. PART If indicatlns a different © relationship to decedent: Please atat• TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Estmbliahod 1 2. Account Bmisnce 2 S. Percent Tazmbla 3 X 4. Aaount Sub~sot to Tax 4 $ 5. Debts end Deductions 5 6. Amount Taxablo 6 $ 7. Tax Rmte 7 X 6. T1X Dus 8 $ PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION AMOUNT PAID Filell:010900000145 Under penalties of perjury, I dselmre that the facto I have roportod~•Obo`vo era true, eorrae-ts and oomploto to the best of my knoNlodso mnd belief. HOME W/ d )3z y 8 7/ 6 ~.~~../~.~, ~~~ i WORK ~S"6 ) Z~l~i/ 9n~!'t" y zo /SS (Page 3 of 7) PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF iNDIYIDUAL TAxES ~ AND FILE NO. O1(9 q- O/~~ Po Boa 2Bace1 TAXPAYER RESPONSE ACN 09110045 NARRISB(NW PA Lrt20-scat DATE 02-20-2009 aM)aR IX M fN-au D TYPE OF ACCOUNT EST. OF MATTHEW D SHAFFER ® SAVINGS APR t7 2009 sex ^ CHECKING DATE OF DEATH 12-11-2008 ~ TRUST OONxTY ADAMS ~ CERTIF. RENLT PAYMENT AND FORMS T0: VICTORIA SHAFFER REGISTER OF WILLS 64 GREENHOUSE RD ADAMS CO COURT HOUSE GARDNERS PA 17324 GET7YSBURG, PA 17325 ADAMS COUNTY NTNL BANK proridad tM Dogartrmt with tM infonatian baler. which Ms bun usrd in wleulatina the potantld tax duo. Roeerds indieat• that at the Nath of tM shove-nand daaadant, you wawa • feint ernaMbamfiaiarv at this aeeeunt. H You fad the inforratlon is inaerreat. please obtain rrittm correction fret tM finanoial institution, 6taeh • copy to thi• fora and retrrn it to the absra addrasa. Th3a oaeount fs taxable !n aaaordanoa with tM InMritanca lax fora of tM Canaonraalth of Prrusaylvania. Plosao epll :T37) 7aT-5527 with auaatione. COMPLETE PART I BELOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Aocount No. 9080899 Dats 12-31-2001 To •nsuro aropar cradtt to the account. tre Establiahad copies of this notiea gust eceoepasy Account Baianc• 850.07 oayasnt to tM Raaiator of Wills. Naka check _.. _ payable to "Ropistar of Wills. ABSnt". Percent Tsxabl• Arount Subject tv Tax Tax Rate Potential Tax Du• CHECK ONE BLOCK ONLY A. NOTES If tax payeenta ors wade within Mna tenths of tM daeoMnt'^ date of death. deduct a 5 percent discount on the tax Ow. A1y InMrita:roa Ta: dra rill bweaa dalinm:snt nine rantha after the data of dadA. shove inforawtion and tmt duo is earract. Raait payrnt to the Reaiator of Wills with tre copies of this notiea to ebtain ^ dlseeunt or avoid intaroat, or eMek box •A" and return this hotica to th• Raeistar of Will: and an official asaessaant will ba issued by the PA Dapartaant of Ravonua. !. ~ TM above easel Ms bwn or rill bo rroorbtl and tax ptld rite tM Pomssylwnia IMarltonee Tact return to bo filed by the aststa roprawntativa. C. ~ Tha above infoty^~ation is ineorr a and/or dobta and deductions taro paid. Cwolab PART LJ and/or PART a3 below. PART If indicating a different tax rata, please atat• © rolationshlp to da wdont: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Acoount Balance 2 3. Percent Texsble 3 X 4. Arount Subieot to Tax 4 5. Debts and Deductions 6 - 6. Arount 7axab3• 6 S 7. Tax Rat• 7 X 8. Tax Du• fi # PART DEBTS AND DEAUCTIONS CLAIMED Fileg:010900000165 Und r penalties o Psrlury I declare that the Pacts I have reporlad shore •r/• ~/tt~~rQQue, Fcc~~orrect end e r late to the n rlsdga and belief. OME C ~ ) T1Z7 '-c_J WORK C 7 TAXP R S AT RE LEPHO UM ER (Page 4 of 7) BUREAU DF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PD Bmc zaocgl WIRRISWR6 PA 17128-0601 ROWENA J SNAPPER 64 GREENHOUSE RA GARDNERS PA 17324 ~~~~p COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOMANCE OR DISALL 04-ANCE OF DEDUCTIONS, 4ND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-ISIB EX AFP (O1-og) DATE 05-18-2009 ESTATE OF SNAPPER MATTHEW D DATE OF DEATH 12-11-2008 FILE NUMBER 01 09-0145 COUNTY ADAMS SSN/DC ACN 09110041 APPEAL DATE: 07-17-2009 (See reverse skit uwder Objecdon~ Amount Raaittad MAKE CHECK PAYAHLE AND REMIT PAYMENT T0: REGISTER OF WILLS ADAMS CO COURT HOUSE GETTYSBURG, PA 17325 CUT ALONG THIS LIN ""'b RETAIN LOWER PORTION FOR YOUR RECORDS 4- REY-1548 EX-APP C~1 - j----- ^ "------------------------------------------------------------ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE DR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS ~Ti ~,~ 18009 ESTATE OF SNAPPER MATTHEW D DATE OF DEATH 12-11-2008 COUNTY ADAMS FILE N0. O1 09-0145 S.51D.C. N0. 198-30-0472 ACN 04110041 TAX RETURN WAS: CX) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION - r FINANCIAL INSTITUTION: ADAMS COUNTY NTNL BANK ACCDUNT N0. 9061789 TYPE OF ACCOUNT: d()SAVINGS C ) CHECKING ( )TRUST C )TIME CERTIFICATE DATE ESTABLISHED 12-31-2001 Account Balance Parcartt Taxable Amount Sub?aCt to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due 864.12 X 0.166 144.02 .OD 144.02 X .00 .00 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. (SAKE CHECK OR MONEY ORDER PAYABLE T0: "RESISTER OF WILLS, AGENT." TAX CREbITSI PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID TOTAL TAX CREDIT ,00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 ^ IF PAID AFTER THIS DATE, SEE C IF TOT REVERSE FOR CALCULATION OF ADDIT IONAL INTEREST. ^ AL DUE LS LESS THAN •1, NO PAYMENT IS REgUIRED. IF TOTAL DUE IS AEFLECTED AS A "CREDIT" ( CR), YOU MAY BE DUE A REFUND SEE REVERSE SIDE OF THIS FORM FOR IN47RUCTLONB. ) . FileN :010900000165 (Page 5 of 7) r ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX INHERITANCE TAX DIVISION APPRAISENENT, ALLOWANCE OR DISALLONANCE PO BOX 20DiD1 OF DEDUCTIONS. AND ASSESSMENT OF TAX ON IaRRISBDRG PA 17128-D4D2 JOINTLY HELD OR TRUST ASSETS REV-1540 FX AFP LO1-09) DATE 06-OB-2009 ESTATE OF SHAFFER MATTHEW D VICTORIA SHAFFER 64 GREENHOUSE RD GARDNERS PA 17324 F~~.E:O DATE OF DEATN 12-11-2008 FILE NUMBER O1 09-0145 COUNTY ADAMS SSN/DC ACN 09110045 APPEAL DATE: 08-07-2009 (See naverst skit uxder Ob/ecdoas) Amount Re~itted MAKE CHECK PAYABLE AND REMIT PAYMENT TOs } REGISTER OF WILLS ~7V~ ADAMS CO COURT HOUSE GETTYSHURG, PA 17325 CUT ALONG THIS LINE ""-H RE AIN LOWER PORTION FOR YOUR RECORDS 4- ----- ----- --------- ---------------------------------------------------------- REV-1548 EX-AFP-CO1=09) NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS ESTATE OF SHAFFER MATTHEW D DATE OF DEATH 12-11-2008 COUNTY ADAMS FILE N0. O1 09-0145 S.S/D.C. N0. 198-30-0472 ACN 09110045 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: ADAMS COUNTY NTNL BANK ACCOUNT N0. 9080899 TYPE OF ACCOUNT: OC)SAVINGS C ) CHECKING ( )TRUST C )TIME CERTIFICATE DATE ESTABLISHED 12-31-2001 Account Balance Percent Taxabl® Amount Subject to Tax Debts and Deductions Taxabl• Amount Tax Ret• Tax Due TAX CREDITS: 850.07 X_ 0.500 425.04 .oo 425.04 x .45 19.13 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 DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID D4YMENT MUST HE MAD E BY 09-12-2009x. TOTAL TAX CREDIT .00 BALANCE OF TAX DUE 19.13 INTEREST AND PEN, ,00 TOTAL DUE 19.13 IF PAID AFTER THIS DATE, ( IF TOTAL DUE IS SEE REVERSE FOR CALCULATION OF ADDIT IONAL INTEREST. D LESS THAN O1, NO PAYMENT IS REQUIRED. IF TOTAL DUE SEE REVERSE IS REFLECTED SI AS A "CREDI U MAY BE DUE A REFUND. DE OF THIS FORM FOR INSTRUCTIONS. ) Pile0:010900000165 (Page 6 of 7) TO: REGISTER OF WILLS OF ADAMS COUNTY, PA FROM: CLERK OF COURTS OF ADAMS COUNTY, PA ESTATE OF: Matthew D. Shaffer REGISTER'S FILE NUMBER: OI09-0145 DATE OF DEATH: ORPHANS' COURT NUMBER: OC-62-2009 YOU ARE HEREBY NOTIFIED AS PURSUANT TO LOCAL RULE NO. 17.1 THAT: ELECTION TO TAKE AGAINST OR UNDER WILL PETITION TO SETTLE SMALL ESTATE AWARDING ALLOWANCE TO SURVIVING SPOUSE OF AN INTESTATE ORDER OF COURT AWARDING FAMILY EXEMPTION 0 APPOINTMENT OF ORPHANS' COURT AUDITOR Q ORPHANS' COURT AUDITORS REPORT [~]X CLAIM AGAINST ESTATE HAS BEEN FILED IN THE OFFICE OF THE ADAMS COUNTY CLERK OF ORPHANS' COURTS ON 6/5/2009. b/5!2009 DATE TRANSMITTED .~~ '~ ~~ ~ ~+r x ., rile1F:010900000145 ~~~.~® (Page 7 of 7) COMMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO ~( RBOf01 {NRRISBU~. PA 1TIZa•0641 NOTICE OF INHERITANCE TAX APPRAISEMENTr ALLOWANCE OR DISALLONANCE OF DEDUCTIONS. AHD ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1546 E% AFP <O1 -B9) DATE 07-13-2009 ESTATE OF SNAPPER MATTHEW D DATE OF DEATH 12-11-2008 FILE NUMBER O1 09-0145 COUNTY ADAMS SSN/DC ACN 09110043 APPEAL DATE: 09-11-2009 (Sce reverse side andar Objecaoxs) Amount Raaitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS ADAMS CO COVRT HOUSE GETTYSBUR6, PA 17325 TIMOTHY L SHAFFER 64 GREENHOUSE RD GARDNERS PA 17324 P11.~® 1 k Ctl-T ALON6 THIS-LI ~,'~- RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1$7i! EX AFP C 1- 9) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLDWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT DF TAX ON JOINTLY MELD OR TRUST ASSETS DATE 07-13-2009 ESTATE OF SHAFFER MATTHEW D DATE OF DEATH 12-i1-2008 COUNTY ADAMS FILE N0. O1 09-0145 S.S/D.C. N0. 198-30-0472 ACN 09110043 TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATIDN FINANCIAL INSTITUTION, ADAMS COUNTY NTNL BANK ACCOUNT N0. 9061789 TYPE OF ACCOUNT: 6()SAVINGS C ) CHECKING C )TRUST ( )TIME CERTIFICATE DATE ESTABLISHED 12-31-2001 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rata Tax Due TAX CREDITS: 864.12 X 0.166 144.02 .00 144.02 X .45 6.48 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TD THE REGISTER OF WILLS AT THE A$OVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS. AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 04-21-2009 AA652503 .00 6.48 TOTAL TAX CREDIT 6.48 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE ,00 IF PAID AFTER THIS DATE. SEE REVERSE FOR CALCULATION OF ADDITIDNAL INTEREST. C IF TOTAL DUE IS LESS THAN •lr NO PAYMENT IS REQUIRED. LF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR)r YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORK FOR INSTRUCTIONS. ) File~:010900000145 O ~() r N O M I ~ ~N~ t0 g ~ ~ ~ Q ~ l 4 N ~ ~~ i ~~ ~, ~. QM W ~ V J 0~ O 0 ° ~ 1M(1 0 C T ~r -Q ~~ S ~F~ W ~~ Q r W O x x H U' a a o w U f11 W ~'~ 9+aR'O H H D h zoo+~ o ~ oa U W W ~ z~na caao z a q ~¢w~w a H a aaa~n W Q 'J H wzoa ~ w U a oa a U C7 ~ U __. t.. _.. e__.._ _. ..+r..~ .... .. _.. -,: i ._. T r. ~) ~, rt ~~ it I~° rt