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BUREAU OF INDIVIDUAL TAXES j ~,~T,-~Q I OF INHERITANCE TAX
INHERITANCE TAX DIVISION l_.~t,;-'7?'1T{S~V ALLOWANCE OR DISALLOWANCE
PO BOX 280601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON
HARRISBURG PA 17128-0601 JOINTLY H LD OR TRUST ASSETS
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Pennsylvania ~
DEPARTMENT OF REVENUE
REV-1548 EX AFP (12-89)
DATE 02-01
~~~
ALEXIS BOURINSKI
1171 BOILING SPRINGS RD
MECHANICSBURG PA 17055
-2010
ESTATE OF BOURINSKI JOYCE
DATE OF DEATH 12-03-2009
FILE NUMBER 21 10-0002
COUNTY CUMBERLAND
SSN/DC
ACN 09180003
APPEAL DATE: 04-02-2010
(See reverse side under Objections)
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
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EV-1548 EX AFP C12-09)
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE• 0 -01-2010
ESTATE OF: BOURINSKI JOYCE DATE OF DEATH: 12-03-2009 COUNTY: CUMBERLAND
FILE NO.: 21 10-0002 S.S/D.C. NO.:
ACN: 09180003
TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED
JOINT OR TRUST ASSET
FINANCIAL INSTITUTION: MEMBERS 1ST FCU
TYPE OF ACCOUNT: C )SAVINGS C ) CHECKING C )TRUST
DATE ESTABLISHED 01-14-2000
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
5,486.02
X 0.166
914.35
- .00
914.35
x .45
41.15
INFORMATION
ACCOUNT NO.: 190278-42
CX)TIME CERTIFICATE
NOTE: TO ENSURE 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 (-)
AMOUNT PAID
YAYMtNI MUST BE MADE BY 09-04-2010*.
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE 41.15
INTEREST AND PEN. .00
TOTAL DUE 41.15
* IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.