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SCHRACK ~ LINSENBACH
LAW OFFICES
124 W. HARRISBURG ST.
P.O. BOX 310
DILLSBURG, PA 17019-0310
PHONE (717) 432-9733
FAX (717) 432-1053
May 3, 2010
Register of Wills
Cumberland County Court House
1 Court House Square
Carlisle, PA 17013
Re: The Estate of Mira Graves
File #: 21-09-00792
Dear Register:
Attorneys
WM. D. SCHRACK III
BRIAN C. LINSENBACH
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You will find enclosed herewith the original and one copy of a REV-1500, which supports the
insolvent estate of~ the noted decedent. This submission is accompanied by the Executrix's check
# 1880, payable to the Register of Wills, for the sum of $15.00.
I also enclose a face page of the Return, stamped COPY, and ask that it be time stamped and
returned to me in the envelope provided. All receipts should accompany the copy.
Thank you for your attention to this request.
Sincerely,
__---'.
. D. Schrack III
SCHRACK &LINSENBACH
WDS/jsg
enc.
J 15056D71120
REV-1500 EX (06-05)
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
Po Box.28oso1 INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 ~ RESIDENT DECEDENT 21 0 9 0 0 7 92
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
193 20 1790 10 28 2008 04 23 1921
Decedent's Last Name Suffix Decedent's First Name MI
GRAVES MIRA
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
a 1. Original Retum ^ 2. Supplemental Return ^ 3. Remainder Return (date of death
prior to 12-13-82)
^ 4. Limited Estate ^ 4a. Future Interest Compromise 5. Federal Estate Tax Return Re uired
(date of death after 12-12-82) ^ Q
g Decedent Died Testate
(Attach Copy of tMll)
^ Decedent Maintained a Living Trust ',a`=" 8. I otal plumber of Safe De Oslt Boxe.,
~ (Attach Copy of Trust)
p ~
~
^ 9. Litigation Proceeds Received ^ 10. S ousal PQvertYYCredit (date of death 11. Election to tax under Sec. 9113(A)
b~tween 12-31 ~91 and T-1-95) ^
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
WM. D. SCHRACK III 717 432 9733
Firm Name (If Applicable)
SCHRACK & LINSENBACH
First line of address
124 W. HARRISBURG STREET
Second line of address
P.O. BOX 310
City or Post Office State
D I LLSBURG pp~
Correspondent's a-mail address: Schracklaw@comcast.net
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ZIP Code
17019-0310
unaer penalties of perjury, 1 declare that I have examined this return, inGuding accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIG~RE OF PERSON~E$PONSIBLE~ FILING RETURN IIATG .~
ADDRESS
Ann G. Fox
13 Montego Court, Dillsburg, PA 17
SIGNATURE OF PREPARE,R-OTHEft1'HAN REPRESENTATIVE
ADDRESS
Wm. D. Schrack III
124 W. Harrisburg St., P.O. Box 310, Dillsburg, PA 17019-0310
L Side 1
15056071120 15056071120 J
J
15056072120
REV-1500 EX
Decedent's Social Security Number
Decedents name: Mira Graves 19 3 2 0 17 9 0
RECAPITULATION
1. Real Estate (Schedule A) ....................................................................................... 1.
2. Stocks and Bonds (Schedule B) ............................................................................. 2. 1 , 218.0 8
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3.
4. Mortgages & Notes Receivable (Schedule D) ........................................................ 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 5 8 8 . 0 3
7. Inter-Vivos Transfers 8~ Miscellaneous N,nq Probate Property
(Schedule G) ^ Separate Billing Requested............ 7.
8. Total Gross Assets (total Lines 1-7) ..................................................................... 8. 1 , 8 0 6.11
9. Funeral Expenses ~ Administrative Costs (Schedule H) ....................................... a. 7 q 5 ~- ~. ~ ~ 5
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. -i ~~.
11. Total Deductions (total Lines 9 ~ 10) ................................................................... 11. 7 , 511.3 5
12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. - 5 , 7 0 5 . 2 4
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ............................................... 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) ............................................... 14. - 5 , 7 0 5 . 2 4
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .00 15. 0 , 0 0
16. Amount of Line 14 taxable
at lineal rate X .045 0. 0 0 16' 0. 0 0
17. Amount of Line 14 taxable
at sibling rate x .12 0. 0 0 1 ~' 0.0 0
18. Amount of Line 14 taxable
at collateral rate X .15 0. 0 0 18' 0. 0 0
19. Tax Due .................................................................................................................. 19. 0 . 0 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^
Side 2
15056072120 15056072120
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-09-00792
DECEDENT'S NAME
Mira Graves
STREET ADDRESS
Country Meadows Retirement Community, 4837 E. Trindle Rd.
CITY
Mechanicsburg STATE
PA ZIP
17050
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. Interest/Penalty if applicable
p. Interest
E. Penalty
0.00
Total Credits (A + B + C)
(1) 0.00
(2) 0.00
(3}
T otal Interest/Penalty (D + E)
4. If i"ine '? is greater than Line ~? + Line 3, enter the difference. This is the QVERPAYMENT.
Check box on Page 2 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
g. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(4)
(5) 0.00
(5A)
(5B) Q.~Q
ake heck Pa able to: REGISTER OF WILLS AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred :............................................................................... ^
b. retain the right to designate who shall use the property transferred or its income :.................................. ^
c. retain a reversionary interest; or ............................................................................................................... ^
d. receive the promise for life of either payments, benefits or care? ............................................................ ^
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without ^ ^
receiving adequate consideration? .................................................................................................................... x
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ^ ^x
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................................. ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)).
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero
(0) percent [72 P.S. §9116 (a) (1.1) (ii)). The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements
for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a
natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent,
except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116 (a) (1.3)). A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Rev-15A3 EX+ (6-98)
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Graves, Mira 21-09-00792
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER CUSIP
NUMBER
DESCRIPTION
UNIT VALUE VALUE AT DATE
OF DEATH
1 46 shares of AT&T common stock
I 26.48
~ 1,218.08
TOTAL (Also enter on Line 2, Recapitulation) 1,218.08
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule B (Rev. 6-98)
Rev-1509 EX+ (6-98)
SCHEDULE F
COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY
' INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Graves, Mira 21-09-00792
If an asset was made Joint within one year of the decedent's date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Ann G. Fox 13 Montogo Court Daughter
Dillsburg, PA 17019
B.
C.
JOINTLY OWNED PROPERTY:
ITEM
NUMBER
LETTER
FOR JOINT
TENANT
DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT
NUMBER OR SIM-LAR IDENTIFYING NUMBER. ATTACH DEED FOR
JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSE % OF
DECD S
~
INTEREST DATE OF DEATH
DECEDENTUS NTEREST
1 ~ :~ 03/15/1978 PSECU a savings account #0193201790-51 799.93 50.000% 399.97
2 A 04/03/2006 Wachovia Bank, N.A. -checking account 376.12 50.000% 188.06
#1010140797644
TOTAL (Also enter on Line 6, Recapitulation) I 588.03
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98)
REV-1151 EX+ (10-06)
,.
COM INHER~ANCE TFgP~ RET~,RN ANIA
RESIDENT DECEDEN
ESTATE OF FILE NUMBER
Graves, Mira 21-09-00792
------ -. ~.__ .................,........ `Nv. wu v~ ~ v~.~ ~cuu1C 1.
ITEM
R DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
See continuation schedule(s) attached ~ 6,668.35
S_ I A®MINISTRATIVE COSTS:
.. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(sl Commission said
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
2. Attorney's Fees Schrack & Linsenbach 750.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zit,
Relationship of Claimant to Decedent
4. Probate Fees 54.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 39.00
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 7,511.35
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Graves, Mira 21-09-00792
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Ex enses
1 Cocklin Funeral Home 3,752.35
2 Evergreen Cemetery Association of New Haven and Crematory 406.00
3 Giordano Bros. Monuments 2.510.00
H-A 6,668.35
Other Administrative Costs
4 Register of Wills -additional Short Certificate 4.00
5 Register of Wills -Inheritance Tax Return filing fee 15.00
6 Safeco Bond and Affidavit of Lost Securities 20.00
H-B7 39.00
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
REV-1513 EX+(11-OS)
COM INHF~ITAN~E T~~~RL~/ANIA
R IDEN DE ED ry
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
graves, Mira ~ 21-09-00 792
NAME AND ADDRESS OF RELATIONSHIP TO
SHARE OF ESTATE
AMOUNT OF ESTATE
NUMBER PERSONfSI RECEIVING PROPERTY DECEDENT (Words) ($$$)
I TAXABLE DISTRIBUTIONS (include outright spousal
• distributions, and transfers
under Sec. 9116 a 1.2
Ann G. Fox Daughter residuary estate
13 Montego Court
Dillsburg, PA 17019
Tota I
Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 150 0 cover sheet as a r o riate.
NON-TAXABLE DISTRIBUTIONS:
II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08)
Judge\Bill\CLIENTS\GRAVES, Mira\Last Will
~ttst tll ttx~ `~ES#~attent
OF
MIRA GRAVES
BE IT REMEMBERED, that I, MIRA GRAVES, presently of Country Meadows -
Apartment 575, 4833 East Trindle Road, Mechanicsburg, Cumberland County, Pennsylvania, being
of sound mind, memory and understanding, do make, publish and declare this as and for my Last
Will and Testament,h_ereby revoking and making null and void any and all Wills and Testaments
ITEM ~: I direct that my hereinafter named Executrix pay all my just debts, any funeral
expenses, and the expenses of the administration of my estate. With this direction, I authorize and
empower my Executrix to expend for my funeral expenses and interment such amounts as she may
consider necessary and proper, without regard to any limit that may be prescribed by a court of law.
ITEM 2: I direct my Executrix to pay all inheritance, estate, succession, and legacy
taxes of whatsoever nature and kind, to which my estate, or the transfer of any property passing
hereunder or otherwise passing by reason of my demise, maybe subject, and to charge such taxes
against my residuary estate, it being my intention that none of the aforesaid taxes, either federal or
state, on any property required to be included in my gross estate, under the provisions of any state
or federal law now in force or hereafter enacted, shall be prorated among the persons interested in
my estate to whom such property is or may be transferred or to whom any benefit accrues.
ITEM 3: All Harmon Family Memorabilia and Graves Family Memorabilia that are
found in the possession of my daughter, Ann G. Fox, were given to her in times past, and are hers
to keep. Those items shall not be deemed a part of my estate.
ITEM 4: I give and bequeath all of the Graves Family Genealogical Material that are
in my possession to the Public Library, in East Arlington, Vermont, including all legal
documents, letters, and other materials, provided that they be maintained in the Archives of the
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Library, and made available to the general public for use and research, but not be removed from the
Library premises.
ITEM 5: I give, devise, and bequeath all the rest, residue and remainder of my estate.,
of whatsoever nature, and wheresoever situate, whether it be real, personal, or mixed, including
property over which I iilay have a power of appointment, unto nzy beloved, daughter, ANN G. F.OX,
absolutely.
ITEM 6: I nominate, constitute and appoint my daughter, ANN G. FOX, as
~.r cr ~~ (.~~ X ~~7 i_i i ~~ i ; % ~ ~~- ~,)a/ 7 ~~ .riTl~f ; F~~! i fl? i . ~? i C' ~"t_i"1 ~ t" ~ r ~~~ ;^P r; s~iY'.__ ~ j n ;~i ;.iP '-~n ~^~ r^
IN WI . FOSS i~VFIEREOF, I have hereunto set my hand and seal this r`,~"~ ~ .f~ day
,,.
of ''~ , 2005.
MIRA GRAVES
The preceding instrument, consisting of this and one (1) other typewritten page, was on the
day and date thereof signed, sealed, published, and declared by the Testatrix herein named, as and
for her Last Will and Testament, in the presence of us, who, at her request, in her presence and in
the presence of each other, have subscribed our names as witnesses hereto.
~~
~ OF
<:
Page -2-
COMMONWEALTH OF PENNSYLVANIA
. SS.
COUNTY OF YORK
We, GRAVES, ~~ ~ ,/ and
~ ~ ,
r ,the Testatrix and.~~ie witnesses, respectively,
whose names a e signed to the a ched or foregoing instrument, being first duly sworn, do hereby
declare to the undersigned authority that the Testatrix signed and executed the instrument as her
1/ast ~Xjill and Testament, and that she signed willingly, and that she executed it as her free and
hearing of the T estatri~: signed the Wil'1 as witnesses, and that to the best of their knowledge, the
Testatrix was at the time eighteen (18) years of age or older, of sound mind, and under no constraint
or undue influence.
~,;'
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MI A GRAVES
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SWORN TO AND SUBSCRIBED
BEFORE THIS /f f,~ DAY
OF , 2005.
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N Y UBL}
lrrctart~ sear /,.
.knots, C#a+e, Nolary ~
D6nsburg Boa, York Ctx~~ty
A+tY Cortxrksior~ E.~hes Oct. 25.2006
• ~+~Y~ AssoC~.tlon Of N~ari
® REPOERT FORM (.omputershare
RETURN THIS FORM -ALONG WITH THE PROPERLY COMPLETED AFFiDA~/IT
THIS IS A SCANNABLE FORM FOR COMPUTERSHARE USE ONLY.
PLEASE DO NOT MAKE ANY MARKS ON THIS FORM. RETURN IT TO COMPUTERSHARE WITH
YOUR PROPERLY COMPLETED AFFIDAVIT.
Company Code I ~.T-~
Account Number 00005372267
Shareholder Name M~RA GRAVES
Below is a listing of the certificates by certificate number and share quantity that will be replaced.
Surety Database information: I.,R IssueID, Share Amount, Market Value, Expected Check Amount
CO1 $1163.80
46 $20.00
Check # (to be
filled out by _
Computershare)
Originating I 0929g~F00366452
wm#
~ DOCREP ~
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I ~ioCt.'f1?LCt5 :~rir{ sT10CE'.. ~f';t"UII P-:'^.~E tv~~iaY r~~ VvyVif~/.C~l"(1~UtL''Sl~rf~~`.Ct~}f(1/flii/~Si(?1.
W M D SCRACK III
124 W HARRISON ST
PO BOX 310
DILLSBURG PA 17019-0310
September 9, 2009
Company:
Registration:
yol~lei~ f~L~:.~~~ ~I~r ?~IG~r~ ~f,,Aa-_
Dear Shareholder:
~ ~~
~~;
AT&T INC.
MIRA GRAVES
`~npn537226i
~1~:!t~0~83GLc6/
~omputershare
Computershare Investor Services
250 Royall Street
Canton Massachusetts 02021
www.computershare.com
We are currently unable to process your request at this time. The submitted documents were either
incomplete or did not comply with our legal requirements for the following reasons:
There are 46 certificated (physical) share(s) in this account. Physical share(s) are in the
possession of the shareholder. If you are not in receipt of certificate #1552318, please contact us
for further instructions. The physical certificate must be mailed to us if you wish to sell all shares.
If you have any further questions, please visit our website at www.com~utershare.com/att or you may
contact us by phone at 800-351-7221. We offer an automated telephone service to assist you at any time,
or you may reach a representative during regular business days, 9 a.m. to 8 p.m. Eastern Time.
Sincerely,
Service Representative
Enclosure: None ~ 1 --~
~sC.~1--- ~ .fir E? ~~5~
,~~ ~~~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX ++ i,
INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE I'~
PO BOX 280601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON
HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS REV-1548 EX AFP (01-09)
DATE 03-02-2009
ESTATE OF GRAVES MIRA
DATE OF DEATH 10-28-2008
FILE NUMBER 67 08-1804
COUNTY YORK
SSN/DC 193-20-1790
ANN G FOX ACN 08159054
13 MONTEGO CT APPEAL DATE: 05-01-2009
D I L L S B U R G PA 17 019 - 9 3 8 2 (See reverse side under Objections)
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
45 NORTH GEORGE STREET
YORK, PA 17401-1240
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1548 EX AFP C01-09)--------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
__-- ____-- DAT E 0 3- 9 2- 2 0 0 9
FILE NO. 67 08-1804 S.S/D.C. N0. 193-20-1790 ACN 08159054
TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: PSECU
ACCOUNT N0. 0193201790-S1
TYPE OF ACCOUNT: 4c )SAVINGS C ) CHECKING C )TRUST C )TIME CERTIFICATE
DATE ESTABLISHED 03-~15-I978
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
799.93
K_ 0.500
399.97
- ~-_.... 3 9 9 . 9T,
_. __.-..__..._....OD
X .45
.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. MAKE CHECK
OR MONEY ORDER PAYABLE T0:
"REGISTER OF WILLS, AGENT."
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT C+)
INTEREST/PEN PAID C-) AMOUNT PAID
O
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
IF PAID AFTER THIS DATE- SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
C IF TOTAL DUE IS LESS THAN ~1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR), YOU MAY BE DUE A REFUND.
COMMONWEALTH OF PENNSYLVANYA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX
INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
PO BOX 280601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON
HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS REV-1548 EX AFP CO1-09)
DATE 03-02-2009
ESTATE OF GRAVES MIRA
DATE OF DEATH 10-28-2008
FILE NUMBER 67 08-.1804
COUNTY YORK
ANN G FOX SSN/DC 193-20-1790
ACN 09101750
13 MONTEGO CT APPEAL DATE: 05-01-2009
D I L L S B U R G P A 17 019 (See reverse side under Objections)
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
_ 45 NORTH GEORGE STREET
YORK, PA 17401-1240
CUT ALONG THIS LINE ~"~ RETAIN LOWER PORTION FOR YOUR RECORDS ~'
REV-1548 EX AFP C01-09~--------------------------------------------------------------------
NOT:ICE QF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDU~CtI':ONS, AND•:ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST .ASSE:TS
_. ,. DATE ~~°®~°~®®~
FILE N0. 67 08-1804 S.S/D.C. N0. 193-20-1790 ACN 09101750
TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: WACHOVIA BK NA ACCOUNT N0. 1010140797644
TYPE OF ACCOUNT: ( )SAVINGS 4C) CHECKING C )TRUST C )TIME CERTIFICATE
DATE ESTABLISHED 04-03-2006
Account Balance
Percent Taxable
Amount $u.b~e~c;t -to Tax
Debts and -Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
376.12 NOTE:
X 0 ..500
1°8.8 . Q6
,_
188.06
~ _. x.0.....1
X ~~.~
.
.oo
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YQUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABCIVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE T0:
"REGISTER OF WILLS, AGENT."
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT C+)
INTEREST/PEN PAID C-) AMOUNT PAID
C
0
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN •1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR), YOU MAY BE DUE A REFUND.