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BUREAU OF INDIVIDUAL TAXES ~~~ ~~,~-~i ~ ~~; ~~~~~F INHERITANCE TAX DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION APP~AISkM~~i~',-t ALLOWANCE OR DISALLOWANCE
PO BOX 280601 '`qF ~ ' D CTY~NS., AND ASSESSMENT OF TAX ON REV-1548 EX AFP (12-09)
HARRISBURG PA 17128-0601 r~ ~`~~' `~~`'~
JOINTLY HELD OR TRUST ASSETS
DIANA D MILLER
8 CEDAR ROAD
~Oi~~~'~ -~ P~ 2~ 37
ORP~N'~ ~,~~~~T
.ter ~
CARLISLE PA 17015
DATE 11-08-2010
ESTATE OF BURKHOLDER TROY A
DATE OF DEATH 11-20-2009
FILE NUMBER 21 10-0035
COUNTY CUMBERLAND
SSN/DC 188-20-8796
ACN 09177244
APPEAL BY DATE:O1-07-2011
(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 ~'-
REV-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: 11-08-2010
ESTATE OF:BURKHOLDER TROY A DATE OF DEATH:11-20-2009
FILE NO.: 21 10-0035 S.S/D.C. NO.: 188-20-8796
ACN: 09177244
TAX RETURN WAS: CX) ACCEPTED AS FILED C ~ CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO.: 363535-00
TYPE OF ACCOUNT: CX}SAVINGS ( 3 CHECKING ( TRUST ( 3TIME CERTIFICATE
DATE ESTABLISHED OS-O1-2009
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
3,787.76
X 1.000
3,787.76
- .00
3,787.76
x .045
170.45
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 (+)
INTEREST/PEN PAID C-)
AMOUNT PAID
INTEREST IS CHARGED THROUGH 11-1b-2010
AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORM
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE 170.45
INTEREST AND PEN. 1.65
TOTAL DUE 172.10
* IF PAID AFTER THIS DATE, SEE REVERSE 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.
COUNTY:CUMBERLAND
_~-~~j