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' NOTICE
F INHERITANCE TAX pennsyLvania ~
BUREAU OF INDIVIDUAL TAXES , DEPARTMENT OF REVENUE
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INHERITANCE TAX DIVISION -;-i ~-~~ ~ 'APPRAISEMENT, ALLOWANCE OR DISALLOWANCE r
PO BOX 280601 ``~ ` " `' OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP C12-09)
HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS
~~ ~ ~ ~`~~~ ~ 2 ~~""! ~~~ ~# J DATE 11 - 15 - 2010
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LEONARD BOURINSKI~~~~~
1171 BOILING SPRINGS RD
MECHANICSBURG PA 17055
ESTATE OF BOURINSKI JOYCE
DATE OF DEATH 12-03-2009
FILE NUMBER 21 10-0002
COUNTY CUMBERLAND
SSN/DC
ACN 09179999
APPEAL BY DATE:O1-14-2011
(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: 11-15-2010
ESTATE OF:BOURINSKI JOYCE DATE OF DEATH:12-03-2009
FILE NO.: 21 10-0002 S.S/D.C. NO.:
COUNTY:CUMBERLAND
ACN: 09179999
TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO.: 190277'-00
TYPE OF ACCOUNT: C ~ SAVINGS C ? CHECKING C TRUST C )TIME CERTIFICATE
DATE ESTABLISHED 01-14-2000
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
914.64 NOTE:
X O.lb6
152.44
- .00
152.44
x .00
.00
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 ADORES>. MAKE CHECK
OR MONEY ORDER PAYABLE T0:
"REGISTER OF WILLS, AGENT."
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT C+)
INTEREST/PEN PAID C-)
AMOUNT PAID
TOTAL TAX PAYMENT .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 REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.
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