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UREAU OF INDIVIDUAL TAXES art ~ ~~
~~~~-'";-~~-^~ +~„,y~; OF INHERITANCE TAX pennsylvan~a
DEPARTMENT OF REVENUE ~
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INHERITANCE TAX DIVISION ~-,~ F»
f.,.~-IS'~i~, ALLOWANCE OR DISALLOWANCE
~~
1
Po Box 280601 DUB 1't"O~IS, AND ASSESSMENT OF TAX ON
~ ~ REV-1548 EX AFP (12-10)
HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS
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~~ ~~~ ~~ T~ ~ ~ i ~ DATE 12-27-2010
SUSAN M CHUBB
606 SOUTH MOUNTAIN ROAD
DILLSBURG PA 17019
ESTATE OF CHUBB JOSEPHINE
DATE OF DEATH 09-13-2010
FILE NUMBER 21 10-1153
COUNTY CUMBERLAND
SSN/DC 201-16-2827
ACN 10156.781
APPEAL BY DATE:02-25-2011
(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 ~
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REV-1548 EX AFP C12-10)
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE: 12-27-2010
ESTATE OF:CHUBB JOSEPHINE DATE OF DEATH:09-13-2010
FILE NO.: 21 10-1153 S.S/D.C. NO.: 201-16-2827
ACN: 10156781
TAX RETURN WAS: CX) ACCEPTED AS FILED t ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO.: 20585-11
TYPE OF ACCOUNT: C )SAVINGS C ~ CHECKING C )TRUST C )TIME CERTIFICATE
DATE ESTABLISHED 03-05-1984
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
G~.ERK JF
ORPN/~'~ ~~t~RT
~~~~~?~~~ ~a Ctn., P~!
15,1b6.66
X 0.166
2,527.83
- .00
2,527.83
x .045
113.75
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
11-19-2010 CD013679 5.69 113.75
TOTAL TAX PAYMENT 119.44
BALANCE OF TAX DUE 5.69CR
INTEREST AND PEN. .00
TOTAL DUE 5.69CR
COUNTY:CUMBERLAND
* 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. '