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~ NOTICE OF INHERITANCE TAX
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BUREAU OF INDIVIDUAL T X
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INHERITANCE TAX DIVISION r~.. (
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~ 548 EX AFP C12-10)
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PO BOX 280601
- - i -- F~ii'EDUCTIONS, AND ASSESSMENT OF TAX ON
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HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS
"~' ~ DATE 02- 14 - 201 1
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CHARLOTTE M Q1C'SA '
969 CHARTERHOUSE CT
WESTERVILLE OH 43081
ESTATE OF POZSGAY MADELINE M
DATE OF DEATH 10-29-2010
FILE NUMBER 21 11-0042
COUNTY CUMBERLAND
SSN/DC 163-44-4552
ACN 10173681
APPEAL BY DATE:04-15-2011
(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 ~"1 RETAIN LOWER PORTION FOR YOUR RECORDS E~
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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: 02-14••2011
ESTATE OF:POZSGAY MADELINE M DATE OF DEATH:10-29-2010 COUNTY:CUMBERLAND
FILE NO.: 21 11-0042 S.S/D.C. NO.: 163-44-4552
ACN: 10173681
TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: DOLLAR BANK ACCOUNT NO.: 60660610823
TYPE OF ACCOUNT: C )SAVINGS ( ? CHECKING C TRUST CX)TIME CERTIFICATE
DATE ESTABLISHED 08-09-1994
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
15,012.27
X 0.500
7,506.14
- .00
7,506.14
Y .045
337.78
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 ORDEIR PAYABLE T0:
"REGISTER OF WILLS, AGENT."
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT C+)
INTEREST/PEN PAID C-)
AMOUNT PAID
PAYMENT MUST BE MADE BY 07-30-2011*.
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE 337.78
INTEREST AND PEN. .00
TOTAL DUE 337.78
* 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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