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BUREAU OF INDIVID ~~nr~~~_ - L,~1,
~ '~~CIICE
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OF INHERITANCE TAX Pennsylvania i
UAL TAXES _
r DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION ~ `;,~. ,, APrP'RA1rS~M~lT, ALLOWANCE OR DISALLOWANCE
PD BOX 280601 ~"OF`'DEDUEfiY'ONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP (12-10)
HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS
- ' ~~ 4'U'- c:~ ~;~ ~: `,;j DATE 08-01-2011
CLERr~ OF
ORP~-!Af~`~ COURT
CUMRER# f;~u~ ~~1, PA,
DAREN D ANDERSON
691 SOUTH 82ND STREET
HARRISBURG PA 17111
ESTATE OF ANDERSON VIOLET M
DATE OF DEATH 04-13-2011
FILE NUMBER 21 11-0582
COUNTY CUMBERLAND
SSN/DC 127-28-6716
ACN 11127469
APPEAL BY DATE:09-30-2011
(See reverse side under Objeetions)
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: 08-01-2011
ESTATE OF:ANDERSON VIOLET M DATE OF DEATH:04-13-2011 COUNTY:CUMBERLAND
FILE NO.: 21 11-0582 S.S/D.C. NO.: 127-28-6716
ACN: 11127469
TAX RETURN WAS: CX) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO.: 186161-00
TYPE OF ACCOUNT: CX)SAVINGS C ) CHECKING ( )TRUST ( )TIME CERTIFICATE
DATE ESTABLISHED 07-27-1999
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
672.85 NOTE:
X 0.500
336.43
- .00
336.43
x .045
15.14
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 (-)
AMOUNT PAID
05-16-2011 CD014470 .76 14.37
07-25-2011 SBADJUST .00 .O1
TOTAL TAX PAYMENT 15.14
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" (CR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.