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BUREAU OF INDIVIDUAL TAiC$S,r -i h NOTICE OF INHERITANCE TAX
INHERITANCE TAX DIVISION kaP~~ISEMENT, ALLOWANCE OR DISALLOWANI:E
PO BOX 280601 - ~0'F' ~~DUCTIONS, AND ASSESSMENT OF TAX ON
HARRISBURG PA 17128-0601
JOINTLY HELD OR TRUST ASSETS
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T E R R Y R ~~~~~b N" ' ~, I?~ ~?,;
607 COPPER CIRCLE
CARLISLE PA 17015
pennsy(vania r;
DEPARTMENT OF REVENUE
REV-1548 EX AFP (12-10)
DATE 08-29-2011
ESTATE OF LONG JANE
DATE OF DEATH 04-26-2011
FILE NUMBER 21 11-0763
COUNTY CUMBERLAND
SSN/DC 246-28-1785
ACN 11136182
APPEAL BY DATE:10-28-2011
(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 RE(:ORDS ~
REV-1548 EX AFP C12-10)----"~---""---"---'--------------------,._
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NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DIS~ILLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUStT ASSETS
DATE: 08-29-2011
ESTATE OF:LONG JANE DATE OF DEATH:04-26-2011.
COUNTY:CUMBERLAND
FILE NO.: 21 11-0763 S.S/D.C. NO.:
246-28-1785 ACN: 11136182
TAX RETURN WAS: CX) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MEMBERS 1ST FCU
ACCOUNT NCB.: 317066-11
TYPE OF ACCOUNT: ( )SAVINGS (X) CHECKING C )TRUST C )TIME CERTIFICATE
DATE ESTABLISHED 10-30-2007
Account Balance
Percent Taxable
X 883.86
NOTE: TO ENSURE PROPER CREDIT TO
Amount Subject to Tax 0.500 YOUR ACCOUNT, SUBMIT THE
Debts and Deductions - 441.93
UPPER PORTION OF THIS NOTICE
Taxable Amount .00 WITH YOUR TAX PAYMENT TO THE
Tax Rate
~ 441.93
REGISTER OF WILLS AT THE
Tax Due 045 ABOVE ADDRESS. MAKE CHECK
19.89 OR MONEY ORDER PAYABLE T0:
TAX CREDITS: "REGISTER OF WILLS, AGENT."
PAYMENT RECEIPT
DATE DISCOUNT (+)
NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
07-11-2011 CD014691
.99 19.89
TOTAL TAX PAYMENT 20.88
BALANCE OF TAX DUE .99CR
INTEREST AND PEN. .00
TOTAL DUE .99CR
* 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.