HomeMy WebLinkAbout09-14-11 (2)BUREAU OF INDIVIDUAL
INHERITANCE 7AX DIVISION TAXES f
PO BOX 280601 ~~~~f~'_. ~pP~;r~~O~CE OF INHERITANCE TAX
HARRISBURG PA 17128-0601 ~{ OF ODE 1~~f1 1' ALLOWANCE OR DISALLDWANCE
~C(~„~;;, A4~ NS, AND ASSESSMENT OF
J'OS~l~LY HELD OR TRUST TAX ON
ASSETS
~!` S''~' l~ f~-; fL`'~ ~'
CLERK ~~
OR N ~, ~,
JOSEPH A MARTIet~M~~H~ ~,~ O~,f~P
104 HEMLOCK DR Q
CLARKS SUMMIT Pq 18411
Pennsylvania -';
DEPARTMENT OF REVENUE
REV-1548 EX AFP {12-10) ~~~
MAKE CHECK PAYABLE AND EMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 170
DATE 09-13-
.ESTATE OF 2m11
DATE OF DEATH MARTIN
FILE 09-25-2 10 LILLIAN
COUNTYUMBER 21 10-1 85
SSN/DC CUMBERLAND
ACN 196-22-4 40
APPEAL BY 101589621
DATE:11- 2-2011
(See reverse side under Ob coons
Amount Resitted ~
G
CUT ALONG 13
THIS LINE y
REV-1548 -~- " ' _ RETAIN LOWER PORTION FOR YOUR
EX AFP C12-107 ______
NOTICE OF INHERITANCE TAX ---___ RECORDS ~I
DEDUCTIONS, AND ASSESSMENTAOFRAISEMENT _____
TAX ON JOINTLyWANCE OR DISALLOWANCE
HELD OR TRUST ASSETS ~F
ESTATE OF: MARTIN DATE:
LILLIAN 09-1 -2011
G DATE OF DEATH:09-
FILE NO,; 25-2010
21 10-1085 S.S/D.C, COU~ITY:CUMBE-RL~D
TAX RETURN NO'Q 196-22_4140
WAS' (X) ACCEPTED
AS FILED ( ) CHANGED CN' 10158962
FINANCIAL INSTITUTION: PSECU JOINT OR TRUST
TYPE OF ASSET INFORMATION
ACCOUNT: C )SAVINGS ACCOUNT
DATE ESTABLISHED ~ ~ CHECKING NO': 984884 973-S4
11-24-2008 ~ )TRUST ( )TIME
Account Balance CERTIFICATE
Percent Taxable 4,870.19
Amount Sub' X NOTE: TO ENSURE PROP~~iER CREDIT TO
Debts and Deductions x 0.166
Taxable Amount 811.71 YOUR ACCOUNT, SUBMIT THE
.00 UPPER PORTION QF THIS NOTICE
Tax Rate 811,71 WITH YOUR
Tax Due REGISTER OFAX ~AYMENT TO THE
.045 WILLS AT THE
TAX CREDITS: 36.53 ABOVE ADDRESS ., MAKE CHECK
OR MONEY ORDER (PAYABLE T0:
PAYMENT "REGISTER OF
DATE RECEIPT WIC-LS, AGENT."
NUMBER DISCOUNT {+)
INTEREST/PEN PAID {_) AMOUNT PAID
INTEREST IS CHARGED
AT THE RATES APPLICABLEOUGH 09-21-2011
REVERSE SIDE OF THIS FORMS OUTLINED ON THE TOTAL TAX P
BALANCE OF AYMENT
TAX DUE •00
INTEREST AND PEN, 36.53
TOTAL DUE •26
IF PAID 36.79
AFTER THIS DATE,
IF TOTAL DUE IS REFLECTED SEE REVERSE FOR
SEE REVERSE AS A "CREDIT" CALCULATION OF ADDITIONAL INTEREST.
SIDE OF THIS FORM FOR {CR)' YOU MAy BE
INSTRUCTIONS. DUE A REFUND.