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BUREAU OF INDIVIDUAL TAXES ~~r~~ II OF INHERITANCE TAX DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION ~~~`-Itj t9r'-r'RA~~ ~E ALLOWANCE OR DISALLOWANCE
PO BOX 280601 r ipy REV-1548 EX AFP C12-11)
HARRISBURG PA 1 7128-0601 ~ ~"}i~~ j ~~ ~~W~7_ \_S, AND ASSESSMENT OF TAX ON
~, -•' J0~ HELD OR TRUST ASSETS
i •~~ F.. DATE 02-06-2012
~' ~ ~CB _3 P~ ~: ~~ ESTATE OF MAY GRAHAM H
DATE OF DEATH 07-01-2011
FILE NUMBER 21 11-1343
CLERK C;r COUNTY CUMBERLAND
C~PNAN~S (;~(!~~' SSN/DC 243-30-2507
TONY G MAY ~' J~A~ERi 1~'~f~ C~ PA ACN 11158767
67 DORY LANE APPEAL BY DATE:04-06-2012
CLAYTON NC 27520 -4452 (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 F'
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REY-1548 EX AFP C12-11)
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE: 02-06-2012
ESTATE OF:MAY
FILE NO.: 21 11-1343
GRAHAM H DATE OF DEATH:07-O1-2011 COUNTY:CUMBERLAND
S.S/D.C. NO.: 243-30-2507
ACN: 11158767
TAX RETURN WAS: CX) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO.: 8751-00
TYPE OF ACCOUNT: CX)SAVINGS C ) CHECKING C )TRUST C )TIME CERTIFICATE
DATE ESTABLISHED 08-31-1966
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
2,205.24
X 0.166
367.55
- .00
367.55
Y .045
16.54
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 (+)
INTEREST/PEN PAID C-)
AMOUNT PAID
12-14-2011 CD015347 .00 16.54
TOTAL TAX PAYMENT 16.54
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" CCR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.