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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 28D601
HARRISBURG PA 17126-0601
EDRIS A DAVIES
2039 HARVEST DR
MECHANICSBURG PA
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APPI~%~~St ,`~ALLOIIFOrN+t:E OR DISALLOWANCE
OF DEDUCTIONS, AND ASSESSMENT OF TAX ON
JOINT Y H LD QR TI;UST ASSETS
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DEPARTMENT OF REVENUE
REV-1548 EX AFP C12-lll
DA E 04-02-2012
ESTATE OF DAVIES EDRIS W
~~~}{ (~[= DATE OF DEATH 03-26-2011
~R~}_i,~:~~}`~ ~J~~ij}^T FILE NUMBER 21 11-0544
Cpl}~,i~~ ~` ~,`'-~ l.(.' OUNTY CUMBERLAND
'~N/DC
ACN 11130162
APPEAL BY DATE:06-O1-2012
17055 (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~
REV-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: 04-02-2012
ESTATE OF:DAVIES EDRIS
W DATE OF DEATH:03-26-2011 COUNTY:CUMBERLAND
FILE NO.: 21 11-0544 S.S/D.C. NO.: ACN: 11130162
TAX RETURN WAS: CX) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: SOVEREIGN BANK ACCOUNT NO.: 1685549212
TYPE OF ACCOUNT: C )SAVINGS C ) CHECKING (X)TRUST C )TIME CERTIFICATE
DATE ESTABLISHED 11-02-2009
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
4,369.49 NOTE:
X 1.000
4,369.49
- .00
4,369.49
x 15
655.42
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
T \ITrI'f .-fir
-••. .-.. ~~+. a.a a. 11MnvGL 1I7RUUl]I'7 Uµ-j11-jpll
AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORM
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE 655.42
INTEREST AND PEN. 5.70
TOTAL DUE 661.12
* 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.
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