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BUREAU OF INDIVIDUAL TAXES "~1`MA7~C~.Of~,;E~ANCE TAX DEPARTMENT OF REVENUE
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INHERITANCE TAX DIVISION
Po Box 280601 R
SYeM~NT
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I~A1 OR DISALLOWANCE
APP
of D~~DW~1`IbN~,:~~~~AN~t.~-¢~ESSMENT DF TAX ON REV-1548 EX AFP c1z-11)
HARRISBURG PA 17128-0601 7~1~}~TtY HELD `0~'XRUST ASSETS
012
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~ ~,~:~c~ATE OF DONIVAN
ROYAL S
DATE OF DEATH 05-04-2011
FILE NUMBER 21 11-0564
CLER
K CF COUNTY CUMBERLAND
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r~T SSN/DC 160-20-2591
CATHY S WATERS ~~~t~,`~~~__~~~ (~) ~i"} PQCN 11179006
116 W HILLCREST DR APPEAL BY DATE:06-15-2012
CAR L I S L E PA 17 013 - 1215 (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 ~
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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: 04-16-2012
ESTATE OF:DONIVAN ROYAL S DATE OF DEATH:05-04-2011
FILE NO.: 21 11-0564 S.S/D.C. NO.: 160-20-2591
COUNTY:CUMBERLAND
ACN: 11179006
TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: SOVEREIGN BANK ACCOUNT NO.: 0591134373
TYPE OF ACCOUNT: ( )SAVINGS C ~ CHECKING C )TRUST C )TIME CERTIFICATE
DATE ESTABLISHED 10-21-2008
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
1,176.19
X 0.166
196.04
- .00
196.04
Y .045
8.82
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 C+)
INTEREST/PEN PAID C-)
AMOUNT PAID
12-27-2011 CD015391 .00 8.82
TOTAL TAX PAYMENT 8.82
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. n ~