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BUREAU OF INDIVIDUAL TAXES ~r" '" '-' u'+ ,~; ~l~fICE OF INHERITANCE TAX
INHERITANCE TAX DIVISION APPRAIS~I~ENT, ALLOWANCE OR DISALLOWANCE
Po BOX 280601 ryrrq OF DEDUCTIONS, AND ASSESSMENT OF TAX ON
HARRISBURG PA 17128-0601 ,(i',; ~ ~ j,~~-';~ '}': ny;' ~ IHT-LY HELD OR TRUST ASSETS
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BEVERLY L ESLINGER
3815 MOUNTAIN VIEW RD
MECHANICSBURG PA 17050-2131
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DEPARTMENT OF REVENUE
REV-1546 EX AFP C12-11)
DATE 04-23-2012
ESTATE OF HAVERSTOCK MARTIN L
DATE OF DEATH 07-24-2010
FILE NUMBER 21 10-1003
COUNTY CUMBERLAND
SSN/DC
ACN 1113528b
APPEAL BY DATE:06-22-2012
(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 <~
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: 04-23-2012
ESTATE OF:HAVERSTOCK MARTIN L DATE OF DEATH:07-24-2010
FILE NO.: 21 10-1003 S.S/D.C. NO.:
COUNTY:CUMBERLAND
ACN: 11135286
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: CITIZENS BANK OF PENNSYLVANIA ACCOUNT NO.: 6100743691
TYPE OF ACCOUNT: ( )SAVINGS CX) CHECKING f )TRUST C )TIME CERTIFICATE
DATE ESTABLISHED 08-04-1982
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
2,623.55
X 0.166
437.27
- .00
437.27
x .15
65.59
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
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AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORM
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE 65.59
INTEREST AND PEN. 2.01
TOTAL DUE 67.60
~ 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.