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BUREAU OF INDIVIDUAL TAXES `' ~'-''~' ~ `~' ~ '~''~ ICE OF INHERITANCE TAX
INHERITANCE TAX DIVISION ~~AP'?Ri~TS~~d'j:NT, ALLOWANCE OR DISALLOWANCE
PO BOX 280601 r' ~` ~ 'O~F~ D~~D' IONS, AND ASSESSMENT OF TAX ON
HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS
Pennsylvania ° ~" e
DEPARTMENT OF REVENUE
REV-1548 EX AFP (12-11) ~ ~~~~
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~Ea t~,"s'', uJ i ~..• c:~ DATE 04-23-2012
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BEVERLY S LEHMAN'~'~~~~~'~~'~"`~' ~'~"'~~
280 BARNSTABLE RD
CARLISLE PA 17015-9412
ESTATE OF SHUGHART THELMA M
DATE OF DEATH 04-15-2011
FILE NUMBER 21 11-0523
COUNTY CUMBERLAND
SSN/DC
ACN 11132959
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 F'
REV-1548 EX AFP (12-11~ ----------------------------------------------------------------
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:SHUGHART THELMA
M DATE OF DEATH:04-15-2011 COUNTY:CUMBERLAND
FILE NO.: 21 11-0523 S.S/D.C. NO.: ACN: 11132959
TAX RETURN WAS: (X) ACCEPTED AS FILED ( 3 CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: PNC BANK NA ACCOUNT NO.: 5140191331
TYPE OF ACCOUNT: ( )SAVINGS CX) CHECKING ( )TRUST C )TIME CERTIFICATE
DATE ESTABLISHED 01-30-2007
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
PAYMENT RECEIPT
DATE NUMBER
13,156 00 NOTE:
X 0.166
2,192.71
- .00
2,192 71
x 045
98.67
DISCOUNT C+)
INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 05-01-2012
AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORM
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."
AMOUNT PAID
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE 98.67
INTEREST AND PEN. ,87
TOTAL DUE 99.54
* 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.
~~