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POHBOX 28060 ~DD VISIONL TAXES i~Cl~tJ~r'{t" ~~~~~~ T S,AANDWASSESSMENTSOFLTAXNON
HARRISBURG PA 17128-0601 ~~~~~~) ~ `~~ ~'~
JOINTLY HELD OR TRUST ASSETS
Pennsylvania `~ ~~. ~~~~
DEPARTMENT OF REVENUE
REV-1548 EX AFP (12-11)
~~~2JUN 12 Ahilt~ JJ ESTATE OF COOK1-2012 LINDA C
DATE OF DEATH 01-16-2011 ~
L..t`.r FILE NUMBER a I - II G~rv~~
ryryC~~E~~~PLl~~4~#`S {i~RT COUNTY CUMBERLAND
LEO E COOK WmU~rt~l~ ~„ (~ SSN/DC 191-12-4473
ACN 11146942
528 SKYLARK DR APPEAL BY DATE:08-LO-2012
S E B R I N G F L 3 3 8 7 5 (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: 06-11-2012
ESTATE OF:000K LINDA C DATE OF DEATH:O1-16-2011 COUNTY:CUMBERLAND
FILE NO.: S.S/D.C. NO.: 191-12-4473 ACN: 11146942
TAX RETURN WAS: tX) ACCEPTED AS FILED C ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: WELLS FARGO ACCOUNT NO.: 1000135259152
TYPE OF ACCOUNT: ( )SAVINGS CXJ CHECKING C )TRUST ( )TIME CERTIFICATE
DATE ESTABLISHED 05-21-1998
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
789.00
X 0.500
394.50
- .00
394.50
x .15
59.18
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
+,•, ~n~.~, is ~. nrartoCL ~ riKUUbFI U6-lY-ZU1L
AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORM
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE 59.18
INTEREST AND PEN. 1.20
TOTAL DUE 60.38
* 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.