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i OF pennsylvania
INHERITANCE TAX
DEPARTMENT OF REVEN UE
BUREAU OF INDIVIDUAL TAXES
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ON REV-1548 IX AFP (12-11)
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HARRISBURG PA 17128-o6a1 JOINTLY HEL D OR TRUST ASSETS
2C12AU624 t~i~il~ ~~ DATE 08-28-2012
ESTATE OF HE:NDRY THOMAS 0
DATE OF DEATH Obi-28-2012
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1;....:-. ~~~~,~. ~.. ~" FILE NUMBER 21. 12-0538
OPYi-~'a~~S COUfit COUNTY CUMBERLAND
PA
LINDA H MYERS ., ACN 12131500
1002 BAYTHORNE DR APPEAL BY DATE:10-27-2012
MECHANICSBURG PA 17050-210 0 (See reverse side under Objections)
Amount Renitted~
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSESQUARE
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: OS-28-2012
ESTATE OF: HENDRY THOMAS 0 DATE OF DEATH:04-28-2012 COUNTY:CUMBERLAND
FILE NO.: 21 12-0538 S.S/D.C. NO.: 439-38-4891 ACN: 12131500
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MID PENN BK ACCOUNT NO ..: 18008029
TYPE OF ACCOUNT: ( )SAVINGS ( b CHECKING ( )TRUST ( )TIME CERTIFICATE
DATE ESTABLISHED 12-20-2010
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
108,345.58 NOTE:
X 0.166
18.057.96 -
- .00
18,057.96
x .045
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-) pMOU NT PAID
07-07-2012 CD016229 40.63 7'71.98
TOTAL TAX PAYNENT 812.61
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" (CR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.