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BUREAU OF INDIVIDUAL ~~" r (if ~('~[[[
NOTICE
T~k~(ll?I}-(~t
frF~G OF INHERITANCE TAX
, ~
~ AISEMENT, ALLOWANCE OR DISALLOWANCE
INHERITANCE TAX DIVISION
PO BOX 280601
PE;~~'l~~r'^' ~ ~j ~~~~~
~
~}1EDUCTIONS,
AND ASSESSMENT OF TAX ON
HARRISBURG PA PI28-0601 ~"
" " ~ JOINTLY HELD OR TRUST ASSETS
2~l20CT 26 b~tgil~ 37
JOHN E ~~tBERLAAID CO.. PA
15 LYNN AVE
NEWBURG PA 17240-9229
Pennsylvania ~
DEPARTMENT OF REVENUE
REV-1548 IX AFP (12-1ll
DATE 10-29-2012
ESTATE OF BYERS EVELYN L
DATE OF DEATH 07-27-2012
FILE NUMBER 21 12-1043
COUNTY CUMBERLAND
SSN/DC 202-2D-4618
ACN 12144219
APPEAL BY DATE:12-28-2012
(See reverse side under Objections)
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSE SgUARE
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: 10-29-2012
ESTATE OF:BYERS EVELYN L DATE OF DEATH:07-27-2012
FILE NO.: 21 12-1043 S.S/D.C. NO.: 202-20-4618
ACN: 12144219
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO.: 13170-00
TYPE OF ACCOUNT: IX)SAVINGS C ) CHECKING ( )TRUST ( )TIME CERTIFICATE
DATE ESTABLISHED 04-10-1972
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAY rDCnTTC•
4.023.90
X 0.166
670.66
- .00
670.66
~. 045
30.18
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 (-) AMOUNT PAID
09-20-2012 CD016550 1.51 28.66
LO-22-2012 SBADJUST .00 .O1
TOTAL TAX PAYNENT 30.18
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
COUNTY:CUMBERLAND
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. A
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.