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HomeMy WebLinkAbout12-07-12 RECORDED 0-771C tOr pennsylvania ~ BUREAU OF INDIVIDUAL TAXES REGISTER OF ~b .ISE OF INHERITANCE TAX DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE PO BOX 280601 n[' OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP (12-11) HARRISBURG PA 17128-0601 CLI12 ULC 7 PJ ,JOjNTe,' ELD OR TRUST ASSETS DATE 12-10-2012 CLERK OF ESTATE OF MCLAUGHLIN MALIE B O`RPHANS' ~ruc;Rf DATE OF DEATH 10-31-2011 FILE NUMBER 21 11-1211 OMBERLANO CO., PA COUNTY CUMBERLAND SSN/DC 144-14-9022 CATHERINE THOMPSON ACN 12103010 199 HALLMAN LN APPEAL BY DATE:02-08-2013 HARRISBURG PA 17112-9616 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS E- R-----------1548 EX-A---FP - C-1--2-1--1) EV-- NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 12-10-2012 ESTATE OF:MCLAUGHLIN MALIE B DATE OF DEATH:10-31-2011 COUNTY:CUMBERLAND FILE NO.: 21 11-1211 S.S/D.C. NO.: 144-14-9022 ACN: 12103010 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PSECU ACCOUNT NO.: 0144149022-S4 TYPE OF ACCOUNT: ( )SAVINGS (X) CHECKING ( )TRUST ( )TIME CERTIFICATE DATE ESTABLISHED 06-16-1999 Account Balance 2,668.15 NOTE: TO ENSURE PROPER CREDIT TO Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 1,334.08 UPPER PORTION OF THIS NOTICE Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 1,334.08 REGISTER OF WILLS AT THE Tax Rate x .045 ABOVE ADDRESS. MAKE CHECK Tax Due 60.03 OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT C+) DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID INTEREST IS CHARGED THROUGH 12-18-2012 TOTAL TAX PAYMENT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 60.03 REVERSE SIDE OF THIS FORM INTEREST AND PEN. .69 TOTAL DUE 60.72 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. 111 NOTICE OF INHERITANCE TAX pennsylvania BUREAU OF INDIVIDUAL TAXES p DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION pp RECORDED /~FF-I VZ C TIONS, ALLOWANCE WASSESSMENT DISALLOWANCE LTAXNON REV-1548 EX AFP (12-11) " PO BOX 280601 +1 iPF HD HARRISBURG PA 17128-0601 R~ 6S 0- 'j,,,+, ¢ LVOINTLY HELD OR TRUST ASSETS (1GV J DATE 12-10-2012 E01t CEO 7 PM I or ESTATE OF MCLAUGHLIN MALIE B U DATE OF DEATH 10-31-2011 FILE NUMBER 21 11-1211 CLERK G COUNTY CUMBERLAND SSN/DC 144-14-9022 CATHERINE pj& ~S# COURT ACN 12103011 199 HALLMANC'LANO CO., PA APPEAL BY DATE:02-08-2013 HARRISBURG PA 17112-9616 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS 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: 12-10-2012 ESTATE OF:MCLAUGHLIN MALIE B DATE OF DEATH:10-31-2011 COUNTY:CUMBERLAND FILE NO.: 21 11-1211 S.S/D.C. NO.: 144-14-9022 ACN: 12103011 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PSECU ACCOUNT NO.: 0144149022-S7 TYPE OF ACCOUNT: (X)SAVINGS C ) CHECKING ( )TRUST ( )TIME CERTIFICATE DATE ESTABLISHED 07-13-1995 Account Balance 193,392.16 NOTE: TO ENSURE PROPER CREDIT TO Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 96,696.08 UPPER PORTION OF THIS NOTICE Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 96,696.08 REGISTER OF WILLS AT THE Tax Rate x .045 ABOVE ADDRESS. MAKE CHECK Tax Due 4,351.32 OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT C+) DATE NUMBER INTEREST/PEN PAID AMOUNT PAID INTEREST IS CHARGED THROUGH 12-18-2012 TOTAL TAX PAYMENT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 4,351.32 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 49.95 TOTAL DUE 4,401.27 ~ 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. RECORDED OFIFt'E OF pennsyLvania BUREAU OF INDIVIDUAL _ R_, ^ NOTICE OF INHERITANCE TAX DEPARTMENT OF REVENUE INHERITANCE TAX DIVISIONR? I s...a OF -l6ISEMENT, ALLOWANCE OR DISALLOWANCE PO BOX 280601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP C12-11) HARRISBURG PA 17128-0601±±t r-,,INTLY HELD OR TRUST ASSETS ZM? DEC ~7 1 1i 1 U0 DATE 12-10-2012 ESTATE OF MCLAUGHLIN MALIE B CLERK OF DATE OF DEATH 10-31-2011 ORPHANS' CCOUR FILE NUMBER 21 11-1211 COUNTY CUMBERLAND CUMBERLAND CIO- P` SSN/DC 144-14-9022 CATHERINE THOMPSON ACN 12103012 199 HALLMAN LN APPEAL BY DATE:02-08-2013 HARRISBURG PA 17112-9616 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: 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: 12-10-2012 ESTATE OF:MCLAUGHLIN MALIE B DATE OF DEATH:10-31-2011 COUNTY:CUMBERLAND FILE NO.: 21 11-1211 S.S/D.C. NO.: 144-14-9022 ACN: 12103012 TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PSECU ACCOUNT NO.: 0144149022-S51 TYPE OF ACCOUNT: C )SAVINGS C ) CHECKING C )TRUST CX)TIME CERTIFICATE DATE ESTABLISHED 07-13-1998 Account Balance 28,415.76 NOTE: TO ENSURE PROPER CREDIT TO Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 14,207.88 UPPER PORTION OF THIS NOTICE Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 14,207.88 REGISTER OF WILLS AT THE Tax Rate x .045 ABOVE ADDRESS. MAKE CHECK Tax Due 639.35 OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT C+) DATE NUMBER INTEREST/PEN PAID AMOUNT PAID INTEREST IS CHARGED THROUGH 12-18-2012 TOTAL TAX PAYMENT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 639.35 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 7.34 TOTAL DUE 646.69 r 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. J SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. pennsylvania' F~rOF INHERITANCE TAX DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES REC0RDE OF F- IM' ~ CE OR D CE INHERITANCE TAX DIVISION REG1STE F01Ji* t4.g8S,AANDWASSESSMENTSOFLTAXNON REV-1548 EX AFP (12-11) PD BOX 280601 V i J ! I~ HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS ~y ry ~ii~C DEC ~7 ( Pn 1 Oro DATE 12-10-2012 ESTATE OF MCLAUGHLIN MALIE B CLERK OF DATE OF DEATH 10-31-2011 E- FILE NUMBER 21 11-1211 ORPHANS' COUR- T COUNTY CUMBERLAND P BERLAND C _ ^A SSN/DC 144-14-9022 CATHERINE THOM ACN 12103013 199 HALLMAN LN APPEAL BY DATE:02-08-2013 HARRISBURG PA 17112-9616 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: 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: 12-10-2012 ESTATE OF:MCLAUGHLIN MALIE B DATE OF DEATH:10-31-2011 COUNTY:CUMBERLAND FILE NO.: 21 11-1211 S.S/D.C. NO.: 144-14-9022 ACN: 12103013 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PSECU ACCOUNT NO.: 0144149022-S52 TYPE OF ACCOUNT: ( )SAVINGS ( ) CHECKING ( )TRUST (X)TIME CERTIFICATE DATE ESTABLISHED 04-23-1999 Account Balance 17,844.82 NOTE: TO ENSURE PROPER CREDIT TO Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 8,922.41 UPPER PORTION OF THIS NOTICE Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 8,922.41 REGISTER OF WILLS AT THE Tax Rate x .045 ABOVE ADDRESS. MAKE CHECK Tax Due 401.51 OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT C+) DATE NUMBER INTEREST/PEN PAID AMOUNT PAID INTEREST IS CHARGED THROUGH 12-18-2012 TOTAL TAX PAYMENT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 401.51 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 4.61 TOTAL DUE 406.12 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. NOTICE OF INHERITANCE TAX pennsylvania BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE PO BOX 280601 RECORDED p~ I?1J~rT K, AND ASSESSMENT OF TAX ON REV-1548 EX AFP (12-1ll HARRISBURG PA 17128-0601 tfa ~ y(1 Ti LfY HELD OR TRUST ASSETS REGISTER 0 LS DATE 12-10-2012 ESTATE OF MCLAUGHLIN MALIE B Et~12 D~'~ n DATE OF DEATH 10-31-2011 FILE NUMBER 21 11-1211 CLERK OF COUNTY CUMBERLAND SSN/DC 144-14-9022 CATHERINE THOMPVWHANS' COURT ACN 12103014 199 HALLMAN LN CU-M8ERLAND CO., PA APPEAL BY DATE:02-08-2013 HARRISBURG PA 17112-9616 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS 4-- 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: 12-10-2012 ESTATE OF:MCLAUGHLIN MALIE B DATE OF DEATH:10-31-2011 COUNTY:CUMBERLAND FILE NO.: 21 11-1211 S.S/D.C. NO.: 144-14-9022 ACN: 12103014 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PSECU ACCOUNT NO.: 0144149022-S53 TYPE OF ACCOUNT: ( )SAVINGS C ) CHECKING C )TRUST (X)TIME CERTIFICATE DATE ESTABLISHED 11-10-1998 Account Balance 8,380.35 NOTE: TO ENSURE PROPER CREDIT TO Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 41190.18 UPPER PORTION OF THIS NOTICE Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 4,190.18 REGISTER OF WILLS AT THE Tax Rate x .045 ABOVE ADDRESS. MAKE CHECK Tax Due 188.56 OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT C+) DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID INTEREST IS CHARGED THROUGH 12-18-2012 TOTAL TAX PAYMENT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 188.56 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 2.16 TOTAL DUE 190.72 ~i 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. NOTICE OF INHERITANCE TAX pennsylvania BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE PO BOX 280601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP C12-11) HARRISBURG PA 17128-0601 RECORDED Y-gbQ~iJT.L1F HELD OR TRUST ASSETS REGIS I E OF V!N-LS DATE 12-10-2012 ESTATE OF MCLAUGHLIN MALIE B 3 DEC DATE OF DEATH 10-31-2011 '4012 DEC 7 PR ( 1 00 FILE NUMBER 21 11-1211 COUNTY CUMBERLAND CLERK OF SSN/DC 144-14-9022 CATHERINE THOMPSON ACN 12103015 199 HALLMAN LN ORPHANS COURT APPEAL BY DATE:02-08-2013 HARRISBURG C+ER>AND100,, PA (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: 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: 12-10-2012 ESTATE OF:MCLAUGHLIN MALIE B DATE OF DEATH:10-31-2011 COUNTY:CUMBERLAND FILE NO.: 21 11-1211 S.S/D.C. NO.: 144-14-9022 ACN: 12103015 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PSECU ACCOUNT NO.: 0144149022-S55 TYPE OF ACCOUNT: ( )SAVINGS C ) CHECKING ( )TRUST O)TIME CERTIFICATE DATE ESTABLISHED 12-08-2000 Account Balance 23,567.33 NOTE: TO ENSURE PROPER CREDIT TO Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 11,783.67 UPPER PORTION OF THIS NOTICE Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 11,783.67 REGISTER OF WILLS AT THE Tax Rate x .045 ABOVE ADDRESS. MAKE CHECK Tax Due 530.27 OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT C+) DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID INTEREST IS CHARGED THROUGH 12-18-2012 TOTAL TAX PAYMENT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 530.27 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 6.09 TOTAL DUE 536.36 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. BUREAU OF INDIVIDUAL NOTICE OF INHERITANCE TAX P e n n sy lva rn a F TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE PO BOX 280601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP (12-11) HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS RECORDED 07r1 C- E 0 DATE 12-10-2012 RECAST=;=5 ESTATE OF MCLAUGHLIN MALIE B n DATE OF DEATH 10-31-2011 FILE N 21 11 -1211 OUNTYUMBER CUMBERLAND ZU9 DEC 7 PM 1 u G C SSN/DC 144-14-9022 CATHERINE THOMPSON CLERK O ACN 12103016 199 HALLMAN LN ~y TOM $ BY DATE:02-08-2013 HARRISBURG AR T'1'I~ 2`~- 9 li 1~(See reverse side under Objections) CUMBERLAND CO., RA Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: 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: 12-10-2012 ESTATE OF:MCLAUGHLIN MALIE B DATE OF DEATH:10-31-2011 COUNTY:CUMBERLAND FILE NO.: 21 11-1211 S.S/D.C. NO.: 144-14-9022 ACN: 12103016 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PSECU ACCOUNT NO.: 0144149022-S56 TYPE OF ACCOUNT: ( )SAVINGS C ) CHECKING ( )TRUST (X)TIME CERTIFICATE DATE ESTABLISHED 09-13-2006 Account Balance 12,781.57 NOTE: TO ENSURE PROPER CREDIT TO Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 6,390.79 UPPER PORTION OF THIS NOTICE Debts and Deductions - •00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 6,390.79 REGISTER OF WILLS AT THE Tax Rate x 045 ABOVE ADDRESS. MAKE CHECK Tax Due 287.59 OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID INTEREST IS CHARGED THROUGH 12-18-2012 TOTAL TAX PAYMENT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 287.59 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 3.30 TOTAL DUE 290.89 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.