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BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
PO BOX 280601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 IX AFP C12-12)
HARRISBURG PA 17128-0601
RERDED
f►91 ffffeFdp OR TRUST ASSETS
REGISTER OF VTILLS DATE 04-15-2013
ESTATE OF COOK ADAM R
��€!I�J APR ll R 1 c �� � j2 DATE OF DEATH 01-09-2013
J FILE NUMBER 21 13-0333
COUNTY CUMBERLAND
CLERK OF SSN/DC
JOHN L HYATT SR pp ACN 13106798
457 MOUNT OLIVET CHURYPHANS� COURT APPEAL BY DATE:06-14-2013
FAWN GROVE PACUMBEfObAND CO., 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
-------------------------------------------------------------------------------------------
REV-1548 EX AFP C12-12)
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE: 04-15-2013
ESTATE OF:000K ADAM R DATE OF DEATH:01-09-2013 COUNTY:CUMBERLAND
FILE NO. : 21 13-0333 S.S/D.C. NO. : 200-24-7570 ACN: 13106798
TAX RETURN WAS: (X) ACCEPTED AS FILED t ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. : 439606-00
TYPE OF ACCOUNT: ( ))SAVINGS ( ) CHECKING C )TRUST t )TIME CERTIFICATE
DATE ESTABLISHED 11-15-2011
Account Balance •00 NOTE: TO ENSURE PROPER CREDIT TO
Percent Taxable X 0. 166 YOUR ACCOUNT, SUBMIT THE
Amount Subject to Tax •00 UPPER PORTION OF THIS NOTICE
Debts and Deductions •00 WITH YOUR TAX PAYMENT TO THE
Taxable Amount •00 REGISTER OF WILLS AT THE
Tax Rate Y .045 ABOVE ADDRESS. MAKE CHECK
Tax Due •00 OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)
TOTAL TAX PAYMENT .00
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.
NOTICE OF INHERITANCE TAX pennsyLvania
BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
PO BOX 280601 OF DUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 IX AFP (12-12)
HARRISBURG PA 17128-0 C R O r F"^� O JOINTLY HELD OR TRUST ASSETS
RE GI i '' i DATE 04-15-2013
ESTATE OF COOK ADAM R
{1P t1 �c DATE OF DEATH 01-09-2013
?��� R
4 J i ' FILE NUMBER 21 13-0333
COUNTY CUMBERLAND
.ERK Or SSN/DC
JOHN L HYApp 0U RT ACN 13106799
457 MOUNT OLQ J&�CH- APPEAL BY DATE:06-14-2013
FAWN G R O V EOU B E 939 Y{�s 9 k (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 C12-12)
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE: 04-15-2013
ESTATE OF:000K ADAM R DATE OF DEATH:01-09-2013 COUNTY:CUMBERLAND
FILE NO. : 21 13-0333 S.S/D.C. NO. : 200-24-7570 ACN: 13106799
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. : 439606-11
TYPE OF ACCOUNT: C )SAVINGS ( X) CHECKING ( )TRUST t )TIME CERTIFICATE
DATE ESTABLISHED 11-15-2011
Account Balance •00 NOTE: TO ENSURE PROPER CREDIT TO
Percent Taxable X 0.166 YOUR ACCOUNT, SUBMIT THE
Amount Subject to Tax •00 UPPER PORTION OF THIS NOTICE
Debts and Deductions - •00 WITH YOUR TAX PAYMENT TO THE
Taxable Amount •00 REGISTER OF WILLS AT THE
Tax Rate x .045 ABOVE ADDRESS. MAKE CHECK
Tax Due •00 OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX PAYMENT .00
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.
pennsylvania
BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
PO BOX 280601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP C12-12)
HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS
RECORDED OFFICE OF DATE 04-15-2013
REGISTER DP VVILLS ESTATE OF COOK ADAM R
D I DATE OF DEATH 01-09-2013
fl
PR 1IPR 15 P 3 32 COUNTYUMBER CUMBERLAND
SSN/DC
MARY E HYATT CLERK OF ACN 13113144
457 MOUNT OLIVET CHUR , APPEAL BY DATE:06-14-2013
FAWN GROVE P A 1 W 8#R C CURT (See reverse side under Objections)
CUMBERLAND CO., PA 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 C12-12)
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE: 04-15-2013
ESTATE OF:000K ADAM R DATE OF DEATH:01-09-2013 COUNTY:CUMBERLAND
FILE NO. : 21 13-0333 S.S/D.C. NO.. : 200-24-7570 ACN: 13113144
TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. : 439606-00
TYPE OF ACCOUNT: CX)SAVINGS C ) CHECKING ( )TRUST C )TIME CERTIFICATE
DATE ESTABLISHED 11-15-2011
Account Balance •00 NOTE: TO ENSURE PROPER CREDIT TO
Percent Taxable X 0.166 YOUR ACCOUNT, SUBMIT THE
Amount Subject to Tax •00 UPPER PORTION OF THIS NOTICE
Debts and Deductions •00 WITH YOUR TAX PAYMENT TO THE
Taxable Amount •00 REGISTER OF WILLS AT THE
Tax Rate x .045 ABOVE ADDRESS. MAKE CHECK
Tax Due •00 OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)
TOTAL TAX PAYMENT .00
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.
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 IX AFP C12-12)
HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS
RECORDED OFFICE Dr DATE 04-15-2013
REGISTER Of WILLS ESTATE OF COOK ADAM R
DATE OF DEATH 01-09-2013
FILE 21 13-0333
U-13 APR 15 FM 3 32 COUNTYUMBER CUMBERLAND
SSN/DC
MARY E HYATT CLERK DE ACN 13113145
457 MOUNT OLIVET CHURCH COURT BY DATE:06-14-2013
FAWN GROVE P A 17 3 2'l L g (See reverse side under Objections)
CUMBERLAND CO., PA 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 (12-12)
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE: 04-15-2013
ESTATE OF:000K ADAM R DATE OF DEATH:01-09-2013 COUNTY:CUMBERLAND
FILE NO. : 21 13-0333 S.S/D.C. NO. : 200-24-7570 ACN: 13113145
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. : 439606-11
TYPE OF ACCOUNT: C )SAVINGS ( )0 CHECKING C )TRUST C )TIME CERTIFICATE
DATE ESTABLISHED 11-15-2011
Account Balance •00 NOTE: TO ENSURE PROPER CREDIT TO
Percent Taxable X 0.166 YOUR ACCOUNT, SUBMIT THE
Amount Subject to Tax •00 UPPER PORTION OF THIS NOTICE
Debts and Deductions •00 WITH YOUR TAX PAYMENT TO THE
Taxable Amount •00 REGISTER OF WILLS AT THE
Tax Rate Y .045 ABOVE ADDRESS. MAKE CHECK
Tax Due •00 OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)
TOTAL TAX PAYMENT .00
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" CCR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.