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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'*
BUREAU OF INDIVIDUAt..(tAXE$:: l .
INHERITANCE TAX DIVISION"'-
PO BOX 280601
HARRISBURG PA 11128-0601
NOTICE OF INHERITANCE TAX
APPRAISEKENT~ ALLOMANCE OR DISALLOHANCE
OF DEDUCTION~~ AND ASSESSKENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REY-1S4R EX AFP 112-14)
28
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
03-01-2005
ETSWEILER
04-21-2004
~S"J..":t.~
CUMBERLAND
174-20-8129
04127395
Allount R.llitt.d
SOPHIA
M
WILLIAM '.H ETSWEILER
68731 SHEPARD DR
ST CLAIRSVILLE OH 43950
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REli:is4-i-ix--AFP--(Oi~03i------------------------------------------------------------------------------------
~~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 03-01-2005
ESTATE OF ETSWEILER
SOPHIA
M DATE OF DEATH 04-21-2004
COUNTY
CUMBERLAND
FILE NO. S.S/D.C. NO. 174-20-8129
TAX RETURN WAS: (X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
04127395
FINANCIAL INSTITUTION: ORRSTOWN BANK
ACCOUNT NO.
106001761
TYPE OF ACCOUNT: () SAVINGS (~ CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 11-14-2000
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
7,187.16
0.166
1,197.88
.00
1,197.88
.00
.00
NOTE: TO INSURE 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 TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .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 LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRl, YOU MAY BE DUE A REFUND.
- ----- ---- .'" ...u...., I:nDM FOR INSTRUCTIONS. l
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