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05-23-14
pennsylvanE BUREAU OF INDIVIDUAL SAXES NOTICE OF INHERITANCE TAX DEPARTMENT OF REVENUE INHERZTANCE TAX DIVISION APPRAZSEMENL, ALLOWANCE OR DISALLOWANCE PO BOX 288601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP (12-13) HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS DATE 05-26-2014 ESTATE OF LAY JOSEPHINE J DATE OF DEATH 01-20-2013 FILE NUMBER 21 14-0447 COUNTY CUMBERLAND SSN/DC E E DACHEUX ACN 14122485 92 N WALNUT ST APPEAL BY DATE:07-25-2014 SPRING GROVE PA 17362-1026 (See reverse side under Objections) Amount Remitted f MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS I COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS REV-1548 EX AFP (12-13) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 05-26-2014 ESTATE OF: LAY JOSEPHINE J DATE OF DEATH:01-20-2013 COUNTY:CUMBERLAND FILE NO. : 21 14-0447 S.S/D.C. NO. : ACN: 14122485 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: SUSQUEHANNA BANK ACCOUNT NO, : 10009860817 TYPE OF ACCOUNT: ( )SAVINGS { ) CHECKING ( )TRUST ( ))TIME CERTIFICATE DATE ESTABLISHED 09-13-2011 Account Balance 8,003.03 NOTE: TO ENSURE PROPER CREDIT TO Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 4,001 .52 UPPER PORTION OF THIS NOTICE Debts and Deductions .00 WITH YOUR TAX PA"ENT TI% THE Taxable Amount 4,001.52 REGISTE97OF WILLV=AT 7HFn Tax Rate V . 12 ABOVE AURF�S. WE C-TNEK Tax Due 480. 18 OR MONE 1EO01LDE PX BL�Ei 'Mc�: "REGISTER "F rW IL h!Sa, AGp N,t." TAX CREDITS: t` W PAYMENT RECEIPT DISCOUNT C+) v DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID © C, `'I -n 05-07-2014 C0019131 7.84- 600.2x; Fst { r r r Cno In C 0 TOTAL TAX PAYMENT 592.39 BALANCE OF TAX DUE 112.21CR INTEREST AND PEN. .00 TOTAL DUE 112.21CR n 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. 1�VyW) SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.