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BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX ' DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
PO BOX 280661 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP (12-13}
HARRISBURG PA 11128-0601 JOINTLY HELD OR TRUST ASSETS
DATE 08-18-2014
ESTATE OF HOLLIBAUGH JOHN T
DATE OF DEATH 03-28-2014
FILE NUMBER 21 14-0657
COUNTY CUMBERLAND
SSN/DC
BETH TYRRELL ACN 14120440
5504 BEARCREEK DR APPEAL BY DATE:10-17-2014
MECHANICSBURG PA 17050-1983 (See reverse side under Objections)
Amount Remitted F
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE -"1 RETAIN LOWER PORTION FOR YOUR RECORDS 4—
_----______--___--__--_-______---______________^-_________--________
REV-1548 EX AFP C12-13)
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE: 08-18-2014
ESTATE OF: HOLLIBAUGH JOHN T DATE OF DEATH:03-28-2014 COUNTY:CUMBERLAND
FILE NO. : 21 14-0657 S.S/D.C. NO. : ACN: 14120440
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. : 22501-00
TYPE OF ACCOUNT: ( X)SAVINGS C } CHECKING ( )TRUST ( )TIME CERTIFICATE
DATE ESTABLISHED 09-30-1979
Account Balance 4,,115.79 NOTE: TO ENSURE PROPER CREDIT TO
Percent Taxable X 0.166 YOUR ACCOUNT, SUBMIT THE
Amount Subject to Tax 685.98 UPPER PORTION OF THIS NOTICE
Debts and Deductions 685.98 WITH YOUR TAX PAYMENT TO THE
Taxable Amount .00 REGISTER OF WILLS AT THE
Tax Rate v .045 ABOVE ADDRESS. MAKE CHECK
Tax Due .00 OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS: n ==
PAYMENT RECEIPT DISCOUNT 70
:I7'iJ C
DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID G—)C-D�-L '• � C^ jT
= ._ —,-,
S _
C7.>
IV ~�
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
e 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.