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BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX DEPARTMENT OF REVENUE
INHERITANCE X DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE QV
REV-1548 EX AFP (12-13)
PO BOX 28060RECC ,
-0vj:C(Ci OF OF DEDUCTIONS, AND ASSESSMENT OF TAX ON
HARRISBURG PA 17128661 JOINTLY HELD OR TRUST ASSETS
REC110-7---, r ^ ,.',LLS
DATE 11-03-2014
ESTATE OF GOVER MATTHEW R
?9N INIOU 9 8 DATE OF DEATH 11-27-2012
FILE NUMBER 21 12-1323
C LE, r COUNTY CUMBERLAND
SSN/DC
ANDREVPNARR,'GOVER.. i ACN 13166393
142CWW-F0R-,n•;WAY APPEAL BY DATE:01-02-2015
CAMP HILL PA 17011-3919 (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 —11' 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: 11-03-2014
ESTATE OF:GOVER MATTHEW R DATE OF DEATH:11-27-2012 COUNTY:CUMBERLAND
FILE NO. : 21 12-1323 S.S/D.C. NO. : ACN: 13166393
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: FULTON BANK NA ACCOUNT NO. : 930-0223144
TYPE OF ACCOUNT: ( )SAVINGS ( ) CHECKING ( X)TRUST ( )TIME CERTIFICATE
DATE ESTABLISHED 11-17-2011
Account Balance 2,987. 11 NOTE: TO ENSURE PROPER CREDIT TO
Percent Taxable X 1 .000 YOUR ACCOUNT, SUBMIT THE
Amount Subject to Tax 2,987.11 UPPER PORTION OF THIS NOTICE
Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE
Taxable Amount 2,987. 11 REGISTER OF WILLS AT THE
Tax Rate Y .045 ABOVE ADDRESS. MAKE CHECK
Tax Due 134.42 OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
INTEREST IS CHARGED THROUGH 11-11-2014 TOTAL TAX PAYMENT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 134.42
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 4.86
TOTAL DUE 139.28
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.