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BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
PO BOX 280601gI(+(}p(�E� OFFICE �F OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP (11-14)
HARRISBURG PA 5'��+8��1663RE JOINTLY HELD OR TRUST ASSETS
REGISTER OF WILLS
DATE 12-22-2014
_ { ESTATE OF GOOD DAVID R
?glq 0EC 19 9 I .11 20 DATE OF DEATH 02-04-2014
FILE NUMBER 21 14-1119
CLERK OF COUNTY CUMBERLAND
SSN/DC
KAREN ORPHAMO URT ACN 14153992
430 eUV911 A �? r P ji APPEAL BY DATE:02-20-2015
MECHANICSBURG PA 17050-2573 (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 4--
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REV-1548 EX AFP C11-14)
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE: 12-22-2014'
ESTATE OF:GOOD DAVID R DATE OF DEATH:02-04-2014 COUNTY:CUMBERLAND
FILE NO. : 21 14-1119 S.S/D.C. NO. : ACN: 14153992
TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: SANTANDER BANK ACCOUNT NO. : 0841199965
TYPE OF ACCOUNT: C )SAVINGS ( X) CHECKING ( )TRUST ( )TIME CERTIFICATE
DATE ESTABLISHED 06-19-2009
Account Balance 9,418.60 NOTE: TO ENSURE PROPER CREDIT TO
Percent Taxable X 0. 166 YOUR ACCOUNT, SUBMIT THE
Amount Subject to Tax 1 ,569.80 UPPER PORTION OF THIS NOTICE
Debts and Deductions •00 WITH YOUR TAX PAYMENT TO THE
Taxable Amount 1 ,569.80 REGISTER OF WILLS AT THE
Tax Rate Y .045 ABOVE ADDRESS. MAKE CHECK
Tax Due 70.64 OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT C+)
AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
11-22-2014 CDO19962 .00 70.64
12-15-2014 SBADJUST .00 . 10
TOTAL TAX PAYMENT 70.64
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.