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pennsylvania
BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
PO BOX 280601 �+ -.,i, ^,� ��..,,n OF DEDUCTIONS, AND ASSESSMENT OF TAX ON
REV-1548 EX AFP (11-14)
HARRISBURG PA 1712R-E.Gf)R[)E D LI F Fi C E OF JOINTLY HELD OR TRUST ASSETS
REGIS)TF- ^F WILLS
DATE 02-16-2015
ter r� ESTATE OF DLUZESKI BENJAMIN
?015 j EU 17
FM
1 15 DATE OF DEATH 08-27-2012
FILE NUMBER 21 14-0297
COUNTY CUMBERLAND
CLEI ', OF SSN/DC
DOLORES QPDDLi1-ZESKJIu— ACN 14113601
6038 WI I,AI-DLR ;, APPEAL BY DATE:04-17-2015
MECHANI $t1k��"' PA 1705006851 (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 H
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: 02-16-2015
ESTATE OF:DLUZESKI BENJAMIN DATE OF DEATH:08-27-2012 COUNTY:CUMBERLAND
FILE NO. : 21 14-0297 S.S/D.C. NO. : 197-60-7789 ACN: 14113601
TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: WELLS FARGO ACCOUNT NO. : 000008176102336
TYPE OF ACCOUNT: C )SAVINGS ( X) CHECKING ( )TRUST ( )TIME CERTIFICATE
DATE ESTABLISHED 06-29-2011
Account Balance 1,624.23 NOTE: TO ENSURE PROPER CREDIT TO
Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE
Amount Subject to Tax 812. 12 UPPER PORTION OF THIS NOTICE
Debts and Deductions .00 WITH YOUR TAX PAYMENT TO THE
Taxable Amount 812. 12 REGISTER OF WILLS AT THE
Tax Rate x .15 ABOVE ADDRESS. MAKE CHECK
Tax Due 121 .82 OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID
03-28-2014 CDO18958 .00 121.82
02-09-2015 SBADJUST .00 3.05
TOTAL TAX PAYMENT 121 .82
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. �J