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HomeMy WebLinkAbout02-23-15 BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX �` pennsyLvania DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION _ APPRAISEMENT, ALLOWANCE OR DISALLOWANCE PO BOX 2806 1 . q R`�'t ~f n REV-1548 EX AFP (11-14) p E`�` , , i 1 v E O F~ OF DEDUCTIONS, AND ASSESSMENT OF TAX ON HARRISBURG �A 1 1 8-0601 REGI ;J'LLJ JOINTLY HELD OR TRUST ASSETS DATE 02-24-2015 HIS IFE0U 23 Pik 13 .:2 ESTATE OF BOURINSKI LEONARD J _� ! t DATE OF DEATH 02-27-2014 FILE NUMBER 21 14-0204 (; i F COUNTY CUMBERLAND ALEXI9"bF`P11r 11 : SSN/DC BOUR,INSKI ACN 14116206 117( UV9,[t;NG' SPRINGS, RD APPEAL BY DATE:04-25-2015 MECHANICSBURG PA 17055-9733 (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-- 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: 02-24-2015 ESTATE OF: BOURINSKI LEONARD J DATE OF DEATH:02-27-2014 COUNTY:CUMBERLAND FILE NO. : 21 14-0204 S.S/D.C. NO. : ACN: 14116206 TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. : 212584-05 TYPE OF ACCOUNT: ( )SAVINGS C ) CHECKING ( ))TRUST ( )TIME CERTIFICATE DATE ESTABLISHED 12-29-2001 Account Balance 182,350.66 NOTE: TO ENSURE PROPER CREDIT TO Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 91, 175.33 UPPER PORTION OF THIS NOTICE Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 91, 175.33 REGISTER OF WILLS AT THE Tax Rate x .045 ABOVE ADDRESS. MAKE CHECK Tax Due 4,102.89 OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) INTEREST IS CHARGED THROUGH 03-04-2015 TOTAL TAX PAYMENT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 4,102.89 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 32.63 TOTAL DUE 4,135.52 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. \V\J BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX PennsylvaniaDEPARTMENT OF REVENUE INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE _ PO BOX 280601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP (11-14) HARRISBURG D v 17 F!"",F OF JOINTLY HELD OR TRUST ASSETS r � r- `►+r PLEG1, ._ :- ,I:-L.S DATE 02-24-2015 HIS ESTATE OF BOURINSKI LEONARD J HIS IFEB 23 Pf(1 1 2 332 DATE OF DEATH 02-27-2014 FILE NUMBER 21 14-0204 _ COUNTY CUMBERLAND CLFi. 0r SSN/DC VANEBOU,Rd-NSKI ACN 14116207 f t � { `; JG $PR-1NGS,._RD 117�{{ I APPEAL BY DATE:04-25-2015 MEL`H`71 -1 PA 17055-9733 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT 1'0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE ---> RETAIN LOWER PORTION FOR YOUR RECORDS (— 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: 02-24-2015 ESTATE OF: BOURINSKI LEONARD J DATE OF DEATH:02-27-2014 COUNTY:CUMBERLAND FILE NO. : 21 14-0204 S.S/D.C. NO. : ACN: 14116207 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS IST FCU ACCOUNT NO. : 212584-05 TYPE OF ACCOUNT: C )SAVINGS C ) CHECKING ( X)TRUST ( )TIME CERTIFICATE DATE ESTABLISHED 12-29-2001 Account Balance 182,350.66 NOTE: TO ENSURE PROPER CREDIT TO Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 91 ,175.33 UPPER PORTION OF THIS NOTICE Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 91, 175.33 REGISTER OF WILLS AT THE Tax Rate x .045 ABOVE ADDRESS. MAKE CHECK Tax Due 4,102.89 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 03-04-2015 TOTAL TAX PAYMENT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 4,102.89 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 32.63 TOTAL DUE 4,135.52 * 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. C ` ` pennsylvania BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE —_ PO BOX 280601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP (11-14) HARRISBURG PA 17128-0601 R E C O- E r YJ,O tJTL�IYFHELD OR TRUST ASSETS RFVl, DATE 02-24-2015 LS ESTATE OF BOURINSKI LEONARD J DATE OF DEATH 02-27-2014 ?015 FEB 23 PI-11 12 32 FILE NUMBER 21 14-0204 COUNTY CUMBERLAND C� SSN/DC ALEXIS BOURINn�S1KI ACN 14116208 1171 BOILING SPRINtVk-1b'-;;r` 0 'f!— APPEAL BY DATE:04-25-2015 MECHANICSBURG C10�:E17�55=9.733 (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-- 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: 02-24-2015 ESTATE OF: BOURINSKI LEONARD J DATE OF DEATH:02-27-2014 COUNTY:CUMBERLAND FILE NO. : 21 14-0204 S.S/D.C. NO. : ACN: 14116208 TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. : 7830-11 TYPE OF ACCOUNT: C )SAVINGS C ) CHECKING ( X)TRUST C )TIME CERTIFICATE DATE ESTABLISHED 02-12-1981 Account Balance 39,274.25 NOTE: TO ENSURE PROPER CREDIT TO Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 19,637.13 UPPER PORTION OF THIS NOTICE Debts and Deductions .00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 19,637. 13 REGISTER OF WILLS AT THE Tax Rate Y .045 ABOVE ADDRESS. MAKE CHECK Tax Due 883.67 OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT C+) DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID INTEREST IS CHARGED THROUGH 03-04-2015 TOTAL TAX PAYMENT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 883.67 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 7.03 TOTAL DUE 890.70 IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. �\ \ SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. �) _ pennsytvania BUREAU OF INDI �11TA%7EnLXE' C i FiCE O NOTICE OF INHERITANCE TAX DEPARTMENT OF REVENUE INHERITANCE TAX D SIS O APPRAISEMENT, ALLOWANCE OR DISALLOWANCE PO BOX 280601 (�� REV-1548 EX AFP (11-14) HARRISBURG PA 1712 -0-661 �` UI OF DEDUCTIONS, AND ASSESSMENT OF TAX ON p JOINTLY HELD OR TRUST ASSETS �5 i EU L� P�p i 1 �� �2 DATE 02-24-2015 1,15 ESTATE OF BOURINSKI LEONARD J � f ,` OF FILE OF DEATH 02-27-2014 FILE NUMBER 21 14-0204 0RPHA►i',' '".'_: COUNTY CUMBERLAND VAN ESSACUOURINSKI SSN/DC ACN 14116209 1171 BOILING SPRINGS RD APPEAL BY DATE:04-25-2015 MECHANICSBURG PA 17055-9733 (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 REV-1548 EX AFP (11-14)-------------------------------------------------------------------- NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 02-24-2015 ESTATE OF: BOURINSKI LEONARD J DATE OF DEATH:02-27-2014 COUNTY:CUMBERLAND FILE NO. : 21 14-0204 S.S/D.C. NO. : ACN: 14116209 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. : 7830-11 TYPE OF ACCOUNT: ( )SAVINGS ( ) CHECKING CX)TRUST ( )TIME CERTIFICATE DATE ESTABLISHED 02-12-1981 Account Balance 39,274.25 NOTE: TO ENSURE PROPER CREDIT TO Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 19,637.13 UPPER PORTION OF THIS NOTICE Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 19,637. 13 REGISTER OF WILLS AT THE Tax Rate Y .045 ABOVE ADDRESS. MAKE CHECK Tax Due 883.67 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 03-04-2015 TOTAL TAX PAYMENT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 883.67 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 7.03 TOTAL DUE 890.70 x 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. �n\ SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. W [[�� ((''�� C' +C 17 0 F NOTICE OF INHERITANCE TAX lipennsyLvania BUREAU OF INDI'VIII�L'`TARE _INHERITANCE TAX DIp�SIQN''-- +j ' t APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE PO BOX 280601 `C` f ` ' �" i L``)OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP (11-14) HARRISBURG PA 17128-0601 FEBJOINTLY HELD OR TRUST ASSETS ?_015 B 23 PM 12 2 DATE 02-24-2015 ESTATE OF BOURINSKI LEONARD J G L r;' DATE OF DEATH 02-27-2014 0 R PHAN C`. =- FILE NUMBER 21 14-0204 COUNTY CUMBERLAND CUMCIE- #: SSN/DC ALEXIS BOURINSKI ACN 14116210 1171 BOILING SPRINGS RD APPEAL BY DATE:04-25-2015 MECHANICSBURG PA 17055-9733 (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 E'er 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: 02-24-2015 ESTATE OF: BOURINSKI LEONARD J DATE OF DEATH:02-27-2014 COUNTY:CUMBERLAND FILE NO. : 21 14-0204 S.S/D.C. NO. : ACN: 14116210 TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS IST FCU ACCOUNT NO. : 7830-05 TYPE OF ACCOUNT: C )SAVINGS C ) CHECKING ( X)TRUST ( )TIME CERTIFICATE DATE ESTABLISHED 07-09-2002 Account Balance 23,306. 16 NOTE: TO ENSURE PROPER CREDIT TO Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 11,653.08 UPPER PORTION OF THIS NOTICE Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 11,653.08 REGISTER OF WILLS AT THE Tax Rate x .045 ABOVE ADDRESS. MAKE CHECK Tax Due 524.39 OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT C+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID INTEREST IS CHARGED THROUGH 03-04-2015 TOTAL TAX PAYMENT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 524.39 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 4. 17 TOTAL DUE 528.56 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. NOTICE OF INHERITANCE TAX • u " `nnsytvania BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE PO BOX 280601 i Coq Cf FESE 0F0F DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP (11-14) HARRISBURG PA 171 060 JOINTLY HELD OR TRUST ASSETS DATE 02-24-2015 � �� �� y �� ESTATE OF BOURINSKI LEONARD J FEB DATE OF DEATH 02-27-2014 FILE NUMBER 21 14-0204 CL1-_t,`j OF COUNTY CUMBERLAND , ,,,, , ,,:-,� SSN/DC VANESSA d � 0'URINSKI ACN 14116211 1171 BQG(L $,PkiNGS--RD �'.'�� APPEAL BY DATE:04-25-2015 MECHANICSBURG PA 17055-9733 (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 <— REV-1548 EX AFP (11-14)-------------------------------------------------------------------- NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 02-24-2015 ESTATE OF: BOURINSKI LEONARD J DATE OF DEATH:02-27-2014 COUNTY:CUMBERLAND FILE NO. : 21 14-0204 S.S/D.C. NO. : ACN: 14116211 TAX RETURN WAS: CX) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. : 7830-05 TYPE OF ACCOUNT: C )SAVINGS C ) CHECKING ( ))TRUST ( )TIME CERTIFICATE DATE ESTABLISHED 07-09-2002 Account Balance 23,306. 16 NOTE: TO ENSURE PROPER CREDIT TO Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 11,653.08 UPPER PORTION OF THIS NOTICE Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 11,653.08 REGISTER OF WILLS AT THE Tax Rate x .045 ABOVE ADDRESS. MAKE CHECK Tax Due 524.39 OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID INTEREST IS CHARGED THROUGH 03-04-2015 TOTAL TAX PAYMENT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 524.39 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 4. 17 TOTAL DUE 528.56 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. �1 BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX PennsylvaniaDEPARTMENT OF REVENUE INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE PO BOX 280601 r((� n^�(- n r 'r OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP (11-14) HARRISBURG PAP1❑'P32h�0r' E D C'F! I C C Q JOINTLY HELD OR TRUST ASSETS BORISKI MIS FEBDATE 02-24-2015 ESTAMIS B 23 P1 � 12 �2 DATETOFODEATH 02-27-2014 LEONARD J FILE NUMBER 21 14-0204 COUNTY CUMBERLAND SSN/DC ALEXISOft�' ;;,,$6,l�RI;NSKIT ACN 14116212 1171C�q,ft f-NG SPRINGS RD APPEAL BY DATE:04-25-2015 MECHANICSBURG PA 17055-9733 - (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-- REV-1548 EX AFP (11-14)-------------------------------------------------------------------- NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 02-24-2015 ESTATE OF: BOURINSKI LEONARD J DATE OF DEATH:02-27-2014 COUNTY:CUMBERLAND FILE NO. : 21 14-0204 S.S/D.C. NO. : ACN: 14116212 TAX RETURN WAS: CX) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS IST FCU ACCOUNT NO. : 190278-05 TYPE OF ACCOUNT: ( X)SAVINGS ( ) CHECKING ( )TRUST C )TIME CERTIFICATE DATE ESTABLISHED 12-24-2009 Account Balance 498.82 NOTE: TO ENSURE PROPER CREDIT TO Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 249.41 UPPER PORTION OF THIS NOTICE Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 249.41 REGISTER OF WILLS AT THE Tax Rate x .045 ABOVE ADDRESS. MAKE CHECK Tax Due 11 .22 OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID INTEREST IS CHARGED THROUGH 03-04-2015 TOTAL TAX PAYMENT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 11.22 REVERSE SIDE OF THIS FORM INTEREST AND PEN. .09 TOTAL DUE 11 .31 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. BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX ��� DEPARTMENT OF REVENUE Pennsylvania INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE — PO BOX 280601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP (11-14) HARRISBURG PA 1710 P,'-� O r�'E O`i OF JOINTLY HELD OR TRUST ASSETS R } V!IL-I' DATE 02-24-2015 ESTATE OF BOURINSKI LEONARD J ?015 FEB L3 FIT11 1.3 12, DATE OF DEATH 02-27-2014 FILE NUMBER 21 14-0204 COUNTY CUMBERLAND CLE 0 t- SSN/DC ALEXISO P,p RINSICI , ` ACN 14116213 1171 BO('��4G SPRINGS. RD APPEAL BY DATE:04-25-2015 MECHANICSB'U-kG t PA 17055-'9733 (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 <'-- 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: 02-24-2015 ESTATE OF: BOURINSKI LEONARD J DATE OF DEATH:02-2.7-2014 COUNTY:CUMBERLAND FILE NO. : 21 14-0204 S.S/D.C. NO. : ACN: 14116213 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS IST FCU ACCOUNT NO. : 190278-40 TYPE OF ACCOUNT: ( )SAVINGS C ) CHECKING C )TRUST ( X)TIME CERTIFICATE DATE ESTABLISHED 08-10-2012 Account Balance 11,999.65 NOTE: TO ENSURE PROPER CREDIT TO Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 5,999.83 UPPER PORTION OF THIS NOTICE Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 5,999.83 REGISTER OF WILLS AT THE Tax Rate x .045 ABOVE ADDRESS. MAKE CHECK Tax Due 269.99 OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) INTEREST IS CHARGED THROUGH 03-04-2015 TOTAL TAX PAYMENT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 269.99 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 2. 15 TOTAL DUE 272. 14 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.