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REGIS i LAR' s WILLS
DATE 04-27-2015
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APR 29 PM 12 16 ESTATE OF NOSS WAYNE E
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APR DATE OF DEATH 12-02-2012
FILE NUMBER 21 12-1344
CLEF," OF COUNTY CUMBERLAND
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ACN 1 1350573505710
G0�9,BSr1GNAL'*'H1LL K APPEAL BY DATE: 06-26-2015
MECHANICSBURG PA 17050-1648 (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
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NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS
AND ASSESSMENT OF TAX ON SECURITY ACCOUNTS HELD IN BENEFICIARY FORM
DATE: 04-27-2015
ESTATE OF: NOSS WAYNE E DATE OF DEATH: 12-02-2012 COUNTY: CUMBERLAND
FILE NO. : 21 12-1344 S.S/D.C. NO. : ACN: 13505710
TAX RETURN WAS: (X) ACCEPTED AS FILED ( )CHANGED
BENEFICIARY FORM OF ASSET INFORMATION
NAME OF SECURITY: FIDELITY INVESTMENTS ACCOUNT NO. : 670146
TYPE OF ASSET: ( ) SECURITIES C X SECURITY ACC C ) STOCK C ) BONDS
DOD Valuation .00 NOTE: TO ENSURE PROPER CREDIT TO
Percent Taxable X 0.200 YOUR ACCOUNT, SUBMIT THE
Amount Subject to Tax .00 UPPER PORTION OF THIS NOTICE
Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE
Taxable Amount .00 REGISTER OF WILLS AT THE
Tax Rate X . 045 ABOVE ADDRESS. MAKE CHECK
Tax Due .00 OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT C+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
TOTAL TAX PAYMENT .00
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" CCR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.