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BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION -ARrA41SErNT; IPO
ALLOWANCE OR DISALLOWANCE BOX 280601 RECORDED 01-04F V&Q ErNT, AND ASSESSMENT OF TAX ON REV-1548 EX AFP (11-14)
HARRISBURG PA 17128-0601 REGIST�71 'IlLf53NTLY HELD OR TRUST ASSETS
DATE 09-07-2015
7015 SEP 8 PM 12 92 ESTATE OF ALFERY LOUIS J
DATE OF DEATH 03-14-2015
FILE NUMBER 21 15-0867
COUNTY CUMBERLAND
49 W SIMPSON !CTUBCR ' " .. . APPEAL BY DATE:11-06-2015
MECHANICSBURG PA 17055-6323 (See reverse side under Objections)
Amount Remitted F
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
I COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS
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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: 09-07-2015
ESTATE OF:ALFERY LOUIS J DATE OF DEATH:03-14-2015 COUNTY:CUMBERLAND
FILE NO. : 21 15-0867 S.S/D.C. NO. : ACN: 15138792
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION:-PSECU ACCOUNT NO. : 0194280841S4
TYPE OF ACCOUNT: ( )SAVINGS ( )0 CHECKING C )TRUST C )TIME CERTIFICATE
DATE ESTABLISHED 08-15-1976
Account Balance 3,413.82 NOTE: TO ENSURE PROPER CREDIT TO
Percent Taxable X 0.166 YOUR ACCOUNT, SUBMIT THE
Amount Subject to Tax 568.98 UPPER PORTION OF THIS NOTICE
Debts and Deductions 568.98 WITH YOUR TAX PAYMENT TO THE
Taxable Amount .00 REGISTER OF WILLS AT THE
Tax Rate y .045 ABOVE ADDRESS. MAKE CHECK
Tax Due .00 OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)
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" (CR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.