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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIV~~n OfR!;F OF IIOTICE OF INHERITAllCE TAX
IIIERITAHCE TAlC DIVISIlIIl~)::;",': . '.' - APPRAISEHENT, ALLOIIAllCE OR DISALLOIIAllCE
PO lOX 28...1 ' . OF DEDUCTIONS, AND ASSESSKENT OF TAX ON
HARRI...... 'A 17128-...1 " JOINTLY HELD OR TRUST ASSETS
'*
AEV-l548 EX AFP (03-D5)
_n.'1
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN'DC
ACN
05-0Z-Z005
SMITH
OZ-Z7-Z00'l
..!\- ~'5- '\5\0
CUMBERLAND
ZOl-18-1833
O'llZ089'1
_t R_l tteel
MOISELLE
P
,'-') r" i'.. 09
' n ~ ;L ~ )
('- '
KIMBERLE~'C FRANKLIN
Z06 E BURD ST
SHIPPENSBURG PA 17Z57-1'10Z
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
1"'-~'1r"Ir~Jr1rG~~'....................................................................................
NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE DR DISALLOWANCE OF
DEDUCTIONS. AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 05-0Z-ZP05
ESTATE OF SMITH
MOl SELLE P DATE OF DEATH OZ-Z7-Z00'l
COUNTY
CUMBERLAND
FILE NO. S.S/D.C. NO. ZOl-18-1833
TAX RETURN WAS. (X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
O'llZ089'1
FINANCIAL INSTITUTION. CITIZENS BANK OF PA
ACCOUNT NO.
610079'1687
TYPE OF ACCOUNT. () SAVINGS (lO CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 03-Z9-1980
Account Balanca
Percent Taxeble X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
637.07
0.500
318.5'1
.00
318.5'1
.'15
1'1.33
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
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 05-10-Z005 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 1'1.33
REVERSE SIDE OF THIS FORM INTER!ST AND PEN. .31
TOTAL DUE 1'1.6'1
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
I IF TOTAL IlUE IS LESS THAN tl, 110 PAYHENT IS REIlUIRED.
IF TOTAL IlUE IS REFLECTED AS A "CIIEDIT" I CRI, YOU KAY BE IlUE A REFIHI.
SEE REVERSE SIDE OF THIS FORK FOR DlSTRUCTIONS. I
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