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COMMONWEALTH OF PEMNSYLVANIA
DEPARTMENT OF REVENUE
*
BUREAU OF INDIV~~~cr~$
INHERITANCE TAX DIVIS~
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HARRISBURG PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISENENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS, AND ASSESSNENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-1548 EX AFP (03-05)
OR:';
JEANETT~UJof -NADOLNY -. ,.
164 LEANN CT
ENOLA PA 17025
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
06-07-2005
CONSAGRA
09-18-2004
21 05-0251
CUMBERLAND
159-24-7363
05105356
Dount R_l tt.d
JOHN
A
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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 ~
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NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 06-07-2005
ESTATE OF CONSAGRA
JOHN
A DATE OF DEATH 09-18-2004
COUNTY
CUMBERLAND
FILE NO. 21 05-0251
TAX RETURN WAS:
S.S/D.C. NO. 159-24-7363
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
05105356
FINANCIAL INSTITUTION: MEMBERS 1ST FCU
ACCOUNT NO.
100854-11
TYPE OF ACCOUNT: () SAVINGS (XI CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 03-03-1989
Account Balance
Percent Taxable X
Amount Subject to Tex
Debts end Deductions
Taxable Amount
Tax Rate X
Tax Due
2,026.34
0.166
337.73
.00
337.73
.45
15.20
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 (-)
03-10-2005 CD005077 .00 15.20
TOTAL TAX CREDIT 15.20
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 LESS THAN $1, NO PAYNENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" I CRI, YOU NAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS. I
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