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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'*
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX Za06Dl
HARRISBURG PA 17128.0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE DR DISALLOWANCE
DF DEDUCTIDNS, AND ASSESSMENT DF TAX ON
JOINTLY HELD OR TRUST ASSETS
REY-1548 EX AFP (03-05)
. .""
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DATE
ESTATE OF
DATE OF DEATH
FILE NUIIBER
COUNTY
SSN/DC
ACN
07-04-2005
MCMILLEN
06-29-2004
21 05-0318
CUMBERLAND
177-16-1123
04146544
Alnount R_itt.d
MYRTIS
S
GAIL M BLACK
60 CONWAY ST
CARLISLE PA 17013
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 ...
A~-:r.I'1ri!~~~~GJ:-1nI'....................................................................................
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 07-04-2005
ESTATE OF MCMILLEN
MYRTIS
S DATE OF DEATH 06-29-2004
COUNTY
CUMBERLAND
FILE NO. 21 05-0318
TAX RETURN WAS:
~.S/D.C. NO. 177-16-1123
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
04146544
FINANCIAL INSTITUTION: ORRSTOWN BANK
ACCOUNT NO.
108006372
TYPE OF ACCOUNT: () SAVINGS (lO CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 11-06-2002
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
1.764.32
0.500
882.16
.00
882. 16
.45
39.70
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 (-)
04-05-2005 CD005164 .04- 40.00
TOTAL TAX CREDIT 39.96
BALANCE OF TAX DUE .26CR
INTEREST AND PEN. .00
TOTAL DUE .26CR
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ·
( IF TDTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TDTAL DUE IS REFLECTED AS A "CREDIr' ( CRJ, YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J
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