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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUI\L TA)(ES\
INHERITANCE TAX DIVISION
PO 1l0X 280601
HARRISBURG PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS, AND ASSESSMENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-1548 EX AFP (06-05)
r
: n2
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
11-14-2005
MASON
10-06-2004
21 05-0180
CUMBERLAND
072-48-1967
04146313
APPEAL DATE: 01-13-2006
(See reverse side under Objections)
Amount Remitted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
STACEY
SARA A MASON
135 WINSTON DR
MECHANICSBURG
PA 17055
TO:
CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS +--
REV=is4S-EX-AFP-roi=osi--------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 11-14-2005
ESTATE OF MASON
STACEY
DATE OF DEATH 10-06-2004
COUNTY
CUMBERLAND
FILE NO. 21 05-0180
TAX RETURN WAS:
S.S/D.C. NO. 072-48-1967
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
04146313
FINANCIAL INSTITUTION: FULTON BANK
ACCOUNT NO.
022-0172600
TYPE OF ACCOUNT: ()SAVINGS () CHECKING (>TRUST IX >TIME CERTIFICATE
DATE ESTABLISHED 03-09-2002
X
1.263.57
0.166
210.60
.00
210.60
.15
31. 59
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."
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
x
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
02-23-2005 ..... CD004983 .00 31.59
TOTAL TAX CREDIT 31. 59
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 PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRJ, YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
PI.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDU~-;IAX~ f"\ n~f!r[ rC NOTICE OF INHERITANCE TAX
INHERITANCE TAX DIVISIDN ' ,I' . J:[, '_ ' _', .'APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
PO BOX 280601' . ,OF DEDUCTIONS, AND ASSESSMENT OF TAX ON
HARRIS8URG PA 17128-0601 - . JOINTLY HELD OR TRUST ASSETS
REV-1548 EX AFP (06-05)
CHR I STOPH_S(~MASON
135 WINSTON DR
MECHANICSBURG
;-:
DATE 11-14-2005
ESTATE OF MASON STACEY
DATE OF DEATH 10-06-2004
FILE NUMBER 21 05-0180
COUNTY CUMBERLAND
SSN/DC 072-48-1967
ACN 04146312
APPEAL DATE: 01-13-2006
(See reverse side under Objections)
Amount Remitted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
')iF']
tt;'j't
Il C i:: n?
I ;. ~, 1 l: . '!""- iL.-
PA 17055
CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS +--
REV=is4S-EX-AFP-C03=Osi--------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 11-14-2005
ESTATE OF MASON
STACEY
DATE OF DEATH 10-06-2004
COUNTY
CUMBERLAND
FILE NO. 21 05-0180
TAX RETURN WAS:
S.S/D.C. NO. 072-48-1967
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
04146312
FINANCIAL INSTITUTION: FULTON BANK
ACCOUNT NO.
022-0172600
TYPE OF ACCOUNT: ()SAVINGS () CHECKING (HRUST Q( HIME CERTIFICATE
DATE ESTABLISHED 03-09-2002
X
1,263.57
0.166
210.60
.00
210.60
.15
31. 59
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."
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
X
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
02-23-2005 ..... CD004982 .00 31.59
TOTAL TAX CREDIT 31. 59
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 PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRJ, YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J
Rt.