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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 2B0601
HARRISBURG PA 1712B-0601
NOTICE OF INHERITANCE TAX
APPRAISE"ENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-154B EX AFP (06-05)
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DATE 05-01-2006
ESTATE OF NIELSEN PAIGE A
DATE OF DEATH 01-22-2005
FILE NUMBER {lJ~()b - 03$;2..
COUNTY CUMBERLAND
SSN/DC 218-48-8505
ACN 05120620
APPEAL DATE: 06-30-2006
(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
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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 05-01-2006
ESTATE OF NIELSEN
PAIGE
A DATE OF DEATH 01-22-2005
COUNTY
CUMBERLAND
FILE NO. S.S/D.C. NO. 218-48-8505
TAX RETURN WAS: (X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
05120620
FINANCIAL INSTITUTION: MEMBERS 1ST FCU
ACCOUNT NO.
223978-11
TYPE OF ACCOUNT: ()SAVINGS ~) CHECKING ()TRUST ()TIME CERTIFICATE
DATE ESTABLISHED 11-08-2002
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
2,166.43
0.500
1,083.22
.00
1,083.22
.45
48.74
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 05-09-2006 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 48.74
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 1.67
TOTAL DUE 50.41
· IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
( IF TOTAL DUE IS LESS THAN $1, NO PAY"ENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. )
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