HomeMy WebLinkAbout10-30-06
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
,~~lNHERITANCE TAX
CrI'('Dr"!~T" ()l-I'tEt.ORD ADJUSTMENT
-:':";;JO~NTLV' ,HELD OR TRUST ASSETS
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
2006 OCT 30 PH 3: 32
SAMUEL W FISHER
5282 STRATHMORE DR
MECHANICSBURG PA
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17050
CUT ALONG THIS LINE
REV-1604 EX AFP (03-05)
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSNI'DC
ACN
10-19-2006
FISHER
02-05-2005
70 0341816 /);
CUMBERLAND
207-07-9857
05136845
Allount Relli tted
MARY
.'5-07V2-
J
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
--+ RETAIN LOWER PORTION FOR YOUR RECORDS
+-
------------------------------------------------------------------------------------------------------------------------------------------------------------------
REV-1604 EX AFP (03-05)
-- INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS __
DATE 10-19-2006
ESTATE OF FISHER
MARY
J DATE OF DEATH 02-05-2005
FILE NO. 70 0341816
ADJUSTMENT BASED ON:
COUNTY
CUMBERLAND
S.S/D.C. NO. 207-07-9857
ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MID PENN BANK
ACN
05136845
ACCOUNT NO. 309001192
TYPE OF ACCOUNT: () SAVINGS () CHECKING () TRUST (X) TIME CERTIFICATE
DATE ESTABLISHED 05-01-2000
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
.00
0.500
.00
.00
.00
.45
.00
TAX CREDITS:
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 ADDRESS SHOWN ABOVE.
MAKE CHECK OR MONEY ORDER PAYABLE
TO: "REGISTER OF WILLS, AGENT."
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE 00
· IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. Ob\
( IF TOTAL DUE IS LESS THAN $I, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A ..CREDIT" (CR),
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) I
-'
. .
REV-1470 EX (6-88)
INHERITANCE TAX
EXPLANATION
OF CHANGES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO Box 280601
HARRISBURG PA 17128-0601
DECEDENrs NAME
Mary Fisher
FILE NUMBER
REVIEWED BY
Emerson Luciano
ACN
ITEM
SCHEDULE NO.
EXPLANATION OF CHANGES
The above referenced ACN has been reduced to zero, as this account
was reported in error and will be deleted.
700341816
05136845
PaQe 1