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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BDX 2BO'01 ,..' ,-,
HARRISBURG PA 17128-0'01
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
RECORD ADJUSTMENT
JOINTLY HELD OR TRUST ASSETS
*
REV-l'04 EX AFP (03-05)
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DATE
2: ::OTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
, ACN
06-01-2007
BRITTEN
02-05-2006
21 06-0145
CUMBERLAND
174-16-3944
06001693
DALE
A
C;LE;'~:<
OR'j 'S'
MICHAEL BRITTEN eu:.;"'" I
3434 CRESTMOOR DRIVE
WOODBURY MN 55125
A.ount Re..itted
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
+-
........-.------..---.---------..--..-...--..-..-..----..--.-.....-..-.--.-.-..-...-.-..-..-
REV-1604 EX AFP (03-05)
.. INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ..
DATE 06-01-2007
ESTATE OF BRITTEN
DALE
A DATE OF DEATH 02-05-2006
COUNTY
CUMBERLAND
FILE NO. 21 06-0145
ADJUSTMENT BASED ON:
S. S/D. C. NO. 174 -16 - 3944
ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
ACN
06001693
FINANCIAL INSTITUTION: US SERIES EE SAVINGS BONDS
ACCOUNT NO.
EE/SERIESBONDS
TYPE OF ACCOUNT: () SAVINGS () CHECKING () TRUST () TIME CERTIFICATE
DATE ESTABLISHED 03-07-1985
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
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."
TAX CREDITS:
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 nn
· IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN U, 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.)
REV.1470 EX (6-88)
* INHERITANCE TAX
EXPLANATION
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
PO Box. 280601
HARRISBURG PA 17128-0601
DECEDENT'S NAME FILE NUMBER
Dale A. Britten 2106-0145
REVIEWED BY ACN
Eunice Baker 06001693
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
The above account has been adjusted to zero. The account was reported on the probate
return.
~
ROW
PaQe 1