HomeMy WebLinkAbout06-11-07 (2)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
RECORD ADJUSTMENT
JOINTLY HELD OR TRUST ASSETS
.
BUREAU OF I~~AL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
"1
1 J 1 I
~ L...J
fii
SUSAN M APPLEBY
4715 SEARS RUN DR
MECHANICSBURG PA 17050
CUT ALONG THIS LINE
REV-1604 EX AFP (03-05)
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
05-31-2007
MOORE
09-27-2006
21 06-1152
CUMBERLAND
100-12-8532
06156612
CARRIE
M
Amount Remitted
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 05-31-2007
ESTATE OF MOORE
CARRIE
CUMBERLAND
M DATE OF DEATH 09-27-2006
FILE NO. 21 06-1152
ADJUSTMENT BASED ON:
COUNTY
S.S/D.C. NO. 100-12-8532
ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: AMERICHOICE FCU
ACN
06156612
ACCOUNT NO.
35109
TYPE OF ACCOUNT: (X) SAVINGS () CHECKING () TRUST () TIME CERTIFICATE
DATE ESTABLISHED 05-21-2003
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 (-)
02-16-2007 CD007819 .00 109.41
TOTAL TAX CREDIT 109.41
BALANCE OF TAX DUE 109.41CR
INTEREST AND PEN. .00
TOTAL DUE 'no '-'rog
* 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" (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
DECEDENrS NAME FILE NUMBER
Carrie M. Moore 2106-1152
REVIEWED BY ACN
Eunice Baker 06156612
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