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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
~_INHERITANCE TAX
~rrrr ;RECORD ADJUSTMENT
;:j.brtfTLY HELD OR TRUST ASSETS
I ~ : '. ,
~
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 2B0601
HARRISBURG PA 1712B-0601
2001 JUN 25 Pl~ 3: 51
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JUNE A PECUKONvn I,A]\ ~ \.JY';::"'I",,
610 HILDA CT CU~fr'-~'" , " ')1'\
MECHANICSBURG PA 17055
CUT ALONG THIS LINE
REV-1604 EX AFP (03-05)
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
06-14-2007
MACDONALD
09-04-2005
21 06-0011
CUMBERLAND
216-01-1884
05157510
HELEN
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 06-14-2007
ESTATE OF MACDONALD
HELEN
M DATE OF DEATH 09-04-2005
CUMBERLAND
FILE NO.
21 06-0011
COUNTY
ADJUSTMENT BASED ON:
S.S/D.C. NO. 216-01-1884
ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MEMBERS 1ST FCU
ACN
05157510
ACCOUNT NO.
228600-05
TYPE OF ACCOUNT: (X) SAVINGS () CHECKING () TRUST () TIME CERTIFICATE
DATE ESTABLISHED 04-05-2003
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 (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00 ~l
TOTAL DUE DO (
* 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,)
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
RECORD ADJUSTMENT
JOINTLY HELD OR TRUST ASSETS
REV-161l4 EX AFP (03-05)
JUNE A PECUKONIS
610 HILDA CT
MECHANICSBURG PA 17055
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
06-14-2007
MACDONALD
09-04-2005
21 06-0011
CUMBERLAND
216-01-1884
05157511
HELEN
M
Amount Remitted
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 06-14-2007
ESTATE OF MACDONALD
HELEN
M DATE OF DEATH 09-04-2005
COUNTY
CUMBERLAND
FILE NO.
21 06-0011
S.S/D.C. NO. 216-01-1884
ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
ACN
05157511
ADJUSTMENT BASED ON:
FINANCIAL INSTITUTION: MEMBERS 1ST FCU
ACCOUNT NO.
228600-11
TYPE OF ACCOUNT: () SAVINGS (X) CHECKING () TRUST () TIME CERTIFICATE
DATE ESTABLISHED 04-05-2003
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
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
DATE
RECEIPT
NUMBER
DISCOUNT (+)
INTEREST/PEN PAID (-)
AMOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
* IF PAID AFTER THIS DATE. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1. NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR].
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.]
REV-1470 EX (6-88)
'* INHERIT ANCE TAX
EXPLANATION
COMMONWEALTH OF PENNSYL V AN IA
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
PO Box. 280601
HARRISBURG PA 17128-0601
DECEDENT'S NAME FILE NUMBER
Helen M. MacDonald 2106-0011
REVIEWED BY ACN
Jacquelene Miller 05157510
05157511
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
This account has been adjusted to zero. The account was reported on the probate return.
ROW
Paqe 1