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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
RECORD ADJUSTMENT
JOINTLY HELD OR TRUST ASSETS
*'
r,~r'('\f,r',T'\ nr-'l"f-
lUREAU OF INDIVIDUAL TAxa ,-I 11.'::'l) \) '\'~I=
INHERITANCE TAX DIVISION 'X-:r~"'i:T;
PO BOX 280&01 . """'J'; I .... .
HARRIS8URG PA 17128-0&01
REV-1&04 EX AFP (03-05)
2001 JUN 29 PH I: 03
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
06-27-2007
HAKE
02-03-2007
21 07-0151
CUMBERLAND
191-18-3999
07113353
ELNORA
E
CLERf\ OF
ORPHAN'S COURT
BOBBETTE ClJta:~s8~i\ .-. . PA
826 ACRI RD
MECHANICSBURG PA 17050
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 06-27-2007
ESTATE OF HAKE
EL NORA
E DATE OF DEATH 02-03-2007
COUNTY
CUMBERLAND
FILE NO. 21 07-0151
ADJUSTMENT BASED ON:
S.S/D.C. NO. 191-18-3999
ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
ACN
07113353
FINANCIAL INSTITUTION: COMMERCE BANK
ACCOUNT NO.
513172536
TYPE OF ACCOUNT: () SAVINGS (X) CHECKING () TRUST () TIME CERTIFICATE
DATE ESTABLISHED 09-08-2005
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
II 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 R OF
REVE SE SIDE
THIS FORM FOR INSTRUCTIONS.)
,
COMMONWEALTH OF PENNSYLVANIA
D~*~~~~ r~~ RE~ENUE
,=.J:aj.tltltl-t ANC€r:T~)(
RiEt.p~DQAD~U$iT,~ENT
JOINTLY HEL~:OR l~UST ASSETS
'*'
.
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 2B0601
HARRISBURG PA 17128-0601
REV-1604 EX AFP (03-05)
BOBBETTE
826 ACRI RD
MECHANICS BURG
LARSON
2007 JUN 29 ,.
ES~ ji30F
CG(~t~~~J.?~~~"~~:TH
06-27-2007
HAKE
02-03-2007
21 07-0151
CUMBERLAND
191-18-3999
07112292
ELNORA E
Amount Remitted
PA 17050-2232
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 06-27-2007
ESTATE OF HAKE
ELNORA
E DATE OF DEATH 02-03-2007
COUNTY
CUMBERLAND
FILE NO. 21 07-0151
ADJUSTMENT BASED ON:
S.S/D.C. NO. 191-18-3999
ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
ACN
07112292
FINANCIAL INSTITUTION: CLEARVIEW FCU
ACCOUNT NO.
10278783
TYPE OF ACCOUNT: (X) SAVINGS () CHECKING () TRUST () TIME CERTIFICATE
DATE ESTABLISHED 07-08-1997
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 ""Db
II 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 2B0601
HARRISBURG PA 1712B-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
PECOP,.D,ED ,O!tl. ."~~fI"ANCE TAX
., -,r, " !'.~ ~c.tJ n ADJUSTMENT
Hb.-'JOitMtL'r.ff I"p OR TRUST ASSETS
*'
REV-1604 EX AFP (03-05)
BOBBETTE
826 ACRI RD
MECHANICSBURG
LARSON
2007 JUN 29 PH I: 04 DATE
ESTATE OF
DATE OF DEATH
CLERK OF FILE NUMBER
ORPHAN'S COURT COUNTY
CUf,!flf-:-r)i",'r,r'.'1,. D.^ SSN/DC
, . . '.', ' t'\ ACN
06-27-2007
HAKE
02-03-2007
21 07-0151
CUMBERLAND
191-18-3999
07112293
EL NORA
E
Amount Remitted
PA 17050-2232
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 06-27-2007
ESTATE OF HAKE
ELNORA
E DATE OF DEATH 02-03-2007
COUNTY
CUMBERLAND
F I L E NO. 21 07- 0 151
ADJUSTMENT BASED ON:
S.S/D.C. NO. 191-18-3999
ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
ACN
07112293
FINANCIAL INSTITUTION: CLEARVIEW FCU
ACCOUNT NO.
10278783
TYPE OF ACCOUNT: () SAVINGS (X) CHECKING () TRUST () TIME CERTIFICATE
DATE ESTABLISHED 07-08-1997
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. OIJ
( 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
DECEDENT'S NAME FILE NUMBER
Elnora E. Hake 2107-0151
REVIEWED BY ACN
Eunice Baker 07113353,07112292,
07112293
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