HomeMy WebLinkAbout11-09-07
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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 2B"01
HARRISBURG. PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
~ I~KERITANCE TAX
, RECORD ADJUSTMENT
BENEFICIARY FORM ASSETS
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ETTERS PA 17319-0000
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REV-U04A EX AFP nl-04)
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
11-06-2007
HENNE
05-03-2007
21 07-0508
CUMBERLAND
201-05-9186
07500613
RICHARD
H
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-1604A EX AFP (01-03)
-- INHERITANCE TAX RECORD ADJUSTMENT BENEFICIARY FORM ASSETS __
DATE 11-06-2007
ESTATE OF HENNE
RICHARD
H DATE OF DEATH 05-03-2007
CUMBERLAND
FILE NO. 21 07-0508
ADJUSTMENT BASED ON:
COUNTY
S.S/D.C. NO. 201-05-9186
ADMINISTRATIVE CORRECTION
BENEFICIARY FORM ASSETS
NAME OF SECURITY:
VANGUARD GROUP
TYPE OF ACCOUNT:
( ) SECURITIES () SEC ACCT
DOD Valuation
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
.00
0.000
.00
.00
.00
.45
.00
TAX CREDITS:
PAYMENT
DATE
08-28-2007
RECEIPT
NUMBER
CD008607
DISCOUNT (+)
INTEREST/PEN PAID (-)
.00
AMOUNT PAID
8,823.66
ACN
07500613
ACCOUNT NO.
88009766707
( ) STOCK
( ) BOND
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."
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
II 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.) lb
8,823.66
8,823.66CR
.00
,. . )..
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
Richard H Henne 2107 -0508
REVIEWED BY ACN
Rick Olson 07500613
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
The above referenced ACN has been reduced to zero as this account was reported on the
probate return.
PaQe 1