HomeMy WebLinkAbout12-10-07 (4)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
1"\"''''''''''1"''- ~NHERITANCE TAX
h:':UJhc.h.:D . ~'"\~DJUSTMENT
R[r~~n~J~'..-:\~~'qt'OR TRUST ASSETS
IL..JI'_"~' J ".-' , "1JL.~.J
*'
. ,- .
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 2B0601
HARRISBURG PA 1712B-0601
20a7 DEe I a Pi1
RUSSELL G BRUNGARD
7013 DORSEY RD
LAYTONSVILLE
CLERK OF
ORPHAN'S COURT
cu/Vpr::p 1.~)r'\ ("\ n.~
I ,u...... ~w 1i <t:..)v(J'i r;,
MD 20882-1220
CUT ALONG THIS LINE
REV-1604 EX AFP (03-05)
DATE
/. 27 ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
11-30-2007
BRUNGARD
12-02-2006
21 06-1147
CUMBERLAND
177-09-8483
07104401
T
FRANCES
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 {03-05J
-- INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS __
DATE 11-30-2007
ESTATE OF BRUNGARD
FRANCES
T DATE OF DEATH 12-02-2006
CUMBERLAND
F I L E NO. 21 06 - 1147
ADJUSTMENT BASED ON:
COUNTY
S.S/D.C. NO. 177-09-8483
ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: FULTON BANK
ACN
07104401
ACCOUNT NO.
400-1859844
TYPE OF ACCOUNT: () SAVINGS () CHECKING () TRUST (X) TIME CERTIFICATE
DATE ESTABLISHED 04-06-1992
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
.15
.00
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 PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT"
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
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."
.00
.00
.00
nn
(CR),
~
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 2B0601
HARRISBURG PA 1712B-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
RECORD ADJUSTMENT
JOINTLY HELD OR TRUST ASSETS
*
REV-1604 EX AFP (03-05)
RUSSELL G BRUNGARD
7013 DORSEY RD
LAYTONSVILLE MD 20882
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
11-30-2007
BRUNGARD
12-02-2006
21 06-1147
CUMBERLAND
177-09-8483
07104409
FRANCES
T
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 11-30-2007
ESTATE OF BRUNGARD
FRANCES
T DATE OF DEATH 12-02-2006
COUNTY
CUMBERLAND
FILE NO.
21 06-1147
S.S/D.C. NO. 177-09-8483
ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
ACN
07104409
ADJUSTMENT BASED ON:
FINANCIAL INSTITUTION: CITIZENS BANK OF PA
ACCOUNT NO.
6205298736
TYPE OF ACCOUNT: () SAVINGS (X) CHECKING () TRUST () TIME CERTIFICATE
DATE ESTABLISHED 05-21-2004
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 RESISTER OF WILLS
AT THE ADDRESS SHOWN ABOVE.
MAKE CHECK OR MONEY ORDER PAYABLE
TO: "RESISTER OF WILLS, ASENT."
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 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). a
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) [)
REV-1470 EX (6-88)
'*
INHERITANCE TAX
EXPLANATION
OF CHANGES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO Box 280601
HARRISBURG PA 17128-0601
DECEDENTS NAME
FILE NUMBER
Frances T Brungard
REVIEWED BY
ACN
2106-1147
07104401,07104409
Rick Olson
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