HomeMy WebLinkAbout01-0115
It. -,9. 7J Ie,
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
'*
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21-0/ - / /6./
01100401
01-15-2001
REY-1545 EX AFP (D9-DDl
EST. OF HELEN M KUTZ
S.S. NO. 187-44-8955
DATE OF DEATH 11-23-1999
,;i\hlcOONT.'YZ'; :?~; CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
o CHECKING
o TRUST
[Xl CERTIF.
'01
Ct::
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PEARL A DITMER
1310 ZIMMERMAN RD
CARLISLE PA 17013
.'./1:;
KEYSTONE FINANCIAL BANK NA has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a COpy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth
of Pennsylvania. Questions .~y be answered by calling (711) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 6400091415 Date 06-28-1990
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
7,259.47
50.000
3,629.74
.15
544.46
TAXPAYER RESPONSE
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
x
NOTE: If tax payments are made within three
(3) months of the decedent.s date of death,
you may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
Tax
PART
[!]
A.
[ CHECK ]
ONE
BLOCK B.
ONLY
c.
[] The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
[] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent.s representative.
[] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
PART
~
TAX RETURN - COMPUTATION OF
LINE 1. Date Established 1
2. Account Balance 2
3. Percent Taxable 3
4. Amount Subject to Tax 4
5. Debts and Deductions 5
6. Amount Taxable 6
7. Tax Rate 7
8. Tax Due 8
TAX ON JOINT/TRUST ACCOUNTS
If you indicate a different tax rate, please state your
relationship to decedent:
x
x
PART
@J
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Computation)
I
$
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best of my knowledge and belief.
HOME (
WORK (
TELEPHONE
)
)
NUMBER
DATE
TAXPAYER SIGNATURE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
-'
NO. 21'-01- //\$
01100400
01-15-2001
REV-1543 EX AFP eU9-DDl
"-, 1
Ii
EST. OF HELEN M KUTZ
S.S. NO. 187-44-8955
DATE OF DEATH 11-23-1999
:'OOUNTY CUMBERLAND
TYPE OF ACCOUNT
D SAVINGS
D CHECKING
D TRUST
[X] CERTIF.
PEARL A DITMER
1310 ZIMMERMAN RD '
CAR LI S L E P A 170 1 ~"~~ I
REHIT PAYHENT AND FORHS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
KEYSTONE FINANCIAL BANK NA has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a COpy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. Question~ may ba answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 6400094768 Date 01-23-1991
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
x
21,584.48
50.000
10,792.24
.15
1,618.84
TAXPAYER RESPONSE
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
x
NOTE: If tax payments are made within three
(3) months of the decedent.s date of death,
you may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
Tax
PART
ill
A.
[ CHECK ]
ONE
BLOCK B.
ONLY
c.
[] The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
[] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent.s representative.
[] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
PART
[!]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
If you indicate a different tax rate, please state your
relationship to decedent:
PART
~
TAX RETURN - COMPUTATION
LINE 1. Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
.7. Tax Rate
'8. Tax Due
OF
1
2
3
4
5
6
7
8
x
TAX ON JOINT/TRUST ACCOUNTS
x
PAYEE
DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
I
$
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete to the best of my knowledge and belief.
HOME (
WORK (
TELEPHONE
)
)
NUMBER
DATE
TAXPAYER SIGNATURE
l~c-dO&-1
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
G
'*
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISENENT~ ALLONANCE OR DISALLONANCE
OF DEDUCTION~, AND ASSESSNENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-15~1 EX AFP 112-DDl
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
04-09-2001
KUTZ
11-23-1999
21 01-0115
CUMBERLAND
187-44-8955
01100401
AlIOUnt R_i Heel
M
"r,.,
lj:
I..'n
-}
PEARL A DITMER
1310 ZIMMERMAN RD
CARLISLE PA UP13
(',:l
HELEN
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 ~
Rifv:i~i-EX--~--filr:oO)------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIINS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 04-09-2001
ESTATE OF KUTZ
HELEN
M DATE OF DEATH 11-23-1999
COUNTY
CUMBERLAND
FILE NO. 21 01-0115
TAX RETURN WAS:
S.S/D.C. NO. 187-44-8955
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: KEYSTONE FINANCIAL BANK NA
ACN
01100401
ACCOUNT NO.
6400091415
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST ()() TIME CERTIFICATE
DATE ESTABLISHED 06-28-1990
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
7,259.47
0.500
3,629.74
.00
3,629.74
.15
544.46
x
x
TAX CREDITS:
PAYMENT
DATE
01-26-2001
RECEIPT
NUMBER
AA477937
DISCOUNT (+)
INTEREST/PEN PAID (-)
.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
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
AMOUNT PAID
544.46
BALANCE OF UNPAID INTEREST/PENALTY AS OF 01-27-2001 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" ( CR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
544.46
.00
19.00
19.00
----~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
No.AA 477937 REV-1162 EX (11.96)
RECEIVED FROM:
r
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
F'EARL A DITf'1EH
01100401
$5i+4 . 46
1310 ZIMMERMAN ROAD
CARLISLE. PA 17013
01100400
$ 1 . 618 . 8L.
FOLD HERE
FOLD HERE
ESTATE INFORMATION:
FILE NUMBER
21-2001-0115
NAME OF DECEDENT (LAST)
KUT2 HELEN 11
SSN 187--44-8955
(FIRST)
(MI)
DATE OF PAYMENT
1/26/2001
POSTMARK DATE
0/00/0000
COUNTY
CUl"lBERLAND
$2.163.30
TOTAL AMOUNT PAID
DATE OF DEATH
11/23/1999
REMARKS
AC
if: Ii '_,..t.
RECEIVED BY ///4A:/ L- ";/';/'t/it',__(l/'2U-,,
MARY . L", ~ /j./
REGl STER9 WILLS/~?tf'c/~lI;V
REGISTER OF WILLS - 'A:>/L~/;' ,
/
------~-----~----~--~---~------~~~-~---~--~--~-----
CHECK# NO CHECK #
SEAL
"
1(P~d{)& - /
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
(.".
V'
'*
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
NOTICE OF INHERITANCE TAX
APPRAISEKENTz ALLOMANCE OR DISALLOMANCE
OF DEDUCTION5, AND ASSESS"ENT OF TAX ON
30INTLY HELD OR TRUST ASSETS
IEV-l!i48 Ell AFP <12-11)
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
04-09-2001
KUTZ
11-23-1999
21 01-0115
CUMBERLAND
187-44-8955
01100400
AlIOUIlt R_i Had
HELEN
M
I'J
, :1
PEARL A DITMER
1310 ZIMMERMAN RD
CARLISLE ~A 17013
C:~t
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 ~
Rifi=i541i-i5f-AFii-(~;!:oO)------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 04-09-2001
ESTATE OF KUTZ
HELEN
M DATE OF DEATH 11-23-1999
COUNTY
CUMBERLAND
ACN
01100400
FILE NO. 21 01-0115
TAX RETURN WAS:
S.S/D.C. NO. 187-44-8955
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: KEYSTONE FINANCIAL BANK NA
ACCOUNT NO.
6400094768
TYPE OF ACCOUNT: () SAVINGS ( ) CHECKING ( ) TRUST (~ TIME CERTIFICATE
DATE ESTABLISHED 01-23-1991
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
21,584.48
0.500
10,792.24
.00
10,792.24
.15
1,618.84
X
X
TAX CREDITS:
PAYMENT
DATE
01-26-2001
RECEIPT
NUMBER
AA477937
DISCOUNT (+)
INTEREST/PEN PAID (-)
.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
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
AMOUNT PAID
1,618.84
1,618.84
.00
56.48
56.48
BALANCE OF UNPAID INTEREST/PENALTY AS OF 01-27-2001 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" ( CRl, YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
No.AA 496532 REV-1162 EX (11-96)
RECEIVED FROM:
r
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
PEAF:L A DITMEF~
OllO()i+01
$1'7. C/O
1310 ZlMMERMAN ROAD
CARLISLE. PA 17013
FOLD HERE
FOLD HERE --
ESTATE INFORMATION:
FILE NUMBER
21--2001--0115
NAME OF DECEDENT (LAST)
~~UTZ HEL.EN M
DATE OF PAYMENT
4/30/2001
POSTMARK DATE
0/00/0000
SSN 187-..44--8955
(FIRST)
(MI)
COUNTY
cur'1BEHUl,ND
$19.00
TOTAL AMOUNT PAID
DATE OF DEATH
11/23/1999
DO
REMARKS
RECEIVEDBY "/'/',' .'
M(..RY t. '-~ S
REGISTER, F WILLS
~ ~,., co,"
CHED::# CASH
SEAL
~.~/.' .
-1'1.1 I"
,- /
,:!./ <.....
REGISTER' OF WILLS
. -.-- -- --------'------- ------~--- --- -~----- --"- ----->._--~---
"
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
No.AA 496533 REV-1162 EX (11-96)
RECEIVED FROM:
I"
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
PEAF.:L A D1 TMER
(11100(tOO
$56.48
1310 ZIMMERMAN ROAD
CARLISLE. PA 17013
--- FOLD HERE
FOLD HERE
ESTATE INFORMATION: I
FILE NUMBER
21... 200 1--0 115 SSN 187--44-8955
NAME OF DECEDENT (LAST) (FIRST) (MI)
KUTZ HELEN M
DATE OF PAYMENT
4/:-30/2001
POSTMARK DATE
0/0010000
COUNTY
CUC"lBERLAND
DATE OF DEATH
11/23/1999
c..r-Il' H U 1 1l"'fF.H
$56.48
TOTAL AMOUNT PAID
DO
//1. "'7 ,,_~ _. .' ~'i ,/".,(__
I...... /././4' <. J.//."
/{...I((C~lj.-"(/
/flk ~
h>/L ....~/~.
. "
-- - - - - - -- ---- - - - - - - - - - -- --... - - - - - - - - - -- - ~ -- ---..- -" -- ~ - -- - - - - - -- -- - ------
CHEO~# CASH
SEAL
RECEIVED BY />/ /1// .{
l"IAf~Y' C. L..El.,i;f
HEGISTEf-{ q.l1 WILLS
REMARKS
REGISTER OF WILLS
"
~
It> --~ a~~ I
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
c;i
VI
*'
REY-l'D7 EX AFP 112-DDl
PEARL A DITMER
1310 ZIMMERMAN RD
CARLISLE PA 17013
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
C:OU~TY
ACN
05-21-2001
KUTZ
11-23-1999
21 01-0115
CUMBERLAND
01100401
HELEN
M
Mount Re.itted
,C,.
.. ,'!..
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this for. with your tax pay.ent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV=i6oi-i:x--AFP-fi'2:ooY------...--iNHERIT"ANc'E-YAX--STA-fEME-NY-OF"-Accouiif--...---------------------
ESTATE OF KUTZ
HELEN
M FILE NO. 21 01-0115
ACN 01100401 DATE 05-21-2001
THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW
IS A S~ARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 04-02-2001
PR I NCI PAL TAX DUE: .............................................................................................................................................................................................................
544.46
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
01-26-2001 AA477937 .00 544.46
04-30-2001 AA496532 19.00- 19.00
TOTAL TAX CREDIT 544.46
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
It IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl,
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. l
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
I {;,,;2t(,-
/
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
<::)1-
c "
./"
'*
\
REY-l'D7 EX AFP el2-DDl
PEARL A DITMER
1310 ZIMMERMAN RD
CARLISLE PA 17013
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNty
ACN
05-21-2001
KUTZ
11-23-1999
21 01-0115
CUMBERLAND
01100400
HELEN
M
AlIOunt Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ..
ifEY=i&'ifj-Ex--AFP--fi'2-:ooY------...--iNHERITANCE-YAX-STAfEMENY-OF'-Accouiif--.-..----------------- ----
ESTATE OF KUTZ HELEN M FILE NO.21 01-0115 ACN 01100400 DATE 05-21-2001
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 04-02-2001
P R I N C I PAL TAX DUE: .............................................................................................................................._.....................
1,618.84
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
01-26-2001 AA477937 .00 1,618.84
04-30-2001 AA496533 56.48- 56.48
TOTAL TAX CREDIT 1,618.84
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
It IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SIDE 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. )