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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX OIVISION
PO BOX 2B0601'- - ".
HARRISBURG, PA 17128-0601
INHERITANCE TAX
RECORD' -ADJUSTMENT
'~ENEFICIARY FORM ASSETS
REY-UO~ EX AFP <1l-04)
DANIEL P KUMPF
2166 RAMELLI AVE
VENTURA
DATE
pnr ~-~rp 17 p.'l I?: ,-,-ESTATE OF
,. I,; .\ ,1.1_ cJ -DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
r'l r-'--'t/ "
03-07-2008
KUMPF
03-25-2007
21 07-0345
CUMBERLAND
202-20-0761
07500535
EARL
E
net,- ,
1,...'( 'j
Amount Remitted
CA 93003-0000
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-1604A EX AFP (01-03)
__ INHERITANCE TAX RECORD ADJUSTMENT BENEFICIARY FORM ASSETS --
DATE 03-07-2008
ESTATE OF KUMPF
EARL
E DATE OF DEATH 03-25-2007
COUNTY
CUMBERLAND
FILE NO. 21 07-0345
ADJUSTMENT BASED ON:
S.S/D.C. NO. 202-20-0761
ADMINISTRATIVE CORRECTION
BENEFICIARY FORM ASSETS
ACN
07500535
NAME OF SECURITY:
SMITH BARNEY
ACCOUNT NO.
54J05839-18
TYPE OF ACCOUNT:
( ) SECURITIES () SEC ACCT
( ) STOCK
( ) BOND
DOD Valuation
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
.00
0.333
.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 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.)
.00
.00
.00
-'I
'--p
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
DECEDENT'S NAME
FILE NUMBER
Earl E. Kumpf
REVIEWED BY
ACN
2107-0345
07500535
Eunice Baker
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