HomeMy WebLinkAbout01-02-09COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF :[NDIVIDUAL TAxES _ _ _ ~ -: INHERITANCE TAX
INHERITANCE TAX ^IVISION ~ ~~ Ir ~~~RECDRD ADJUSTMENT
Po eox zao6ol _ -JOINTLY HELD OR TRUST ASSETS
HARRISBURG PA. 17128-0601 .-~• , _.,_..
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ME:CHANICSBURG PA 17055
REV-1604 EX AFP (12-OB)
DATE 12-24-2008
ESTATE OF SAMPSON ANNE
DATE OF DEATH 02-27-2008
FILE NUMBER 21 OS-1006
COUNTY CUMBERLAND
SSN/DC
ACN 08140088
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONIG THIS LINE •--) RETAIN LOWER PORTION FOR YOUR RECORDS F-
REV-1604 EX AFP t12-08)
** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS *~
DATE 12-24-2008
ESTATE CIF SAMPSON ANNE DATE OF DEATH 02-27-2008 COUNTY CUMBERLAND
FILE NO.. 21 08-1006 S.S/D.C. N0. ACN 08140088
ADJUSTIMENT BASED ON: ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: FULTON BANK ACCOUNT N0. 0101-02698
TYPE OF ACCOUNT: ( ) SAVINGS CX) CHECKING C ) TRUST C ) TIME CERTIFICATE
DATE ESTABLISHED 02-27-2001
Account Balance
Percent Taxable
Amount 'Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
19,451.14
X 0.500
9,725.57
5,149.78
4,575.79
X .45
205.91
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
T0: "REGISTER OF WILLS, AGENT."
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT C+)
INTEREST/PEN PAID C-) AMOUNT PAID
09-30-2008 CD010396 .00 437.65
TOTAL TAX CREDIT 437.65
BALANCE OF TAX DUE 231.74CR
INTEREST AND PEN. .00
TOTAL DUE 2 .74 R
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN 81, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR),
vnii Mev RF rniE o aEFUND, SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
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REV-1470 EX (fi-88)
COMMONWEALTH OF PENNSYLVANIA
DEP,4RTMENT OF REVENUE
BURE/aU OF INDIVIDUAL TAXES
PO Box 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME
Anne Sampson
REVIEWED BY
INHERITANCE TAX
EXPLANATION
OF CHANGES
FILE NUMBER
2108-1006
Department of Revenue/ Rick Olson (~ ~v~~ 08140088
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
The deductions submitted have been approved. There is tax due on this account.
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