HomeMy WebLinkAbout02-11-09COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBJRG, PA 1 7 1 28-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
BODTORF KARL
302 W MAIN
TAYOLRS, SC 29687
-------- fold
ESTATE INFORMATION: SSN:
FILE NUMBER: 2108-1 181
DECEDENT NAME: BODTORF MABEL D
DATE OF PAYMENT: 02/ 1 1 /2009
POSTMARK DATE: 02/1 1 /2009
couNTY: CUMBERLAND
DATE OF DEATH: 1 1 / 1 9/2008
REMARKS:
SEAL
CHECK#124
REV-1162 EX(11-96)
N0. CD 010893
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
08161453 ~ 594.57
TOTAL AMOUNT PAID:
594.57
INITIALS: CJ
RECEIVED BY: GLENDA FA,RNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
PENNSYLVANIA INHERITAINCE
INFORMATION NOTICE
BUREAU DF INDIVIDUAL TAXES AN D
PD Box 2aB6o1 i~ ,, TAXPAYER RESPONSIE
HARRISBURG PA 17128-0601 ,.
,,, ,
REV-1443 f74{RN'C~48-OBE+~ ~ - ~~
1'AX
FILE N0. 21 08-1181
ACN 08161453
DATE 12-15-2008
2i?~9~~ ~ ~~ I l P i ~ 28
~~ ~ n ,-
4,
_i
KARL R BODTORF
203 W MAIN ST
TAYLORS SC 29687
EST. OF MABEL D BODTORF
SSN
DATE OF DEATH 11-19-2008
COUNTY CUMBERLAND
REMIT PAYMENT AND FORIMS T0:
REGISTER OF WILLS
CUMBERLAND C:0 COURT HOUSE
CARLISLE, PA 17013
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
PSECU provided the Department with the information below, which Fias been used in calculating the
potential tax due. Records indicate that at the death of the above-named decedent, you were a point owner/beneficiary of this account.
If you feel the 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
Penrsylvanio. Plzast tall (?'_?? 7B7-BZ2? with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0169443942-S1 Date 07-13-1971 To ensure proper credit to the account, two
Established copies of tYiis notice must accompany
payment to the Register of Wills. Make check
Account Balance $ 4,424.62 payable to "'Register of Wills, Agent".
Percent Taxable X 50.000
NOTE:: If tzix payments are made within three
Amount Subject to Tax $ 2, 212 • 31 months of tt~e decedent's date of death,
TaX Rate )( .045 deduct a 5 [percent discount on the tax due.
Any Inherita3nce Tax due will become delinquent
Potential Tax Due $ 99.55 ninEa months after the date of death.
PART TAXPAYER RESPONSE
0 FAILURE 1`q RESPOND WiILL R'ESULT'IN AN OF'FTCIAL TAX ASSESSMENT'
A. The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or check box "A" and return this notice to the Register of
C H E C K Wills and an official assessment will be issued by the PA Department of Revenue.
C ONE
B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
0 N L Y to be filed by the estate representative.
C. ~ The above information is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART ~ below.
PART If indicating a different tax rate, please state
relationship to decedent:
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
PART
OFFICIAL USE ONLY (_-I'AA1=-
PA DEPARTMENT OF REVENUE
OF TAX ON JOINT/TRUST ACCOUNTS PAD
1 i
z $ 2
3 X 3
y $ 4
5 - 5
6 $ 6
7 X z
g +~` ~
DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL (Enter on Line 5 of iax compuca a on, ~
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
co--mfp~lete to the best of my k~n]owledge and belief. HOME C .~ ~ A_~. ~ /~/~
AXPAYER SIGNATURE TELEPHONE NUMBER DATE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
RE:V-1162 EX(71-96)
N0. CD 010892
BODTORF KARL
302 W MAIN
TAYOLRS, SC 29687
------- fold
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
ESTATE INFORMATION: SSty:
FILE NUMBER: 2108-1 181
DECEDENT NAME: BODTORF MABEL D
DATE OF PAYMENT; 02/ 1 1 /2009
POSTMARK DATE: 02/1 1 /2009
couNTY: CUMBERLAND
DATE OF DEATH: 1 1 / 1 9/2008
REMARKS:
08161454 ~ $8.24
TOTAL AMOUNT PAID:
58.24
CHECK#123
INITIALS: CJ
SEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
PENNSYLVANIA INHERITANCE -fAX
INFORMATION NOTICE
AND FILE
BUREAU OF INDIVIDUAL TAXES ,_ ..-
Po Box zaocal ~; ~, TAXPAYER RESPONSE ACN
HARRISBURG PA 17128-0601 - - ~ - DAT E
_, r
-~„_,~,..ra ,fie ,oa_~A, ... ..
i ^~ ~'~~
(,' :~ ~ ~~
N0. 21 08-1181
08161454
12-15-2008
2009 ~F~ 1 t Pfd I ~ 27
{^ ~'-,~
G '~ ' r , ~`' ;~ 7j
f ~ ,~~ ~ 1,_ ,~..,.
,; (~ ~ ~,
KARL R BODTORF
203 W MAIN ST
TAYLORS SC 29687
EST. OF MABEL D BODTORF
SSN
DATE OF DEATH 11-19-2008
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS.
CUMBERLAND CO COUIRT HOUSE
CARLISLE, PA 17013
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
PSECU provided the Department with the information below, which has been used in calculating the
potential tax due. Retards indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account.
If you feel the 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
Pe nn sylvaria. Please call (717J 7B7-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0169443942-S2 Date 06-30-1999 To ensure proper credit to the account, two
Established copies of this notice must accompany
payment to ~:he Register of Wills. Make check
Account Balance $ 385.28 pay+3ble to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If t+3x payments are made within three
Amount Subject to Tax $ 192 • 64 months of the decedent's date of death,
)( .045 deduct a 5 Percent discount on the tax due.
Tax Rate Any Inheritance Tax due will become delinquent
Potential Tax Due $ 8 • 67 nine months after the date of death.
PART TAXPAYER RESPONSE
0 FAILURE Ttl RESPpND WILL RESULT IN AN OFFICIAL TAX AS5E55MENT
A. ~ The above information and tax due is correct.
l/ql Remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or check box "A" and return this notice to the Register of
C H E C K Wills and an official assessment will be issued by the F'A Department of Revenue.
ONE
C
B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the F'ennsvlvania Inheritance Tax return
0 N L Y to be fil ed by the estate representative.
C. ~ The above information is incorrect and/or debts and deductions were paid.
Com plete PART 2~ and/or PART ~ below.
PART If indicating a different tax rate, please state
relationship to decedent:
TAX RETURN - COMPUTATION
LINE I. 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 TAX ON JOINT/TRUST ACCOUNTS 'PAD
1
2
3 X
4
5 -
6
7 X
8
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I have reported .above are true, correct and
cJ mplete to the best of my^^
[~,.~ O ~ ~.,,~~~tY knopwledge
1'LU ~ and belief. HOME
WORK C )
C )
...
YER SIGNA
OFFICIAL USE ONLY Q AAF`'
PA DEPAR'TME'NT OF REVENUE
i
2
3
4
5
6
7
8
TELEPHONE NIJMBEK
~~ -
DATE
TOTAL (Enter on L1ne 5 or iax ~ompucacion,
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
BODTORF KARL
302 W MAIN
TAYOLRS, SC 29687
-------- fold
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ESTATE INFORMATION: SSN:
FILE NUMBER: 2108-1 181
DECEDENT NAME: BODTORF MABEL D
DATE OF PAYMENT: 02/ 1 1 /2009
POSTMARK DATE: 02/1 1 /2009
COUNTY: CUMBERLAND
DATE OF DEATH: 1 1 / 1 9/2008
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
08161455 ~ $6.44
TOTAL AMOUNT PAID:
REMARKS:
CHECK#122
SEAL
INITIALS: CJ
56.44
RECEIVED BY: GLENDA FA.RNER STRASBAUGH
REGISTER C)F WILLS
REV-1162 EX(11-96)
NO. CD 010891
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES ,
PO BOX 266661 ~_!
HARRISBURG PA 17128-0661 ,_,,.~..-,,. -
REV-1543 23E AfF't OB="d8)
N0. 21 08-1181
08161455
12-15-2008
2009 ~E~3 ! 1 P~1 1 ~ 27
(1 t ~ j 1 i `' I ~~ I
i-` I7L1
KARL R BODTORF
203 W MAIN ST
TAYLORS SC 29687
EST. OF MABEL D BODTORF
SSN
DATE OF DEATH 11-19-2008
COUNTY CUMBERLAND
REMIT PAYMENT AND FORKS T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
PSECU provided the Department with the information below, which Fias been used in calculating the
potential tax due. Records indicate that at the death of the above-named decedent, you were a Joint owner/beneficiary of this account.
If you feel the 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
Pcnr.s.le=_nia. Please call (7171 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0169443942-S3 Date 06-30-1999 To ensure proper credit to the account, two
Established copies of this notice must accompany
payment to the Register of Wills. Make check
Account Balance $ 301 .45 payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE:: If tzix payments are made within three
Amount Subject to Tax $ 150 • 73 months of tYie decedent's date of death,
)( .045 deduct a 5 [percent discount on the tax due.
Tax Rate Any Inheritance Tax due will become delinquent
Potential TaX Due $ 6 • 78 nine months after the date of death.
PART TAXPAYER RESPONSE
0 FAILURE 70 RESPOND NULL RESULT IN AN OFFICIAL TAX ASSESSMENT
A.
The above information and tax due is correct.
~ Remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or check box "A" and return this notice to the Register of
C H E C K Wills and an official assessment will be issued by the PA Department of Revenue.
ONE
C
B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
0 N L Y to be fil ed by the estate representative.
C. ~ The above information is incorrect and/or debts and deductions were paid.
Com plete PART 2~ and/or PART 3LJ below.
PART If indicating a different tax rate, please state
relationship to decedent:
(iFFICIAL USE ONLY (~ AAF
PA 'DEPARTMENT OF REVENUE
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST Al:cuunis ~,,+~Au
LINE i. 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
PART
i
a X ~ 3
y $ 4
5 - 5
6 $ 6
7 X 7
8 $ I $
DEBTS AND DEDUCTIONS CLAIMED
naTF PAT^ PAYEE DESCRIPTION AMOUNT PAID
Under penalties of perjury, I declare that the facts I have reported above are true, correct and ///~~~
comnnplnnete to the best ofnmy knowledge and belief. HOME CI~~~ { ~
~)~1..1 ~ nv-~ ~'d'LR I L L r.~ W O R K C d b ~- .~ ., loo
,X PAYER S GNATUR TELEPHONE NUMBER DATE
PENNSYLVANIA INHERITAINCE 1'AX
INFORMATION NOTICE
AND FILE
'~~"'~ ` t~~TAXPAYER RESPONSE ACN
DATE
TOTAL CEnter on Line 5 of iax uomputacion~ ~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
BODTORF KARL
302 W MAIN
TAYOLRS, SC 29687
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX111-96)
N0. CD 010890
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- fold
ESTATE INFORMATION: SsN:
FILE NUMBER: 2108-1 181
DECEDENT NAME: BODTORF MABEL D
DATE OF PAYMENT: 02/ 1 1 /2009
POSTMARK DATE: 02/09/2009
couNTY: CUMBERLAND
DATE OF DEATH: 1 1 / 1 9/2008
08161456 ~ 526.09
TOTAL AMOUNT PAID:
REMARKS:
SEAL
CHECK# 121
INITIALS: CJ
RECEIVED BY:
526.09
GLENDA FA,RNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
PO 80X 280601
HARRISBURG PA 17128-0601
PENNSYLVANIA INHERITAWCE T'AX
INFORMATION NOTICIE
AND FILE
' ~ ~ '' .I ; ~ TAXPAYER RESPONSE= ACN
., ~ DATE
kEY-1543 E%AFF_(b8-QB) ..
Z~E.1~ -~~ S ~ i f ~ ~ • ~ f
N0. 21 08-1181
08161456
12-15-2008
EST. OF MABEL D BODTORF
SSN
DATE OF DEATH 11-19-2008
COUNTY CUMBERLAND
REMIT PAYMENT A,ND FOR14S T0:
REGISTER OF WILLS
CUMBERLAND C:0 COURT HOUSE
CARLISLE, PA 17013
,,
~` , ~~~~
KARL R BODTORF
203 W MAIN ST
TAYLORS SC 29687
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
PSECU provided the Department with the information below, which Fias been used in calculating the
potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account.
If you feel the 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
pennsy lvani a. Please call (717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0169443942-S4 Date 06-15-1999 To ensure proper credit to the account, two
Established copies of tYiis notice must accompany
Account Balance 31 payment to the Register of Wills. Make check
1 220
"'
"
.
~ payable to
Register of Wills, Agent
.
Percent Taxable X 50.000
Amount Subject to NOTE: If tax payments are made within three
Tax $ 610
16
'
.
months of the decedent
s date of death,
TaX Rate X .045 deduct a 5 percent discount on the tax due.
Potential Tax Due Any Inheritance Tax due will become delinquent
$ 27.46
i
th
ft
th
d
d
th
t
n
ne mon
s a
er
e
a
e of
ea
.
P
T TAXPAYER RESPONSE
~
~
FAILURE 70 RESPOND ..WILL RESULT IN AN OFFICIAL"TAX ASSESSMENT
A. The above information and tax due is correct.
Remit payment to the Register of Wills with two copies of this notice to obtain
C H E C K a discount or avoid interest, or 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.
0 N E
~
BLOC K
B. ~ The above asset has been or will be reported and tax paid with the P'ennsvlvania Inheritance Tax return
0 N L Y to be filed by the estate representative.
C. ~ The above information is incorrect and/or debts and deductions were paid.
Complete PART 2~ and/or PART ~ below.
PART If indicating a different tax rate, please state OFFICIAL USE ONLY ~ AAF
relationship to decedent:
PA DEPARTMENT 'OF REVENUE
TAX RE TURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS P.4D
LINE 1. Date Established I 1
2. Account Balance 2 +~ 2
3. Percent Taxable 3 X ~ 3
4. Amount Subject to Tax 4 $ i 4
5. Debts and Deductions 5 - ~ 5
6. Amount Taxable 6 $ i 6
7. Tax Rate 7 X 7
8. Tax Due 8 $ $
PARr DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
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 C )
1
n w r ~ r3ocljC®~ ~u (~ WORK () „"
~XPAYER SIGNATURE TELEPHONE NUMBER
_~_~
TOTAL CEnter on Line 5 of Tax Computation) S
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2$0601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
BODTORF KARL
302 W MAIN
TAYOLRS, SC 29687
- ---- fad
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX(11-961
NO. CD 010889
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
ESTATE INFORMATION: SsN:
FILE NUMBER: 2108-1 181
DECEDENT NAME: BODTORF MABEL D
DATE OF PAYMENT: 02/ 1 1 /2009
POSTMARK DATE: 02/09/2009
couNTY: CUMBERLAND
DATE OF DEATH: 1 1 / 1 9/2008
REMARKS:
CHECK#120
SEAL
08161457 ~ 5469.38
TOTAL AMOUNT PAID:
INITIALS: CJ
5469.38
RECEIVED BY: GLENDA FA,RNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
PENNSYLVANIA INHERIT~-NCE TAX
INFORMATION NOTI(:E
BUREAU OF INDIVIDUAL TAXES AND F I L E
Po Box zao6ol `-'TAXPAYER RESPONSE ACN
HARRISBURG PA 17128-o6a1 -~_ - - _-~ - - DATE
REV-1543 EX AFP (OB-08)- '. ~ ..
N0. 21 08-1181
08161457
12-15-2008
nn~0 r ;-r^~ ~.e
i:'.'~~ 1't_;) I I PI': I' 2 EST. OF MABEL D BODTORF
SSN
-~~; - DATE OF DEATH 1]1-19-2008
~~~ i ~~~ •,.~; ~;~ i COUNTY CUMBE=RLAND
~^i u ~ 1LAj REMIT PAYMENT AND FORMS T0:
V4, ~I Y
KARL R BODTORF REGISTER OF WILLS
203 W MAIN ST CUMBERLAND CO COIJRT HOUSE
TAYLORS SC 29687 CARLISLE, P.A 17013
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
PSECU provided the Department with the information below, which has been used in calculating the
potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account.
If you feel the 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. Please call (717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0169443942-S7 Date 12-06-1991 To ensure proper credit to the account, two
Established copies of this notice must accompany
payment to the Register of Wills. Make check
Account Balance $ 21 , 958.94 payable to "Register of Wills, Agent".
Percent Taxable X 50.000
NOTE: If tax payments are made within three
Amount Subject to Tax $ 10,979.47 months of the decedent's date of death,
Tax Rate X .045 deduct a 5 percent discount on the tax due.
Any Inheritance Tax due will become delinquent
Potential Tax Due $ 494.08 nine months after the date of death.
PART TAXPAYER RESPONSE
FAILURE T'fl RESPONO WILL RESULT' IN A'N OFFICIAL TAX ASSESSMENT'
The
A. above information and tax due is correct.
~ Remit payment to the Register of Wills with two copies of this notice to obtain
a dis count or avoid i nterest, or check box "A" and return this notice to the Register of
C H E C K Wills and an official assessment will be issued by the 1'A Department of Revenue.
ONE
C
B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
0 N L Y to be fil ed by the estate representative.
C. ~ The above information is incorrect and/or debts and deductions were paid.
Com plete PART 2~ and/or PART 3^ below.
PART If indicating a different tax rate, please state QFFIGIAL USE ONLY ~!iAAF
to decedent:
lationshi
p
re PA DEPARTMENT DF REVENUE
TAX RE TURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD
LINE i. Date 'cstablished 1 '
2. Account Balance 2 $ 2
3. Percent Taxable 3 X 3
4. Amount Subject to Tax 4 +fi 4
5. Debts and Deductions 5 5
6. Amount Taxable 6 '~ G
7. Tax Rate 7 X 7
8. Tax Due 8 $ 8
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation) ~
Under penalties of perjury, I declare that the facts I have reported .above are true, correct and
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