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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
BONNIE L ROUSH
447 OAK FLAT RD
NEWVILLE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
,'REOORD ADJUSTMENT
JOI~NITLY "HELD OR TRUST ASSETS
REV-1604 EX AFP (01-09)
L~~~ ~~~Y ~2 r~`j ~L~ ~~ DATE 05-07-2009
ESTATE OF ADAMS BETTY
DATE OF DEATH 01-23-2008
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Ci_E~-~, ~.,~ FILE NUMBER 21 08-0107
~rp;-~ ~"> ~, ~~ )tiT COUNTY CUMBERLAND
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," SSN/DC 162-22-3658
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`~ ACN 08114078
Amount Remitted
PA 17241
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE -~ RETAIN LOWER PORTION FOR YOUR RECORDS 4~
REV-1604 EX AFP (01-09)
** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS **
DATE 05-07-2009
ESTATE OF ADAMS BETTY DATE OF DEATH 01-23-2008 COUNTY CUMBERLAND
FILE N0. 21 08-0107 S.S/D.C. N0. 162-22-3658
ACN 08114078
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MEMBERS 1sT FCU
ACCOUNT N0. 197028-03
TYPE OF ACCOUNT: CX) SAVINGS C ) CHECKING C ) TRUST C ) TIME CERTIFICATE
DATE ESTABLISHED 05-30-2002
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
.00
X 0.500
.00
.00
.00
X .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
T0: "REGISTER OF WILLS, AGENT."
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT C+)
INTEREST/PEN PAID C-) AMOUNT PAID
* LF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDI
( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF T
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR IN
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE
TIONAL INTEREST. //
OTAL DUE IS REFLECTED AS A "CREDIT" (CR), ~]V/\
STRUCTIONS.)
PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address
printed on the reverse side.
--Make check or money order payable to: REGISTER OF WII.LS, AGENT.
Failure to pay the tax, interest, and penalty due may result in the filing of a lien of record in the appropriate county,
or the issuance of an Orphan's Court citation.
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" CREV-1313). Applications are available
online at www.revenue.state.pa.us, any Register of Wills or Revenue District Office, or from the Department's
24-hour answering service for forms orders: 1-800-362-2050; services for taxpayers with special hearing and/or
speaking needs: 1-800-447-3020 (TT only).
REPLY T0: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau
of Individual Taxes, ATTN: Post Assessment Review Unit, P.O. Box 280601, Harrisburg, PA 17128-0601, Phone
C717) 787-6505.
DISCOUNT: If any tax due is paid within three C3) calendar months after the decedent's death, a five percent C5%) discount
of the tax paid is allowed.
PENALTY: The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period.
INTEREST: Interest is charged beginning with first day of delinquency or nine C9) months and one C1) day from the date of
death to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (6Y.) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. Rates for years 1962 through 1999 can be found in the Pennsylvania
Resident Instruction Booklet, (REV-1501), the Pennsylvania Non-resident Instruction Booklet (REV-1736) or on
the Pennsylvania Dept. of Revenue web site www.revenue.state.pa.us. The applicable interest rates for 2000 through
2009 are:
Interest Daily Interest Oaily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
2000 8% .000219 2001 9% .000247 2002 6Y. .000164
2003 5% .000137 2004 4% .000110 2005 5% .000137
2006 7y, .000192 2007 8% .000219 2008 7% .000192
2009 5% .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen C15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.