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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
- INHERITANCE TAX
-''RECORD ADJUSTMENT
-,;.. ; ` {,~OIiyTLY HELD OR TRUST ASSETS
20Q9 JU~# ~:~ ~~~ # _ # f3
CLERK CF
ORPH,~N'S CC~RT
JAMES D HAMACHER CUM~r <_,~.1`E'1 i;~ , PA.
871 MANDY LN
CAMP HILL PA 17011
ii
REY-1604 EX AFP CO1-09)
DATE 06-11-2009
ESTATE OF HAMACHER MARY J
DATE OF DEATH 11-19-2007
FILE NUMBER 21 08-0037
COUNTY CUMBERLAND
SSN/DC
ACN 08121270
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~"1 RETAIN LOWER PORTION FOR YOUR RECORDS ~'
REV-1604 EX AFP (01-09)
** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS **
DATE 06-11-2009
ESTATE OF HAMACHER MARY J DATE OF DEATH 11-19-2007 COUNTY CUMBERLAND
FILE N0. 21 08-0037 S.S/D.C. N0. ACN 08121270
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MST BANK ACCOUNT N0. 31003915935985
TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST (X) TIME CERTIFICATE
DATE ESTABLISHED 02-22-2007
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
.00
X 1.000
.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 ABOYE.
MAKE CHECK OR MONEY ORDER PAYABLE
T0: "REGISTER OF WILLS, AGENT."
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT C+)
INTEREST/PEN PAID (-) AMOUNT PAID
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE
^ IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
C IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR),
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
REV-1470 EX (688)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO Box 280601
Mary J. Hamacher
Bill Lyons
2108-0037
08121270
ITEM
SCHEDULE NO_ EXPLANATION OF CHANGES
The asset has been reported on the inheritance tax return.
INHERITANCE TAX
EXPLANATION
OF CHANGES
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