HomeMy WebLinkAbout10-02-09__ _ _
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' COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
~.'~"`' 1r' ~ ~'~~ ~ ' INHERITANCE TAX
BUREAU OF INDIVIDUAL TaxES - RECORD ADJUSTMENT
INHERITANCE TAX DIVISION - "
Po Box zaocal :_ l ~ ..JOINTLY HELD OR TRUST ASSETS
HARRISBURG PA 17126-0601
REV-1604 EX AFP (O1-D9)
DATE 09-25-2009
ESTATE OF GOODHART ARTHUR
DATE OF DEATH 02-19-2006
FILE NUMBER 21 06-0279
COUNTY CUMBERLAND
SSN/DC 177-16-0070
ACN 07001009
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
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ate, ~ ~ , t,,.~~~;
CHRISTINE A SMI~'~`~
930 GOBIN ST
CARLISLE PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
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REV-1604 EX AFP CO1-09)
** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS **
DATE 09-25-2009
ESTATE OF GOODHART ARTHUR DATE OF DEATH 02-19-2006 COUNTY CUMBERLAND
FILE N0. 21 Ob-0279 S.S/D.C. N0. 177-16-0070 ACN 07001009
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: ALLSTATE LIFE INS Co ACCOUNT N0. GAO82972a
TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING C ) TRUST C ) TIME CERTIFICATE
DATE ESTABLISHED 02-19-200b
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
~Q~~ Q~~ -2 ~~ ~ ~ ~ ~2
175,209.94 NOTE:
X 0.050
8,760.50
.00
8,760.50
X .45
394.22
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 (-) AMOUNT PAID
INTEREST IS CHARGED THROUGH 10-13-2009 TOTAL TAX CREDIT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 394.22
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 77,84
TOTAL DUE
~ IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
C IF TOTAL DUE IS LESS THAN S1, ND 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.)