HomeMy WebLinkAbout01-15-10INHERITANCE TAX
RECORD ADJUSTMENT
_ -, --. --,dQ~4~TLY HELD OR TRUST ASSETS
BUREAU OF INDIVIDUAL TAXES -_ _ _
INHERITANCE TAX DIVISION
PO BOX 280601 ~ _
HARRISBURG PA 17128-0601
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1690 OBERLIN RD
MIDDLETOWN PA 17057-2948
Pennsylvania ~
DEPARTMENT OF REVENUE
REV-1604 EX AFP Q2-09)
DATE 01-07-2010
ESTATE OF GOTSHALL DOROTHY M
DATE OF DEATH 05-02-2009
FILE NUMBER 21 09-0449
COUNTY CUMBERLAND
SSN/DC 206-10-9488
ACN 09159261
Amount Remitted
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 ~
REV-1604 EX AFP (12-09~
** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ~*
DATE: 01-07-2010
ESTATE OF: GOTSHALL DOROTHY M DATE OF DEATH: 05-02-2009 COUNTY: CUMBERLAND
FILE NO.: 21 09-0449 S.S/D.C. N0.:206-10-9488 ACN: 09159261
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: WACHOVIA BK NA ACCOUNT NO.: 247412041980777
TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST CX) TIME CERTIFICATE
DATE ESTABLISHED 12-11-2003
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 .045
.00
NOTE: TO ENSURE 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 RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)
11-23-2009 CD012029 .00 258.84
01-06-2010 REFUND .00 258.84-
TOTAL TAX PAYMENT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A
"CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.