HomeMy WebLinkAbout01-25-10BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
INHERITANCE TAX
RECORD ADJUSTMENT
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BESSIE V CLOUSE ~U, ~ ~ ~~- ~:~. - , ~ ,'~.
844 DOUBLING GAP RD
NEWVILLE PA 17241
Pennsylvania ~
DEPARTMENT OF REVENUE
REV-1604 IX AFP C12-09)
DATE 01-13-2010
ESTATE OF CLOUSE ELMER E
DATE OF DEATH 11-03-2008
FILE NUMBER 21 08-1167
COUNTY CUMBERLAND
SSN/DC 201-18-3982
ACN 09100689
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
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REV-1604 EX AFP C12-09)
** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS **
DATE: 01-13-2010
ESTATE OF: CLOUSE ELMER E DATE OF DEATH: 11-03-2008 COUNTY: CUMBERLAND
FILE NO.: 21 08-1167 S.S/D.C. N0.:201-18-3982 ACN: 09100689
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: ORRSTOWN BANK
TYPE OF ACCOUNT: C ) SAVINGS CX) CHECKING C ) TRUST C ) TIME CERTIFICATE
DATE ESTABLISHED 01-01-2001
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 .15
.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
DATE RECEIPT
NUMBER DISCOUNT C+)
INTEREST/PEN PAID C-) AMOUNT PAID
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A
"CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.
ACCOUNT NO.: lol001041