HomeMy WebLinkAbout12-29-09~~ ~
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
INHERITANCE TAX
RECORD ADJUSTMENT
., r dQ~~-T,L,~F .kiELD OR TRUST ASSETS
_ .. __.~ . r~ , ~.. li;
2009 DEC 29 AP4 i0= 34
C~.ERK ~~f
ORPHA~d'~ ~;QJ~T
DORA F GIERLACICUP;A~'="~~_J'~';~`'e~ :~.~'.. PA
1338 QUAIL RUN CIR
BETHEL PARK PA 15102
Pennsylvania ~
DEPARTMENT OF REVENUE
REV-1604 EX AFP (12-09)
DATE 12••16-2009
ESTATE OF OHARA DORA E
DATE OF DEATH 03••30-2009
FILE NUMBER 21 09-0457
COUNTY CUMBERLAND
SSN/DC 193-14-1910
ACN 09123970
I A1110Unt 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 C12-09)
** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS **
DATE: 12-16-2009
ESTATE OF: OHARA DORA E DATE OF DEATH: 03-30-2009 COUNTY: CUMBERLAND
FILE NO.: 21 09-0457 S.S/D.C. N0.:193-14-1910 ACN: 09123970
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: PSECU ACCOUNT N0.:8502181095-S4
TYPE OF ACCOUNT: ( ) SAVINGS CX) CHECKING C ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 01-24-2006
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
.00
X 0.166
.00
.DO
.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
DATE RECEIPT
NUMBER DISCOUNT C+)
INTEREST/PEN PAID (-) AMOUNT PAID
r
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.