HomeMy WebLinkAbout12-18-09• ~ INHERITANCE TAX
RECORD ADJUSTMENT
1" -~_~~-,~ ~ ~~ JOINTLY HELD OR TRUST ASSETS
BUREAU OF INDIVIDUAL "TAR~$'""._ . t' `,- ~~- J 'i
INHERITANCE TAX DIYISIDN tt~ , -, ~d4t ~ C~
PO BDX 280601 '"i[~~~3/ ~..i~: ./~ ~ ,.- ~.'
HARRISBURG PA 17128-0601
2004 4t:C t 8 Ali i t ~ 36
CLERK J
ORPH~„til`S CO;JRT
JANET ~UI~~-~~~`_ ~~~., PA
135 AMITY ROAD
DUNCANNON PA 17020
Pennsylvania ~
DEPARTMENT OF REVENUE
REV-1604 EX AFP C10-09)
DATE 12-07-2009
ESTATE OF LANTZY LOIS M
DATE OF DEATH 07-03-2008
FILE NUMBER 21 08-0744
COUNTY CUMBERLAND
SSN/DC 161-34-2Q46
ACN 08145213
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 (10-09)
** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSNS **
DATE: 12-07-2009
ESTATE OF: LANTZY LOIS M DATE OF DEATH: 07-03-2008 COUNTY: CUMBERLAND
FILE NO.: 21 08-0744 S._S/D.C. N0.:161-34-2046 ACN: 08145213
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: AMERICHOICE Fcu ACCOUNT N0.:2o56-13
TYPE OF ACCOUNT: C ) SAVINGS CX) CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 02-03-2008
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
5,116.44
X 0.500
2,558.22
.00
2,558.22
X .12
306.98
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 (+)
INTEREST/PEN PAID C-) AMOUNT PAID
INTEREST IS CHARGED THROUGH 12-22-2009
AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORM
* IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITION
"CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THI
TOTAL TAX PAYME T .00
BALANCE OF TAX D E 3
INTEREST AND PEN. 1 .
TOTAL DUE ~, a ,..
AL INTEREST. IF TOTAL DUE IS REFLECTED AS A
S FORM FOR INSTRUCTIONS.