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HomeMy WebLinkAbout05-07-10t INHERI RECORD TANCE TAX ADJUSTMENT • p~ennsy van~a ~ JOINTLY HELD OR TRUST ASSETS DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL _ TAXES -~r~''f'~~~~.~' ~' ~~~ ~ ' i " '° -~- +' ` '- t'+%~ REV-1604 IX AFP (12-09) INHERITANCE TAX DIVISION PO BOX 280601 ~ -' ~ yr ~ j f.x ' 1;- 1" ~~ ~ c^ . + .~+ t•rl : _ ~ ~ ~ + ~ ~ ' HARRISBURG PA 17128-0601 .. . . , - - , DATE 04-29-2010 *~ LU~~ MAC -T A~ I I ~ Q7 ESTATE OF RUSS ~ JULIE A DATE OF DEATH 11-26-2005 1F CL~K C FILE NUMBER 21 06-0156 , 0~~~~~ v~~,,j~~ COUNTY SSN/DC CUMBERL ND 027 -16 - 6414 JULIANN R DANIEL~~~-~~~~~,~~ ~~~ . ~?~ ACN 06114164 1463 GOODYEAR RD Amount Remi ted GARDNERS PA 17324 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUA E 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 ASS TS ~* DATE: 04-29-2010 ESTATE OF: RUSS JULIE A DATE OF DEATH: 11-26-2005 CO NTY: CUMBERLAND FILE NO.: 21 06-0156 S.S/D.C. N0.:027-16-6414 CN: 06114164 ADJUSTMENT BASED ON : ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: ORRSTOWN BANK ACCOUNT NO.: 706002046 TYPE OF ACCOUNT: CX) SAVINGS C ) CHECKING C ) TRUST C ) TIME CERTIFICATE DATE ESTABLISHED 10-31-2005 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID .00 X 1.000 .00 _ .00 .00 X .15 .00 NOTE: TO ENSURE PROI ACCOUNT, SUBM OF THIS NOTICI PAYMENT TO TH' AT THE ADDRES MAKE CHECK OR T0: "REGISTEI ER CREDIT TO YOUR T THE UPPER PORTION WITH YOUR TAX REGISTER OF WILLS SHOWN ABOVE. MONEY ORDER PAYABLE OF WILLS, AGENT." TOTAL TAX PAYME T .00 BALANCE OF TAX DUE .00 INTEREST AND PE .00 TOTAL DUE .~~ * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL UE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIO S. ~.~~ ~ 1 i A REV-1470 EX (6-St3) ~~ , .. ,~' ~'-~ INHERITANCE TAX P-.~-, EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE QF CHANGES BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG PA 17128-0601 DECEDENT'S NAME Fi E NUMBER Julie A. Ross 2106-0156 REVIEWED BY A N Laurel Fulmer 06114164 SCHEDULE ~ INp J EXPLANATION OF CHANGES The above referenced "ACN" number has been adjusted to zero as it was paid and reported on the probate return. Page 1