HomeMy WebLinkAbout12-17-10 (4)INHERITANCE TAX
RECORD ADJUSTMENT
. ,1 ,,.,r~J,O,.INTLY HELD OR TRUST ASSETS
BUREAU OF INDIVIDUAL TAXES !!~_ _ ~ t,_; ~~,+` l.t'
INHERITANCE TAX DIVISION ~~ ~ ,-, I ,~
PO BOX 280601 `~• ~ ~
HARRISBURG PA 17128-0601 '
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CAROL A KAUFMA(~~J~y~~~-~?f ,°;'`~jj? ~~,`~ , PA
607 WALRADT ST
FULTON NY 13069
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DEPARTMENT OF REVENUE t
REV ••1604 EX AFP C12-10)
DATE 12-13-2010
ESTATE OF THOMAS ANNA w
DATE OF DEATH 09-30-2010
FILE NUMBER 21 10-1093
COUNTY CUMBERLAND
SSN/DC 240-28-9514
ACN 10159670
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17D13
CUT ALONG THIS LINE --~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
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REV-1604 EX AFP C12-10)
** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS **
DATE: 12-13-2010
ESTATE OF: THOMAS ANNA W DATE OF DEATH: 09-30-2010 COUNTY: CUMBERLAND
FILE NO.: 21 10-1093 S.S/D.C. N0.:240-28-9514 ACN: 10159670
ADJUSTMENT BASED ON : ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: PsECu
ACCOUNT NO.: 8702318828-s4
TYPE OF ACCOUNT: C ) SAVINGS CX) CHECKING ( ) TRUST C ) TIME CERTIFICATE
DATE ESTABLISHED 02-07-2003
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
5,165.26
X 0.166
860.89
353.65
507.23
X .045
22.82
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
11-03-2010 CD013590 1.14 38.74
TOTAL TAX PAYMENT 39.88
BALANCE OF TAX DUE 17.06CR
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" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.