HomeMy WebLinkAbout04-06651-7o~3
h,,llh,,llh,,,,,Ih,lh,,,Ih,,Ih,,hh'lhhh'hh'hh'l
CONNONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
GREGORY L DROWN
1800 PINE ST
CAMP HILL PA 17011
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FZLE NO. 2!
ACN 04125557
DATE 06-29-2004
TYPE OF ACCOUNT
EST, OF ROGER A BROWN [] SAVINGS
S.S. NO. 198-22-9495 [] CHECKING
DATE OF DEATH 04-$0-2004 [] TRUST
CUMDERLAND [] CERTIF.
REMIT PAYHENT AND FORMS TO:
REGISTER OF WILLS
CUMDERLAND CO COURT HOUSE
CARLISLE, PA 17015
COMPLETE PART I BELOW # # # SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account NO. 01982Z9493
De~o 04-21-Z000
Established
Accoun~ Balance
Percent Taxable X 50.000
Amount Subject to Tax
Tax Ra~a X .O~S
Potential Tax Due 9.07
PART TAXPAYER RESPONSE
ONE
Ym~ must complete PART [] and/or PART [] belou.
PART If you indicate a different tax rate, please state your
TAX RETURN - COMPUTATION OF
2. Accoun)¢ Balance 2,
PART
DATE PAID
TAX ON JOINT/TRUST ACCOUNTS
DEBTS AND DEDUCTIONS CLAIMED
PAYEE DESCRIPTION AMOUNT PAID
TOTAL (Enter on Lino S of Tax Computat/on) $
Under penalties of perjury) Z declare that tho facts Z have reported above are true) correct and
TAXP~R S~RE TELEPHONE HUHBER DATE
GREGORY L BROWN
1800 PINE ST
CAMP HILL PA 17~11
ZNFORMATZON NOTZCE
AND
TAXPAYER RESPONSE
FZLE NO. Zl OH
ACN 06125558
DATE 06-zg-z006
TYPE OF ACCOUNT
EST. OF ROGER A BROWN ~-~SAVING$
S.S. NO. 198-22-9695 []CHECKING
DATE OF DEATH 06-50-Z006 ~ITRuST
COUNTY CUMBERLAND I--)CERTIF.
RERZT PAYHENT AND FORRS TO:
REGISTER OF gills
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
COMPLETE PART 1 BELOW # # N SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 019822969S
Bate 06-21-2000
EstabLished
Account Balance 666.79
Percent Taxable X S0,0 O0
Amount Subject ~o Tax 353.60
Tax Rate X
Potential Tax Due
PART TAXPAYER RESPONSE
A. ~ The above in(ormatJon and tax due is correct.
ONE
You must complete PART ~ and/or PART ~ below,
PART Zf you indicate e differen~ tjx rate~ please state your
TAX RETURN - COMPUTATION OF
LINE 1. Data Establtshe~
2. Account Balance
3. Percent Taxable
~. A.ount Subject to Tax
B. Debts and Deductions
6. Amount Taxable
7. Tax Rata 7
8. Tax Duo
PART
DATE PAID
TAX ON JOINT/TRUST ACCOUNTS
DEBTS AND DEDUCTIONS CLAIMED
PAYEE DESCRIPTION AMOUNT PAID
TOTAL (Enter on LAne $ of T~ Coeputetion) $
Ullder p~nJltles of perjury, I declare that the facts 'r have reported a~ve are ~e, corr~ ~d
ete to ~h. ~ kn~ge d b.li.f.
~ER S~RE TELEPHONE NUMBER DATE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF iNDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128 0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 004164
BROWN GREGORY L
1800 PINE ST
CAMP HILL, PA 17011
........ fold
ESTATE INFORMATION: SSN: 198-22-9493
FILE NUMBER: 2104-0665
DECEDENT NAME: BROWN ROGER A
DATE OF PAYMENT: 07/15/2004
POSTMARK DATE: 07/1 4/2004
COUNTY: CUM BERLAN D
DATE OF DEATH: 04/30/2004
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
00412557 t~9.07
00412558 915.00
TOTAL AMOUNT PAID:
$24.07
REMARKS:
SEAL
CHECK# 361
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
Name of Decedent:
Date of Death:
Will No.:
To the Register:
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
CHARLOTTE S. TAYLOR
June 10, 2004
21-04-0655
I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules
was served on or mailed to the following beneficiaries of the above-captioned estate on August 14, 2003:
David B. Stewart
5 Brandywine Drive
Mechanicsburg, PA 17050
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None
Date: c-~[,g,.. ~,..~tl y9
COYNE & COYNE, P.C.
(J ~igS0alU;;~; C °~, S~ee;tE squire
Camp Hill, PA 17011-4227
(717) 737-0464
Pa. Supreme Ct. No. 53788
Counsel for Personal Representative
BUREAU OF /NDIVIDUAL TAXES
THHERTTAHCE TAX DTVTSTON
DEPT. 280601
HARRTSBURg, PA 17128-0601
GREGORY L BROWN
1800 PINE ST
CAMP HILL
PA 17011
COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE
NOTZCE OF ZNHERTTANCE TAX
APPRAISEHENT, ALLONANCE OR DTSALLO#ANCE
OF DEDUCTIONS, AND ASSESSNENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
DATE 08-09-200q
ESTATE OF BROWN ROGER
DATE OF DEATH 0q-$0-200~
FILE NUNBER 21 0q-0665
COUNTY CUMBER LAND
SSN/DC 198-22-9q95
ACN 0q125557
Amoun~ Remi ~:*l:ed I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
A
CUT ALONG THIS LINE I~ RETAIN LONER PORTION FOR YOUR RECORDS
REV-1548 EX AFP
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 08-09-200~
ESTATE OF BROWN
ROGER A DATE OF DEATH 0~-30-200R COUNTY CUMBERLAND
FILE NO. 21 0~-0665 S.S/D.C. NO. 198-22-9~93 ACN 0q125557
TAX RETURN WAS: (X) ACCEPTED AS FILED ¢ ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: PSECU ACCOUNT NO. 0198229~93
TYPE OF ACCOUNT: C ) SAVINGS ¢ ~ CHECKING ( ) TRUST ( ) TIHE CERTIFICATE
DATE ESTABLISHED 0~-21-2000
Accoun~ Balance
Percen~ Taxable X 0.500
Amoun~ Subjec~ ~o Tax 201.61
Debts and Deduc~/ons - .00
Taxable Amoun~ 201.61
Tax Ra~e X .q5
Tax Due 9.07
TAX CREDTTS:
NOTE:
PAYMENT RECEIPT DISCOUNT (+) ,~.,
AMOUNT
DATE NUMBER INTEREST/PEN PAID ¢-) ....
PAYMENT MUST BE MADE BY 01-$1-2005~.
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REG .~TL~' OF WILLS AT THE
AB09*~ ~DRF_~. ~ CHECK
OR Ivey OR~R PA~LE TO:
'REd'STIR
I
TOTAL TAX CREDIT
· ALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED.
IF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
.00
9.07
.00
9.07
PURPOSE OF
NOTICE=
To fulfill the requirements of Section ZI~O of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (72 P.S.
Section 91~0).
PAYNENT:
Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the
reverse side.
-- Hake check or money order payable to: REGISTER OF WILLS, AGENT.
REFUND (CR):
OBJECTIONS:
ADHIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
A refund afa tax credit, which ams not requested on the tax return, may be requested by completing an "Application
for Refund of Pennsylvania Znheritance and Estate Tax" (REV-IS13). Applications are availabZe at tho Office of
the Register of Nills, any of the 25 Revenue District Offices or by calling the special 2q-hour ansaering service
for forms ordering: 1-800-36Z-ZO50; services for taxpayers aith special hearing and or speaking needs:
1-800-~fiT-30ZO (TT only).
Any party in interest not satisfied aith the appraisement, allowance, or disallowance of deductions or assessment
of tax (including discount or interest) as sheen on this Notice may object aithin sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 2810Z1, Harrisburg, PA 171ZB-10Z1, OR
--electing to have the matter determined at the audit of the account of the personal representative, OR
--appeal to the Orphans' Court
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. Z80601, Harrisburg, PA 171Z8-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-iS01) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decedant's death, a five percent (SZ)
discount of the tax paid is alloaed.
The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you mould appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning aith first day of delinquency, or nine (9) months and one (1) day
from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982
bear interest at the rate of six (6Z) percent par annum calculated at a daily rate of .00016~.
A11 taxes which became delinquent on or after January 1, 198Z will bear interest at a rate ahich w111 vary from
calendar year to calendar year aith that rate announced by the PA Department of Revenue. The applicable
interest rates for 198Z through ZO0~ are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
198~ ZOZ .0005~8 198'~8-1991 11Z .000501 2001 9Z .a002~7
1985 162 .000~58 1992 9Z .O00Z~7 ZOOZ 62 .OOOZ19
198~ 112 .000301 1995-199~ 7Z .00019Z ZOOS 52 .000157
1985 13Z .000556 1995-1998 9Z .O00Z~7 ZO0~ ~Z .000110
1986 lOX .O0027~ 1999 72 .00019Z
1987 9Z .O00Z~7 ZOO0 8Z .OOOZ19
--Interest ls calculated as follo~s:
/NTEREST = BALANCE OF TAX UNPAZD X NUNBER OF DAYS DBLZN{)UENT X DA]:LY I'NTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date sheen on the
Notice, additional interest must be calculated.
BUREAU OF TNDZVTDUAL TAXES
/NHERTTAHCE TAX DTVTSInN
DEPT. Z80601
HARRTSBURG, PA 171Z8-060!
GREGORY L BROWN
1800 PINE ST
CARP HILL
PA 17011
COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE
NOTTCE OF TNHERI'TANCE TAX
APPRATSEHENT~ ALLONANCE OR DISALLO#ANCE
OF DEDUCTIONS~ AND ASSESSMENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
DATE 08-09-200q
ESTATE OF BROWN
DATE OF DEATH 0q-$0-200~
FILE NUMBER 21 0~-0665
COUNTY CUMBERLAND
SSN/DC 198-22-9~95
ACN 0~125558
Amoun'lc
REV-1048 EX &FP COl-OS)
RO6ER A
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS
REV-1548 EX AFP (01-03)
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 08-09-200q
ESTATE OF BROWN
ROGER A DATE OF DEATH 0~-30-200~ COUNTY CUMBERLAND
FILE NO. 21 0~-0665 S.S/D.C. NO. 198-22-9~95 ACN
TAX RETURN WAS: (X) ACCEPTED AS FILED ¢ ) CHANGED
0q125558
JOINT OR TRUST ASSET ZNFORMATION
FINANCIAL INSTITUTION: PSECU ACCOUNT NO. 0198229~95
TYPE OF ACCOUNT: (~ SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 0~-21-2000
Account Balance
Percent Taxable X 0.500
Amount Subject to Tax 333.~0
Debts and DeductAons - .00
Taxable Amount
Tax Rate X .q5
Tax Due 15.00
TAX CREDZTS:
PAYMENT
DATE
RECEIPT
NUMBER
666.79 NOTE:
DISCOUNT (+)
INTEREST/PEN PAID C-)
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVI------------------~BDRE~. Iv~CHECK
OR M_l:~l~ OR]~:R PA~,E TO:
"REG~ER OF:~/ILLS~!:'~GENT."
PAYMENT MUST BE MADE BY 01-$1-2005~. TOTAL TAX CREDIT
BALANCE OF TAX DUEI
INTEREST AND PEN.
TOTAL DUE
~ ZF PAID AFTER TH/S DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND.
SEE REVERSE S/DE OF THIS FORM FOR ZNSTRUCT/ONS. )
.00
15.00
.00
15.00
PURPOSE OF
NOTICE:
To ~ulfill the requirements of Section Z140 oF the Inheritance and Estate Tax Act~ Act Z$ of ZOO0. (TZ P.S.
Sect[on 9140).
PAYNENT:
REFUND [CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PERALTY:
INTEREST:
Detach the tap port[on of this Not[ca and submit with your payment to the Register of Hills printed on the
reverse side.
-- Hake check or money order payable to: REGISTER OF HILLS, AGENT.
A refund of a tax credit, ah[ch was not requested on the tax return, may ba requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of
the Rag[star of Hills, any of the Z3 Revenue District Offices or by calling the special Z4-hour answering service
for forms ordering: 1-800-SSZ-ZOSD; services for taxpayers with special hearing and er speaking needs:
X-BOO-447-SOZO (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment
of tax (including discount or interest) as shown on this Notice amy object within sixty (60) days of receipt of
this Rotice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. Z810Z1, Harrisburg, PA 171ZB-10Zl, OR
--electing to have the matter determined at the audit of the account of the parsenal representative, OR
--appeal to the Orphans' Court
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. Z80601, Harrisburg, PA 171ZB-0601
Phone (717) 787-6505. Sea page 5 of the booklet "Instructions far Inheritance Tax Return for a Res[dent
Decedent" (REV-lSD1) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SZ)
discount of the tax paid is allowed.
The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the tho same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning eith first day of delinquency, or nine (9) months and one il) day
from the date of death, to the data of payment. Taxes which became delinquent before January 1, 1982
bear interest at the rate of slx (6Z) percent per annum calculated et a daily rate of .000164.
Al1 taxes eh[ch became delinquent on or after January 1, 198Z will bear interest at a rate which will vary from
calendar year to calendar year with that rate announced by the PA
Department of Revenue.
The applicable
interest rates for 19BZ through ZOO4 are:
Interest Daily Interest Daily Interest Daily
Year Rata Factor Year Rate Factor Year Rate Factor
198~ ZOZ .000548 1988-1991 1ZZ .000301 ZOO1 9X .000247
1983 162 .000438 1992 92 .000247 ZOO2 62 .O00Z19
1984 llZ .000301 1993-1994 72 .O0019Z ZOO3 5Z .000157
1985 13Z .000556 1995-1998 9Z .000Z47 ZOO4 4Z .000110
1986 lOZ .000Z74 1999 7Z .O0019Z
1987 9Z .0002q7 ZOO0 8Z .O00Z19
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DRLINI;~UENT X DAILY TNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX D/VTSTOH
DEPT. 180601
HARRTSBURG., PA 17118-n601
CONHONWEALTH OF PENNSYLVANIA
BEPARTNENT OF REVENUE
ZNHERZTANCE TAX
STATEMENT OF ACCOUNT
'04 SE? 15 /~8:23
GREGORY L BROWN
1800 PINE ST
CAMP HTLL PA~'-;ITO 11
BATE 08-$0-2004
ESTATE OF BROWN
BATE OF BEATH 04-50-2004
FILE NUHBER 21 04-0665
COUNTY CUHBERLAND
ACN 04125558
r Aeoun~ Reei~ed
ROGER A
MAKE CHECK PAYABLE ANB REHZT PAYNENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
NOTE: To insure proper credL~ ~o your account, subei~ ~he upper portion of ~hLs fore wi~h your ~ex payeen~
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORBS -.~
REV-1607 EX AFP (01-03) ~ INHERITANCE TAX STATEHENT OF ACCOUNT ~
ESTATE OF BROWN
ROGER A FZLE NO. Z1 04-0665 ACN 04125558 DATE 08-50-2004
THIS STATEMENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NANED ESTATE. SHO#N BELO#
ZSA SUNMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-09-Z004
PRINCIPAL TAX DUE:
PAYMENTS (TAX CREDITS):
15.00
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAIB
07-14-2004 CD004164 .75 15.00
IF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( ZF TOTAL DUE ZS LESS THAN $1,
NO PAYNENT ZS REQUIRED.
IF TOTAL DUE ZS REFLECTED AS A 'CREDIT- (CR),
TOTAL TAX CREBZT 15.75
BALANCE OF TAX DUE .75CR
INTEREST AND PEN. .00
TOTAL DUE .75CR
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.
BUREAU OF ZNDZVTDUAL TAXES
ZNHERTTANCE TAX DIVISION
DEPT. Z80601
HARRTSBURG, PA 171Z8-0601
COHHONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
ZNHERTTANCE TAX
STATEHENT OF ACCOUNT
REV-1607 EX &FP
GREGORY L BROWN
1800 PINE ST
CAMP HILL PA 170~~L;
DATE 08-$0-200~
-:ESTATE OF BROWN
DATE OF DEATH 0R-$0-200~
FILE NUHBER 21 0~-0665
._COUNTY CUHBERLAND
'Z~CN 0~125557
ROGER A
Amoun~ Remi~ed
HAKE CHECK PAYABLE AND REHIT PAYHENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper cred/~ ~o your account, submit: ~he upper portion of ~his form wi~h your ~(ax payment.
CUT ALONG THIS L'rNE ~ RETA'rN LONER PORTION FOR YOUR RECORDS ~
REV-1607 EX AFP (01-03) #~ ZNHER'rTANCE TAX STATEHENT OF ACCOUNT
ESTATE OF BROWN ROGER A FZLE NO. 21 0~-0665 ACN 0~125557 DATE
THIS STATEMENT ZS PROVIDED TO ADVZSE OF THE CURRENT STATUS OF THE STATED ACH ZN THE NAMED ESTATE. SHO#N BELO#
ZSA SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTHENT: 08-09-200~
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYHENTS (TAX CREDITS):
9.07
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
07-1q-200q COOOql6q .~5 9.07
IF PAZD AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE 1S LESS THAN $1,
NO PAYHENT IS REQUIRED.
IF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR),
TOTAL TAX CREDIT 9.52
BALANCE OF TAX DUE .~5CR
INTEREST AND PEN. .00
TOTAL DUE .~SCR
YOU HAY BE DUE A REFUND. SEE REVERSE SZDE OF THZS FORH FOR INSTRUCTIONS.