HomeMy WebLinkAbout03-15-11BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
INHERITANCE TAX
RECORD ADJUSTMENT
~.-JOINTLY HELD OR TRUST ASSETS
~_
DIANA D MILLER
8 CEDAR ROAD
CARLISLE PA 17015
pennsylvan~a ~ ~
DEPARTMENT OF REVENUE
REV-1604 EX AFP C12-LO) ~ ~~~~~~
DATE 03-04-2011
ESTATE OF BURKHOLDER TROY A
DATE OF DEATH 11-20-2009
FILE NUMBER 21 10-0035
COUNTY CUMBERLAND
SSN/DC 188-20-8796
ACN 09177245
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
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: 03-04-2011
ESTATE OF: BURKHOLDER TROY A DATE OF DEATH: 11-20-2009 COUNTY: CUMBERLAND
FILE NO.: 21 10-0035 S.S/D.C. N0.:188-20-8796
ACN: 09177245
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MEMBERS iST FCU ACCOUNT NO.: 363535-11
TYPE OF ACCOUNT: C ~ SAVINGS CX7 CHECKING C ~ TRUST C ? TIME CERTIFICATE
DATE ESTABLISHED 08-01-2009
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
.00
X 1.000
.00
_ .00
.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
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" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.
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