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INHERITANCE TAX
RECORD ADJUSTMENT
rrv^ ~ -~ r--_ ~ Q'~~NTLY HELD OR TRUST ASSETS
BUREAU OF INDIVIDUAL TAXESii.~„+ ~ {~t _ l1~
INHERITANCE TAX DIVISION F~
PO BOX 280601 , ,~_ ~~ „ ~-;I i
HARRISBURG PA 17128-0601
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CLERK 0~
QRRt-~~~'S COURT
RUTH B Cul~~~~[.~!~~~U L'~„ P~.
207 S ORANGE STREET
CARLISLE PA 17013
Pennsylvania i~
DEPARTMENT OF REVENUE
REV-1604 EX AFP (12-10)
DATE 03-10-2011
ESTATE OF BARYON LEIA T
DATE OF DEATH 03-27-2010
FILE NUMBER 21 10-0528
COUNTY CUMBERLAND
SSN/DC 407-64-9617
ACN 10120397
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 E~
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REV-1604 EX AFP C12-10~
** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS **
DATE: D3-10-2011
ESTATE OF: BARYON LEIA T DATE OF DEATH: 03-27-2010 COUNTI(: CUMBERLAND
FILE NO.: 21 10-0528 S.S/D.C. N0.:407-64-9617 ACN: 10120397
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MEMBERS 1sT FCU ACCOUNT NO.: 223251-1 1
TYPE OF ACCOUNT: ( ) SAVINGS CX) CHECKING ( ) TRUST C ) TIME CERTIFICATE
DATE ESTABLISHED 01-19-2006
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
.00
X 0.500
.00
.00
.00
X .045
.00
NOTE: TO ENSURE PROPER CREDIT TD YOUR
ACCOUNT, SUBMIT 7'HE 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 (-)
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.
^
.~~
FJ-1470 EX ~6-88)
}1,9 ,_
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO Box 280601
_ HARRISBURG, PA 17128-0601
E)E_CEDENT'S NAME
BARYON LEIA T
F:E=VIEWED BY
Elizabeth A. Bloom
INHERITANCE TAX
EXPLANATION
OF CHANGES
FILE NUMBER
2110-05281
10120397
ITEM --
S~~HEDULE NO. EXPLANATION OF CHANGES
Above-referenced ACN(s) are being adjusted to reflect zero tax due since they have been
reported on the probate return.
r".,~n„~~ov
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