HomeMy WebLinkAbout11-07-11 (2)INHERITANCE TAX
~r~~ ~;~~~ `JOt ~ C D ADJUSTMENT Pennsylvania ~
BUREAU OF INDIVIDUAL TAXES ~~~ ILO OR TRUST ASSETS
INHERITANCE TAX DIVISION DEPARTMENT OF REVENUE
PO BOX 280601 - ~ ~ -
F1~, I ~.~ REV-1604 EX AFP C12-10)
HARRISBURG PA 17128-0601
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JAMES A SHOTSBERGER~~~~` uL~{~~L~ "t~' P'~
3943 BROOKRIDGE DR
MECHANICSBURG PA 17050
DATE 10-21-2011
ESTATE OF SHOTSBERGER HILDA M
DATE OF DEATH 05-11-2010
FILE NUMBER 21 10-0559
COUNTY CUMBERLAND
SSN/DC 196-14-3221
ACN 10139601
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF= WILLS
1 COURTHOUSE SQUARE
CARLISLE F'A 17013
CUT ALONG THIS LINE ---1 RETAIN LOWER PORTION FOR YOUR RECORDS F-
R E V -16 0 4 EX AFP C 12 -10 ~ -------_______________________~__________
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** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS **
DATE• 10-21-2011
ESTATE OF: SHOTSBERGER HILDA M DATE OF DEATH: 05-11-2010• COUNTY:
CUMBERLAND
FILE NO.: 21 10-0559 S.S/D.C. N0.:196-14-3221
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION ACN: 10139601
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: SOVEREIGN BANK
ACCOUNT NO.: 1051074304
TYPE OF ACCOUNT: ( ) SAVINGS (X) CHECKING C ) TRUST C ) TIME CERTIFICATE
DATE ESTABLISHED 10-02-2003
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
PAYMENT RECEIPT
DATE NUMBER
.00
X 0.500
.00
- .00
.00
X .15
.00
INTE EST%PENT PAID (-)
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."
AMOUNT PAID
TOTAL TAX PAYMENT .0
BALANCE OF TAX DUE
.0
INTEREST AND PEN.
TOTAL DUE 0
* 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 INSTk.UCTIONS.