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Home My WebLink About02-03-12r t BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 INHERITANCE TAX 1 f ~ CORD ADJUSTMENT ~~~~~~~~'.-!~~~' '' ~.~O~IV~LW HELD OR TRUST ASSETS ;~i; ..., ~1 },J CLERK 0~ ORPhlAN'S CCllRT MICHAEL THOMAS 729 BOSLER AVE LEMOYNE PA 17043 ,- Pennsylvania ~~~ DEPARTMENT OF REVENUE REV-1604 EX AFP (12-11) DATE 01-26-2012 ESTATE OF THOMAS CATHERINE A DATE OF DEATH 12-03-2010 FILE NUMBER 21 11-0826 COUNTY CUMBERLAND SSN/DC 350-18-7836 ACN 11124495 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 YDUR RECORDS ~ REV-1604 EX AFP C12-11) ** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ** DATE• 01-26-2012 ESTATE OF: THOMAS CATHERINE A DATE OF DEATH: 12-03-2010 COUNTY: CUMBERLAND FILE NO.: 21 11-0826 S.S/D.C. N0.:350-18-7836 ACN: 11124495 ADJUSTMENT BASED ON: PROTEST BOARD DECISION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: METRO BANK ACCOUNT NO.: 7760449481 TYPE OF ACCOUNT: CX) SAVINGS C ) CHECKING C ) TRUST C ) TIME CERTIFICATE DATE ESTABLISHED 09-13-2010 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 .15 .00 NOTE: TO ENSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TD 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. pa BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 260601 HARRISBURG PA 17128-0601 INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS MICHAEL THOMAS 729 BOSLER AVE LEMOYNE PA 17043 Pennsylvania ~ DEPARTMENT OF REVENUE REV-1604 EX AFP (12-11) DATE 01-26-2012 ESTATE OF THOMAS CATHERINE A DATE OF DEATH 12-03-2010 FILE NUMBER 21 11-0826 COUNTY CUMBERLAND SSN/DC 350-18-7836 ACN 11124496 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE ---~ RETAIN LOWER PORTION FOR YOUR RECORDS F- R E V- 1 6 0 4 EX AFP C 1 2- 1 1) --------------------------------------------------------------------------------------------------------------------- ** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ** DATE• 01-26-2012 ESTATE OF: THOMAS CATHERINE A DATE OF DEATH: 12-03-2010 COUNTY: CUMBERLAND FILE NO.: 21 11-0826 S.S/D.C. N0.:350-18-7836 ACN: 11124496 ADJUSTMENT BASED ON: PROTEST BOARD DECISION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: METRO BANK ACCOUNT NO.: 833469299 TYPE OF ACCOUNT: C ) SAVINGS CX) CHECKING C ) TRUST C ) TIME CERTIFICATE DATE ESTABLISHED 09-13-2010 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: .00 NOTE: X 1.000 .00 .00 .00 X .15 .00 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 (+) 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" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.