HomeMy WebLinkAbout05-22-12 INHERITANCE TAX
RECORD ADJUSTMENT Pennsylvania ~
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. OR TRUST ASSETS DEPARTMENT OF REVENUE
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REV-1604 EX AFP (12-11)
PO BOX 280601
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HARRISBURG PA 17128-0601
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' ` ~''Y ` " ~ • L` `~ DATE 05-10-2012
ESTATE OF BURTNER RAYMOND H
DATE OF DEATH 03-08-2011
FILE NUMBER 21 11-0385
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4158 CARLISLE ROAD
Amount Remitted
GARDNERS PA 17324
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---
REV-1604 EX AFP C12-11)
** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS **
DATE: 05-10-2012
ESTATE OF: BURTNER RAYMOND H DATE OF DEATH: 03-08-2011 COUNTY: CUMBERLAND
FILE NO.: 21 11-0385 S.S/D.C. N0.:199-07-6918 ACN: 11118378
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MEMBERS 1sT FCU
ACCOUNT N0.:4949-00
TYPE OF ACCOUNT: (X) SAVINGS ( ) CHECKING ( ) TRUST C ) TIME CERTIFICATE
DATE ESTABLISHED 10-28-1959
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
.00 NOTE:
X 0.500
.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."
TAX CREDITS:
00
.00
X .045
.00
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT C+)
INTEREST/PEN PAID C-) 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.