HomeMy WebLinkAbout05-22-12 (2)INHERITANCE TAX
BUREAU OF INDIVIDUAL TAXES ~ RD ADJUSTMENT
INHERITANCE TAX DIVISION ~F`~i ~~~-. ~ ~~~~~ •~~^
' ' g~~ C CIARY FORM ASSETS
PO BOX 280601
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HARRISBURG PA 17128-0 601 ~,",. t _. ,,,.'-,~J
Pennsylvania i
DEPARTMENT OF REVENUE
REV-1604A EX AFP C12-11) -~-
rti tE~::~~ ~~ ~,,~;~ ~: itl~ DATE 05-08-2012
ESTATE OF TURNBAUGH VIOLET M
DATE OF DEATH 12-18-2010
FILE NUMBER 21 11-0280
NANCY L DIENER (}f 1;-j-- ~ I_;~ ;j~i± COUNTY CUMBERLAND
1287 WOODRUFF PLACE Cl1MBER!.,~J~~l~ vJ., pA SSN/DC 185-01-1563
MORGANTOWN WV 26505-0000 ACN 11500120
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE --1 RETAIN LOWER PORTION FOR YOUR RECORDS E-
REV-1604A EX AFP (12-11~
** INHERITANCE TAX RECORD ADJUSTMENT BENEFICIARY FORM ASSETS **
DATE: 05-08-2012
ESTATE OF: TURNBAUGH VIOLET M DATE OF DEATH: 12-18-2010 COUNTY: CUMBERLAND
FILE N0.:21 11-0280 S.S/D.C. NO.: 185-01-1563 ACN: 11500120
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
BENEFICIARY FORM ASSETS
NAME OF SECURITY: EDWARD JONES
TYPE OF ACCOUNT: CX) SECURITIES ( ) SEC ACCT ( ) STDCK
DOD Valuation
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Due
Tax Rate
TAX CREDITS:
00
X 0.000
.00
.00
.00
X .045
.00
ACCOUNT NO.: 957-12004
( ) BOND
NOTE: TO ENSURE PROPER CREDIT TO YOUR
ACCDUNT, 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 C-) gMDUNT PAID
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE
INTEREST AND PEN. .00
TOTAL DUE .OD
+ IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OFADDITIDNAL INTEREST. IF TOTAL DUE IS REFLECTED AS
A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FDR INSTRUCTIONS.