HomeMy WebLinkAbout07-13-12BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
ODA C HOPPLE
108 SUNSET DR
INHERITANCE TAX
~n~~~R~D~DJUSTMENT
L lti~ R TRUST ASSETS
REGIS+Et~ t;~= ~1tj~~c
~~12 JUL 13 Pi~S i2~ ~
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GRPHAN'S ~CI~F T
CUMBERLAND CO., PA
NEW CUMBERLAND PA 17070-3059
iDATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
pennsylvania'~ ~ ~ ~'
DEPARTMENT OF REVENUE
REV-1604 EX AFP (12-11)
07-09-2012
KOLLER BARBARA R
12-24-2011
21 12-0229
CUMBERLAND
ACN 12104030
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSE SgUARE
CARLISLE PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~-
REV-1604 EX AFP C12-11)
*~ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ~*
DATE• 07-09-2012
ESTATE OF: KOLLER BARBARA R DATE OF DEATH: 12-24-2011 COUNTY: CUMBERLAND
FILE NO.: 21 12-0229 S.S/D.C. N0.: ACN: 12104030
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: FULTON BANK NA ACCOUNT NO.: 400-1859588
TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING C ~ TRUST (X) TIME CERTIFICATE
DATE ESTABLISHED 09-24-1985
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 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 C+)
INTEREST/PEN PAID C-) AMOUNT PAID
02-15-2012 CD015607 .00 320.62
06-18-2012 SBADJUST .00 .O1
TOTAL TAX PAYMENT 320.63
BALANCE OF TAX DUE 320.63CR
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.
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