HomeMy WebLinkAbout07-13-12 (3)INHERITANCE TAX
ORD ADJUSTMENT
~~~N~;~~" LD OR TRUST ASSETS
BUREAU OF INDIVIDUAL TAXES ~U~~/~~" ""'
INHERITANCE TAX DIVISION r~i~~i-~ rte '~~~~~ ~~
PO BOX 280601 ~[u,J. 'v)
HARRISBURG PA 17128-0601
2012 ,1U1 { 3 PM 12~ ~+
O D A C H O P P L E ~VI~EALf~N~ CO..
108 SUNSET DR
NEW CUMBERLAND PA 17070-3059
Pennsylvania ~ . -
DEPARTMENT OF REVENUE
REY-16D4 EX AFP (12-11)
DATE 07-09-2012
ESTATE OF KOLLER BARBARA R
DATE OF DEATH 12-24-2011
FILE NUMBER 21 12-0229
COUNTY CUMBERLAND
SSN/DC
ACN 12104028
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 YOUR RECORDS ~
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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: 12104028
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: FULTON BANK NA ACCOUNT NO.: 9932-31610
TYPE OF ACCOUNT: CX} SAVINGS C ) CHECKING C ) TRUST C ) TIME CERTIFICATE
DATE ESTABLISHED 11-29-1984
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 (+)
INTEREST/PEN PAID (-) AMOUNT PAID
02-15-2012 CD015607 .00 21.66
04-03-2012 CD015819 .00 81.74
TOTAL TAX PAYMENT 103.40
BALANCE OF TAX DUE 103.40CR
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.