HomeMy WebLinkAbout07-30-12BUREAU OF INDIVIDUALTI,T~AfiQ~~~ u~~F~L~. ~, RECORDIADJUSTMENT
POHBOXT280601~ DIVISION ~~~~~~c~ r~~: ~~~~) ~ C BENEFICIARY FORM ASSETS
HARRISBURG PA 17128-0601 f
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FRANK B KONF~~~ ~•~
6301 MIMOSA DRIVE
CHAPEL HILL NC 27514-0000
Pennsylvania ~
DEPARTMENT OF REVENUE
REV-1604A EX AFP (12-11)
DATE 07-19-2012
ESTATE OF KONHAUS FRANCES F
DATE OF DEATH 06-28-2011
FILE NUMBER 21 11-1016
COUNTY CUMBERLAND
SSN/DC
ACN 11501757
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 ~
REV-1604A EX AFP (12-11~
** INHERITANCE TAX RECORD ADJUSTMENT BENEFICIARY FORM ASSETS **
DATE: 07-19-2012
ESTATE OF: KONHAUS FRANCES F DATE OF DEATH: 06-28-2011 COUNTY: CUMBERLAND
FILE NO.: 21 11-1016 S.S/D.C. NO.: ACN: 11501757
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
BENEFICIARY FORM ASSETS
NAME OF SECURITY: MERRILL LYNCH
TYPE OF ACCOUNT: C~ SECURITIES C ) SEC ACCT ( ) STOCK
DOD Valuation
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Due
Tax Rate
TAX CREDITS:
101,141.01
X 0.250
25,285.25
13,854.41
11,430.84
X .045
514.00
ACCOUNT NO.: 872-10826
C ) BOND
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 C-) AMOUNT PAID
09-27-2011 CD015006 25.70 614.20
TOTAL TAX PAYMENT 639.90
BALANCE OF TAX DUE
INTEREST AND PEN. .00
TOTAL DUE 125.90CR
* 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.