HomeMy WebLinkAbout07-30-12 (4)_~ ~~FC~~C ric INHERITANCE TAX
BUREAU OF INDIVIDUAL TAXE~~~jO~~~j~ f C Ii~RECORD ADJUSTMENT
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HARRISBURG PA 17128-0601
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BARBARA K GEISTWHI~JMQ~RLA~D CO., PA
18 CIRCLE DRIVE
CARLISLE PA 17015-0000
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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 11501754
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 C12-11~
** 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: 11501754
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
BENEFICIARY FORM ASSETS
NAME OF SECURITY: MERRILL LYNCH
TYPE OF ACCOUNT: (~ SECURITIES C ) SEC ACCT C ) 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
( ) BOND
NOTE: TO ENSURE PROPER CREDIT TO YOUR
ACCOUNT, SUBMIT THE UPPER PORTION
OF THIS NOTICE WITH YOUR TAX
PAYMEI~IT 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 (-) 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" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.