HomeMy WebLinkAbout09-24-12 (3)INHERITANCE TAX
RECORD ADJUSTMENT
[[~~(~ NTLY HELD OR TRUST ASSETS
BUREAU OF INDIVIDUAL TAX~j~;J ~,%~~~~jt
INHERITANCE TAX DIVISION [~ „f ~-~-, t-,.r ~} C
PO BOX 280601 REG(5 ~ ~~ L~ Y~+~!' V
HARRISBURG PA 17128-0601
~~12 SEP 24 PM 1 ~ 3;~
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ORPHAN'S C~l~RT
EDRIS A ~'~~[} C~„
2039 HARVEST DR
MECHANICSBURG PA 17055-7036
pennsylvania ~
DEPARTMENT OF REVENUE
REV-1604 EX AFP (12-11)
DATE 09-18-2012
ESTATE OF DAVIES EDRIS W
DATE OF DEATH 03-26-2011
FILE NUMBER 21 11-0544
COUNTY CUMBERLAND
SSN/DC
ACN 11130162
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-1604 EX AFP C12-11~
~* INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS **
DATE• 09-18-2012
ESTATE OF: DAVIES EDRIS W DATE OF DEATH: 03-26-2011 COUNTY: CUMBERLAND
FILE NO.: 21 11-0544 S.S/D.C. N0.: ACN: 11130162
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: SOVEREIGN BANK ACCOUNT NO.: 1685549212
TYPE OF ACCOUNT: C ~ SAVINGS ( ~ CHECKING (X) TRUST { ) TIME CERTIFICATE
DATE ESTABLISHED 11-02-2009
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
4,369.49
X 1.000
4,369.49
.00
4,369.49
X .045
196.63
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
INTEREST IS CHARGED THROUGH 10-03-2012 TOTAL TAX PAYMENT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 196.63
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 4.55
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.
' Pennsylvani
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO BoX 280801
SCHEDULE I ITEM
_~ NO.
Edris W pavies
Robin Graff
INHERITANCE rqX
EXPLANATION
OF CHANGES
2111-05a
EXPLANATION OF CHANGES 11130162
Changed tax rate from 15 percent to 4.5 e
beneficiary,
p rcent since a grandchild is a lineal
ROW
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