HomeMy WebLinkAbout09-04-12INHERITANCE TAX
RECORD ADJUSTMENT
~ ,,~,~~ ;-. - ~.-~-- @INTLY HELD OR TRUST ASSETS
BUREAU OF INDIVIDUAL TAX`>'~! -' J~~~L-`~ t
INHERITANCE TAX DIVISION ~" j' ~ t'!
PO BOX 280601 t '~ _'!'. ~ '.. ~~ ~~!'-.i-'1
HARRISBURG PA 17128-0601
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CATHY S -~U~~Q CC}., PA,
116 W HILLCREST DR
CARLISLE PA 17013-1215
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DEPARTMENT OF REVENUE
REV-1604 EX AFP (12-11)
DATE 08-22-2012
ESTATE OF DONIVAN ROYAL S
DATE OF DEATH 05-04-2011
FILE NUMBER 21 11-0564
COUNTY CUMBERLAND
SSN/DC 160-20-2591
ACN 11179006
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 t12-11)
** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS **
DATE• 08-22-2012
ESTATE OF: DONIVAN ROYAL S DATE OF DEATH: 05-04-2011 COUNTY: CUMBERLAND
FILE NO.: 21 11-0564 S.S/D.C. N0.:160-20-2591 ACN: 11179006
ADJUSTMENT BASED ON : ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: SOVEREIGN BANK ACCOUNT NO.: 0591134373
TYPE OF ACCOUNT: ( ) SAVINGS CX) CHECKING C ) TRUST ( ~ TIME CERTIFICATE
DATE ESTABLISHED 10-21-2008
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
.00
X 0.166
.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 0R MONEY ORDER PAYABLE
T0: "REGISTER OF WILLS, AGENT."
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT (+)
INTEREST/PEN PAID C-) AMOUNT PAID
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED A5 A
"CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.