HomeMy WebLinkAbout05-24-13 (2) INHERITANCE TAX
RECORD ADJUSTMENT pennsylvarna
BUREAU OF INDIVIDUAL TAXES JOINTLY HELD OR TRUST ASSETS DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION REV-1604 EX AFP U2-12)
PO BOX 280601
HARRISBURG PA 17128-0601 RECORDED CrvYICE of
REGIS I'R OF ',':PILLS DATE 05-16-2013
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ESTATE OF GREEN MICHAEL T
DATE OF DEA -2008
1.613 FIR 2Li 2 07 FILE NUMBERTH 281 08-09011
COUNTY CUMBERLAND
KRISTEN GREEN CLERK OF SSN/DC 196-48-4639
ACN 08140490
4048 SENECA AVENUECRt'H ANSI COURT Amount Remitted
CAMP HILL CLAN€GRL1AND CCs., CA
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS F
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REV-1604 EX AFP (12-12)
mm INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS xx
DATE: 05-16-2013
ESTATE OF: GREEN MICHAEL T DATE OF DEATH: 08-21-2008 COUNTY: CUMBERLAND
FILE NO. : 21 08-0901 S.S/D.C. NO. : 196-48-4639 ACN: 08140490
ADJUSTMENT BASED ON : ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION : MEMBERS 1ST FCU ACCOUNT NO . : 303655-05
TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING ( X) TRUST C ) TIME CERTIFICATE
DATE ESTABLISHED 04-03-2007
Account Balance •00 NOTE: TO ENSURE PROPER CREDIT TO YOUR
Percent Taxable X 0.500 ACCOUNT, SUBMIT THE UPPER PORTION
Amount Subject to Tax •00 OF THIS NOTICE WITH YOUR TAX
Debts and Deductions - •00 PAYMENT TO THE REGISTER OF WILLS
Taxable Amount •00 AT THE ADDRESS SHOWN ABOVE.
Tax Rate X .045 MAKE CHECK OR MONEY ORDER PAYABLE
Tax Due •00 TO: "REGISTER OF WILLS, AGENT."
TAX CREDITS :
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE . 00
INTEREST AND PEN. . 00
TOTAL DUE no
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.