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INHERITANCE TAX
RECORD ADJUSTMENT pennsytvania
JOINTLY HELD OR TRUST ASSETS DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION REV-1604 EX AFP (12-12)
PO BOX 280601
HARRISBURG PA 17128-0601
°EV RLV-') "n- OF DATE 09-17-2013
ESTATE OF MORRISON LEON C
DATE OF DEATH 12-04-2008
(� FILE NUMBER 21 08-1267
.J i1FP 30 i D! 1 12 � COUNTY
SONDRA MCCOY ACN 09117080
51 HOY RD CLL;,1k Amount Remittetl
CARLISLE ORPHANSPx'(YJA;73 �
CUMBERLAND CO., PA
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE -i RETAIN LOWER PORTION FOR YOUR RECORDS 4-
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REV-1604 EX AFP (12-12)
■ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ■■
DATE: 09-17-2013
ESTATE OF: MORRISON LEON C DATE OF DEATH: 12-04-2008 COUNTY: CUMBERLAND
FILE NO. : 21 08-1267 S.S/D.C. NO. : ACN: 09117080
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: ORRSTOWN BANK ACCOUNT NO. : 4o3m
TYPE OF ACCOUNT: ( ) SAVINGS ( X) CHECKING C 3 TRUST t ) TIME CERTIFICATE
DATE ESTABLISHED 12-31-2001
Account Balance 103,360.70 NOTE: TO ENSURE PROPER CREDIT TO YOUR
Percent Taxable X 0. 166 ACCOUNT, SUBMIT THE UPPER PORTION
Amount Subject to Tax 17,227.13 OF THIS NOTICE WITH YOUR TAX
Debts and Deductions •00 PAYMENT TO THE REGISTER OF WILLS
Taxable Amount 17,227.13 AT THE ADDRESS SHOWN ABOVE.
Tax Rate X .045 MAKE CHECK OR MONEY ORDER PAYABLE
Tax Due 775.22 TO: ^REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)
INTEREST IS CHARGED THROUGH 10-02-2013 TOTAL TAX PAYMENT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 775.22
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 107.
TOTAL DUE
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.