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HomeMy WebLinkAbout07-21-14 INHERITANCE TAX ]pennsylvania BUREAU OF INDIVIDUAL TAXES RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS DEPARTMENT OF REVENUE REV-1601 IX AFP (12-13) INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 DATE 07-09-2014 ESTATE OF WARCHOLA BETTY L DATE OF DEATH 03-21-2013 FILE NUMBER 21 13-0877 COUNTY CUMBERLAND SSN/DC LYNDE K BLYMIER ACN 13124715 132 REX DR Amount Remitted CARLISLE PA 17015-8844 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 +— ----------—------—----------_-----------------—--------------------------_------------------_-------------------—--------------.---------------- REV-1604 EX AFP (12-13) ■ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ■■ DATE: 07-09-2014 ESTATE OF: WARCHOLA BETTY L DATE OF DEATH: 03-21-2013 COUNTY: CUMBERLAND FILE NO. : 21 13-0877 S.S/D.C. NO. : ACN: 13124715 ADJUSTMENT BASED ON : ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION : MEMBERS 1ST FCU ACCOUNT NO. : 151919-D0 TYPE OF ACCOUNT: ( X) SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 06-05-1995 Account Balance 1,916.92 NOTE: TO ENSURE PROPER CREDIT TO YOUR Percent Taxable X 0.500 ACCOUNT, SUBMIT THE UPPER PORTION Amount Subject to Tax 958.46 OF THIS NOTICE WITH YOUR TAX Debts and Deductions 958.46 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 : n o — _ Q r PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID SLJ _,. C T DATE NUMBER INTEREST/PEN PAID (-) Gar". t S � S N CD CD TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE I nn * 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. V