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RECORD ADJUSTMENT - pennsyLvarna
JOINTLY HELD OR TRUST ASSETS DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES -
INHERITANCE TAX DIVISION REV-1604 IX AFP (12-13)
PO BOX 2BO601
HARRISBURG PA 17128-0601
DATE 07-17-2014
ESTATE OF MCALISTER ROBERT G
DATE OF DEATH 03-14-2013
FILE NUMBER 21 14-0196
COUNTY CUMBERLAND
JAY MCALISTER SSN/DC 198-22-8822
ACN 13117143
509 W CUMBERLAND RD
ENOLA PA 17025-2514 Amount Remitted
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—REV-1604 EX AFP (12-13)
■■ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS
DATE: 07-17-2014
ESTATE OF: MCALISTER ROBERT G DATE OF DEATH: 03-14-2013 COUNTY: CUMBERLAND
FILE NO. : 21 14-0196 S.S/D.C. NO. : 198-22-8822 ACN: 13117143
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: SUSQUEHANNA BANK ACCOUNT NO . : 10007889651
TYPE OF ACCOUNT: ( ) SAVINGS ( X) CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 03-17-2010
Account Balance 3.228.92 NOTE: TO ENSURE PROPER CREDIT TO YOUR
Percent Taxable X 0. 166 ACCOUNT, SUBMIT THE UPPER PORTION
Amount Subject to Tax 538. 16 OF THIS NOTICE WITH YOUR TAX
Debts and Deductions - . 00 PAYMENT TO THE REGISTER-�OF WILLS
Taxable Amount 538. 16 AT THE ADDRESSP DWN ABJOVE.
T r-
Tax Rate X . 045 MAKE CHECK OR EY OROER P4--" CE
Tax Due 24.22 TO: "REGISTER� �WI LLS; AGENT"
TAX CREDITS : 'I` co
PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
C7.
y Cn --rT
INTEREST IS CHARGED THROUGH 08-01-2014 TOTAL TAX PAYMENT . 00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 24.22
REVERSE SIDE OF THIS FORM INTEREST AND PEN. .46
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.