HomeMy WebLinkAbout12-15-14 INHERITANCE TAX
RECORD ADJUSTMENT t pennsyLvania
- 'JOINTLY HELD OR TRUST ASSETS DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION REV-1604 EX AFP (11-14)
HARRISBURG
PO BOX 2806PA 1 91 -
01 qg�DED OFFICE OF
REGISTER OF WILLS DATE 12-05-2014
Zop OEC 15 pn 12 17 ESTATE OF KOHLHAAS PHILIP C
DATE OF DEATH 07-28-2013
FILE NUMBER 21 14-0649
CLERI'l OF COUNTY CUMBERLAND
DEREK ORF(Hkbk' A��RT SSN/DC
PA ACN 13143377
81E Fv r
C/O DtW Amount Remitted
2132 MARKET ST
CAMP HILL PA 17011-4706
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 4-
REV-1604 EX AFP (11-14)
INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS
DATE: 12-05-2014
ESTATE OF: KOHLHAAS PHILIP C DATE OF DEATH: 07-28-2013 COUNTY: CUMBERLAND
FILE NO. : 21 14-0649 S.S/D.C. NO. : ACN: 13143377
ADJUSTMENT BASED ON: PROTEST BOARD DECISION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO . : 13797-00
TYPE OF ACCOUNT: ( X) SAVINGS ( ) CHECKING TRUST TIME CERTIFICATE
DATE ESTABLISHED 06-30-1988
Account Balance .0'0 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 .00
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.