HomeMy WebLinkAbout01-26-15 (2) BUREAU OF INDIVIDUAL TAXES RECORD ADJUSTMENTINHERITANCE TAX Pennsylvania
INHERITANCE TAX DIVISION DEPARTMENT OF REVENUE
PO BOX 280601 BENEFICIARY FORM ASSETS Z7
REV-1604A EX AFP <u-14)
HARRISBURG PA 11128-06c�
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REGISTER OF WILLS DATE 01-15-2015
7015 J191V [tlI i 1 12 i, ESTADATETOFOF MCCONNELL DEATH 10-26-2013 MARY E
FILE NUMBER 21 13-1202
GARY E MCCONNELLCLEF ,', Ct' COUNTY CUMBERLAND
1885 W AMERICAN B"N H1RtN ' (" ''�! SSN/DC
ACN 13505292
JACKSON 6 F ,001-9259... Amount Remitted
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-1604A EX AFP (11-14)
** INHERITANCE TAX RECORD ADJUSTMENT BENEFICIARY FORM ASSETS **
DATE: 01-15-2015
ESTATE OF: MCCONNELL MARY E DATE OF DEATH: 10-26-2013 COUNTY: CUMBERLAND
FILE NO. : 21 13-1202 S.S/D.C. NO. : ACN: 13505292
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
BENEFICIARY FORM ASSETS
NAME OF SECURITY: VANGUARD ACCOUNT NO. : 64244550
TYPE OF ACCOUNT: (X) SECURITIES C ) SEC ACCT C ) STOCK C ) BOND
DOD Valuation •00 NOTE: TO ENSURE PROPER CREDIT TO YOUR
Percent Taxable X 0.333 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 Due X .045 MAKE CHECK OR MONEY ORDER PAYABLE
Tax Rate •00 TO: "REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE p
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. „�p�