HomeMy WebLinkAbout05-04-15 INHERITANCE TAX
RECORD ADJUSTMENT pennsyLvarna
BUREAU OF INDIVIDUAL TAXES JOINTLY HELD OR TRUST ASSETS DEPARTMENT OF REVENUE
�N n{ Yi (� REV-1604 EX AFP (11-14)
PONB0AWdd U 1-USw r F i V1 E OC F
RARRISBURQ I L�D6j. WILLS
-
DATE DATE 04-23-2015
?OlS i Y 9 PM 12 16 ESTATE OF LEICHTE MEDA M
DATE OF DEATH 09-11-2012
� FILE NUMBER 21 12-1094
L `'t 0 F
COUNTY CUMBERLAND
^'SH��AFFER SSN/DC
r ,. -t ;< ACN 13143080
CUakIE.FdRk� ARD RD
Amount Remitted
CAMP HILL PA 17011-7442
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 C11-14)
** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS
DATE: 04-23-2015
ESTATE OF: LEICHTE MEDA M DATE OF DEATH: 09-11-2012 COUNTY: CUMBERLAND
FILE NO. : 21 12-1094 S.S/D.C. NO. : ACN: 13143080
ADJUSTMENT BASED ON: PROTEST BOARD DECISION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION : REAL ESTATE LIVERPOOL/PERRY ACCOUNT NO . : 130,011 ,00-091
TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST C ) TIME CERTIFICATE
DATE ESTABLISHED 04-20-1995
Account Balance 70,700.00 NOTE: TO ENSURE PROPER CREDIT TO YOUR
Percent Taxable X 0.500 ACCOUNT, SUBMIT THE UPPER PORTION
Amount Subject to Tax 35,350.00 OF THIS NOTICE WITH YOUR TAX
Debts and Deductions - •00 PAYMENT TO THE REGISTER OF WILLS
Taxable Amount 35,350.00 AT THE ADDRESS SHOWN ABOVE.
Tax Rate X • 12 MAKE CHECK OR MONEY ORDER PAYABLE
Tax Due 4,242.00 TO: "REGISTER OF WILLS, AGENT."
TAX CREDITS :
PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)
11-02-2013 CDO18361 .00 50.00
12-23-2013 CDO18568 .00 50.00
02-02-2015 CD020272 205.52- 4,354.65
TOTAL TAX PAYMENT 4,249. 13
BALANCE OF TAX DUE 7, 13CR
INTEREST AND PEN. 00
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.