HomeMy WebLinkAbout05-26-15 (2) INHERITANCE TAX
RECORD ADJUSTMENT i pennsylvania
JOINTLY HELD OR TRUST ASSETS DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES -
INHERITANCE TA�ff6I,U��jjN -i r-10 E Off. J REV-1604 EX AFP (11-14)
PO BOX 280601 iiJJ
HARRISBURG PA 17Rt l3 1 JT WILLS
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DATE 05-15-2015
?015 Fi-H 26 0n 112 52 ESTATE OF HOLTZMAN DOROTHY J
DATE OF DEATH 01-02-2013
FILE NUMBER 21 13-0261
CLEF_% COUNTY CUMBERLAND
JOHN ORPPA�tHOL ZMANk SSN/DC
^ ACN 13110566
644 �U � CS:T, f Amount Remitted
WORMLEYSBURG PA 17043-1002
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-
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REV-1604 EX AFP (11-14)
** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS *
DATE: 05-15-2015
ESTATE OF: HOLTZMAN DOROTHY J DATE OF DEATH: 01-02-2013 COUNTY: CUMBERLAND
FILE NO. : 21 13-0261 S.S/D.C. NO. : ACN: 13110566
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION : SUSQUEHANNA BANK ACCOUNT NO. : IRA-10005377204
TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING ( X) TRUST C ) TIME CERTIFICATE
DATE ESTABLISHED 07-23-2008
Account Balance 10,663.35 NOTE: TO ENSURE PROPER CREDIT TO YOUR
Percent Taxable X 0.500 ACCOUNT, SUBMIT THE UPPER PORTION
Amount Subject to Tax 5,331 .68 OF THIS NOTICE WITH YOUR TAX
Debts and Deductions •00 PAYMENT TO THE REGISTER OF WILLS
Taxable Amount 5,331 .68 AT THE ADDRESS SHOWN ABOVE.
Tax Rate X .045 MAKE CHECK OR MONEY ORDER PAYABLE
Tax Due 239.93 TO: "REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)
03-11-2013 CDO17309 12.00 227.93
04-18-2014 SBADJUST .00 2.42
TOTAL TAX PAYMENT 242.35
BALANCE OF TAX DUE 2.42CR
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.
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