HomeMy WebLinkAbout06-08-15 INHERITANCE TAX
RECORD ADJUSTMENT Pennsylvani•
a
BUREAU OF INDIVIDUAL TAXES
JOINTLY HELD OR TRUST ASSETS
---1DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION REV-1604 EX AFP (11-14)
PO BOX 280601 /�
HARRISBURG PA 17{ Qf 'i, } u'F F j✓E V F
REGI` T F {LLS DATE 05-28-2015
ESTATE OF HEINAMAN NANCY
JUN 8 Pn l 2 '017 DATE OF DEATH 03-01-2014
J f! � FILE NUMBER 21 14-1099
COUNTY CUMBERLAND
J V SSN/DC
PHILIP E, AHEINAMAN.,.r ACN 14116252
5608 M LANb"CT'
c-,r- Amount Remitted
MECHkWbiiURG . PA 17055-5434
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 E-
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REV-1604 EX AFP (11-14)
** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS **
DATE: 05-28-2015
ESTATE OF: HEINAMAN NANCY DATE OF DEATH: 03-01-2014 COUNTY: CUMBERLAND
FILE NO. : 21 14-1099 S.S/D.C. NO. : ACN: 14116252
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION : MEMBERS 1sT FCU ACCOUNT NO. : 133053-00
TYPE OF ACCOUNT: ( X) SAVINGS C ) CHECKING C ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 06-03-1993
Account Balance 10,657.96 NOTE: TO ENSURE PROPER CREDIT TO YOUR
Percent Taxable X 0.500 ACCOUNT, SUBMIT THE UPPER PORTION
Amount Subject to Tax 5,328.98 OF THIS NOTICE WITH YOUR TAX
Debts and Deductions - 5,328.98 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 C+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C—)
11-12-2014 CDO19922 .00 104.97
TOTAL TAX PAYMENT 104.97
BALANCE OF TAX DUE 104.97CR
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.