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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF R~VENUE
, ,,,~r. "~HE.RJ!i'ANCE TAX
, , ',-- RECORD' ADJUSTMENT
JOINTLY HELD OR TRUST ASSETS
*'
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX Z80601
HARRISBURG PA 171Z8-D6Dl
REV-16D4 EX AFP (03-05)
Pi, 12: 26DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
- ", SSN/DC
ACN
ZOU5 AUG - I
ADELE S BIRX
208 TEXACO RD
MECHANICSBURG
CLCC"
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C"''''''
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CL;: --
PA 17050
07-22-2005
SPARKS
10-03-2004
70 0335004
CUMBERLAND
217-32-7961
05103241
AIIount R...i tted
"'),~ -~S - ()\, "';)..\
SHERMAN
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE
--+ RETAIN LOWER PORTION FOR YOUR RECORDS
-
--------..------..-----------------------------------------------------------------------------------------------------------------
REY-1604 EX AFP (03-05)
__ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS --
DATE 07-22-2005
ESTATE OF SPARKS
SHERMAN
CUMBERLAND
DATE OF DEATH 10-03-2004
COUNTY
ACN
05103241
FILE NO. 70 0335004
ADJUSTMENT BASED ON:
S.S/D.C. NO. 217-32-7961
ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: WAYPOINT BANK
ACCOUNT NO. 3200006771
TYPE OF ACCOUNT: () SAYINGS () CHECKING () TRUST (X) TIME CERTIFICATE
DATE ESTABLISHED 02-16-1999
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
.00
0.500
.00
.00
.00
.45
.00
.
TAX CREDI:TS:
NOTE: TO INSURE PROPER CREDIT TO YOUR
ACCOUNT, SUBMIT THE UPPER PORTION
OF THIS NOTICE WITH YOUR TAX
PAYMENT TO THE REGISTER OF WILLS
AT THE ADDRESS SHOWN ABOYE.
MAKE CHECK OR MONEY ORDER PAYABLE
TO: "REGISTER OF WILLS, AGENT."
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE nn
. IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAN $1, NO PAYNENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRJ, . J
YOU KAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS.J ~ ~
REV.1470 EX (6-88)
*'
INHERITANCE TAX
EXPLANATION
OF CHANGES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENrS NAME
SHERMAN SPARKS
FILE NUMBER
REVIEWED BY
Dianne McClain
ACN
SS # 217-32-7961
05103241
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
The above referenced Account Control Number has been reduced to zero since the
Decedent was a resident of Maryland.
ROW
PaQe 1