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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX Z80601
HARRISBURG PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTM!N1 OF REVENUE
INHERITANCE TAX
RECORD ADJUSTMENT
JOINTLY HELD OR TRUST ASSETS
.
REV-1604 EX AFP (03-05)
JO~YN TOLIVER
25 ~RITAN R!J::
MARelEHEA~= - MA 01945
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
06-13-2006
TAYLOR
10-10-2005
21 05-0913
CUMBERLAND
032-32-3819
06116354
AlIOUI'lt R_itt.cl
HARRY
B
LL,
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MAKE CHECK PAYABLE AND REMIT PAYMENT
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLEI PA 17013
TO:
'-,,0
g; (-)
C~
---------------------------------------------------------------------------------------------
CUT ALONG THIS LINE
--+ RETAIN LOWER PORTION FOR YOUR RECORDS
.....
REV-1604 EX AFP (03-05)
__ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS --
DATE 06-13-2006
ESTATE OF TAYLOR
HARRY
B DATE OF DEATH 10-10-2005
COUNTY
CUMBERLAND
FILE NO. 21 05-0913
ADJUSTMENT BASED ON:
S.S/D.C. NO. 032-32-3819
ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
ACN
06116354
FINANCIAL INSTITUTION: COMMERCE BANK
ACCOUNT NO. 537078131
TYPE OF ACCOUNT: () SAVINGS (X) CHECKING () TRUST () TIME CERTIFICATE
DATE ESTABLISHED 07-05-2005
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
.00
1.000
.00
.00
.00
.12
.00
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 ABOVE.
MAKE CHECK OR MONEY ORDER PAYABLE
TO: "REGISTER OF WILLS, AGENT."
TAX CREDITS:
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 no
. IF PAID AFTER THIS DATEI SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $11 NO PA YHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A ..CREDIT" (CR) I \ .(f!-
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) y\
I .. ,
REV-1470 EX (e.8ll>
*
INHERITANCE TAX
EXPLANATION
OF CHANGES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU Of INDIVIDUAL TAXES
PO Box 280601
HARRISBURG PA 17128-0601
DECEDENrS NAME
FILE NUMBER
2105-0913
06116354
Harry B. Taylor
ACN
REVIEWED BY
Joan Peters
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
The above referenced Account Control Number has been adjusted to zero since the joint
bank account was reported on the Inheritance Tax Return.
ROW
PaQe 1