HomeMy WebLinkAbout09-14-11 (3)i -
BUREAU OF INDIVIDUAL TAXES I~
INHERITANCE TAX DIVISION
PO BOX 280601 ~ ~,i ~f..y~~,~pT2CE qp_
HARRISBURG PA 1 7128-0601 Ap ~S°^EN7~, ~t'~Y~ITANCE TAX pe~n~~/(va~7~ ~`
OF ~ #~b,C~taNSr ~~ (ASSESSMENTSOFLTAXNON OEPARTMENTOFREVENUE ~
JOINTLY'HEL ~„~ TRUST ASSETS
} REV-1548 EX AFP C12-10) ~""~
rM1~1 ~~~ f4 ~i,~~~; G}~STATE 09-13-2'11
DATE OFOF KOUMPIA
~~ ~K Qfi DEATH p6-09_2 10 DIMOSTENI G
~P n COUNTyUMBER
MADELINE G KAUNPIAg ~~J~Rfi 1 ~,r ~'QURT SSN/DC CUMBERLABD
APT 2 ~ ^,~~,~! •^r1
1141 COLUMBUS qyE "-' pl~ ACN 081-24-0 96
LEMOYNE 10157547
APPEAL BY DATE:11-
Pq 17043 (See reverse side 12' 2011
Amount Reaftted under pb~ ~k°ns)
MAKE CHECK PAYABLE AND
REGISTER OF WILLS (EMIT PAYMENT T0:
1 COURTHOUSE SQUARE
CARLISLE Pq 17013
CUT ALONG THIS LINE
REV-15NOTIC AFP C12-10j- ~_-RETAIN-LOWER-PORT__ OR YOU
- ION F__ R RECORDS
DEDUCTIONSINHERITANCE TAX ----'---- ~I
. AND ASSESSMENTAOFRTISEMENT, ALLOWANCE OR --'---
AX ON JOINTLY HELD 0 DISALLOWANCE p~
ESTATE R TRUST ASSETS
OF:KOUMPIAS DATE: _
DIMOSTENI G DATE 09 '2011
FILE NO,: OF DEATH:06-
21 10-1087 09-2010
S.S/D.C. NO.: COUI~TY:CUMBE-
TAX RETURN WqS_ 081-24-0096 II
CX) ACCEPTED AS F
ILED A N: 10157547
FINANCIAL INSTITUTION: M ~ JOINT ~ ) CHANGED
OR TRUST ASSET INFORMATION
TYPE OF ACCOUNT: T BANK
DATE ESTABLISHED ~ )SAVINGS CX1 CHECKING ACCOUNT
03-15-2004 NO'0 9835786 25
~ )TRUST C )TIME CERTIFICATE
Account Balance
Percent Taxable
Amount Sub' X 2,879.13
sect to Tax 0.166 NOTE: TO ENSURE P
Debts and Deductions
Taxable - 479.86 YOUR ACCOUNTOP R CREDIT TO
Amount , SUBMIT THE
Tax Rate .pp UPPER PORTION 0 THIS
Tax Due 479.86 WITH YOUR TqX YMENT NOTICE
REGIST P TO THE
.00 ER OF WIL
TAX CREDITS: .00 ABOVE ADDRESS. SAT THE
OR MONEY MAKE CHECK
PAYMENT ORDER P YABL E T0:
DATE RECEIPT "REGISTER OF WIL
NUMBER DISCOUNT ~+) ~S, AGENT. ~~
INTEREST/pEN pAID (-)
AMOUNT pAID
TOTAL TAX PAYMENT
BALANCE OF TAX DUE .00
INTEREST AND pEN. ~ .00
TOTAL DUE ' .00
IF pAID AFTER THIS •00
IF TOTAL DUE IS DATE, SEE REVERSE FO
SEE REVERSE REFLECTED qS q CREDIT~•R CALCULATION OF
SIDE OF THIS FDRM FOR INSTRUCTIDNS, ADDITIONAL
YOU MAy BE DUE INTEREST.
A REFUND.
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