HomeMy WebLinkAbout01-30-12 (2)BUREAU OF INDIVIDUAL
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
~~12 JAN 30 PN i2: t ~
c~ER~ of
KEITH ~~~,s ~UIJ~
L DEIBERT Cl1M~FR(A,~~ C;i). PA.
4905 E TRINDLE RD OFC C
MECHANICSBURG PA 17050-3643
Pennsylvania - ;
DEPARTMENT OF REVENUE
REV-1548 EX AFP (12-I1~
DATE 01-30-2012
ESTATE OF ANDRIUTSO
DATE OF DEATH 03-05- DIMITRI
FILE NUMBER 2010
COUNTY 21 10-0345
SSN/DC CUMBERLAND
ACN 058-30-7400
APPEAL BY DATE 403 030-
(See reverse sr.'de under Objections)2
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WII'_LS
1 COURTHOUSE SRUARE
CARLISLE PA ].7013
TAXES (~(~(A~I~
.`./iJt 1` ~ INHERITANCE TAX
~"~~tJ''~EI~U~T' '(~ I+LOWANCE OR DISALLOWq~~CE
~+"r ra tl AND ASSESSMENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
CUT ALONG THIS LINE
REV-1548 EX AFP C12=11~- y __RETAIN_LOWER-ppRTION FOR YOUR RECORDS E~
NOTICE OF INHEAtITANCE TAX APPRAISEMENT
DEDUCTIONS, AND+ ASSESSMENT OF ~ ALLOWANCE OR DISALLOWANCE OF
TAX ON JOINTLY HELD OR TRUST ASSETS
ESTATE OF:ANDRIUTSO DATE: 01-30-2012
DIMITRI DATE OF
DEATH:03-05-2010 COUNTY:CUMBE~RL
FILE NO.: 21 10-0345.
S.S/D•C. NO.: 058_30-7400
TAX RETURN WAS: (X) ACCEPTED AS FILED
ACN: 11114920
~ ) CHANGED
OINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: CITIZENS BANK OF PENNSYLVANIA ACCOU
TYPE OF ACCOUNT: C )SAVINGS C ) CHECKING (X)TRUST
DATE ESTABLISHED p4_17_2008 NT NO.: 6221033903
~ )TIME CERTIFICATE
Account Balance
Percent Taxable 12,371.94
Amount Sub' X NOTE: TO ENSURE PROPER
Jett to Tax 0.500 CREDIT TO
Debts and Deductions - 6,185.97 YOUR ACCOUNT, SUBMIT THE
Taxable Amount .00 UPPER PORTION OF THIS NOTICE
Tax Rate 6,185.97 WITH YOUR TAX PAYMENT TO THE
Tax Due Y REGISTER OF WILLS AT THE
15
927.90 ABOVE ADDRESS. MAKE CHECK
TAX CREDITS: OR MONEY ORDER PAYABLE T0:
PAYMENT "REGISTER OF WILLS, AGENT. ~+
DATE RECEIPT
NUMBER DISCOUNT C+)
INTEREST/PEN PAID (_~ AMOUNT PAID
~~_
INTEREST IS CHARGED THROIUGH 02-07-2012
AT THE RATES APPLICABLE I1S OUTLINED ON THE
REVERSE SIDE OF THIS FORM TOTAL TAX PAYMENT
BALANCE OF TAX DUE •00
INTEREST AND PEN, 927.90
TOTAL DUE 33.32
961.22
* IF TOTALADUERISHREFLECTEDSEE REVERSE FOR CALCULATION OF
SEE REVERSE SIDE OF THIS FORMAFORRINSTRUCTIONS. ADDITIONAL INTEREST.
(CR), YOU MAY BE DUE A REFUND.