HomeMy WebLinkAbout12-18-12 (3)
REV-1313 EX (4-10) APPLICATION FOR
Pennsylvania REFUND OF Official Use Only
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DEPARTMENT OF REVENUE PENNSYLVANIA
BUREAU OF INDIVIDUAL TAXES INHERITANCE/ ESTATE
PO BOX 280601 TAX
HARRISBURG, PA 17128-0601 See Instructions on Reverse
TO: PA Department of Revenue
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
FROM: Official Representative Decedent Information
Name Joseph D. Buckley, Esquir Name of Decedent violet A. Bretz
Address 1237 Holly Pike File Number 21-11-0038
Date of Death 12/29/2010
Carlisle, PA 17013-4435 Social Security Number 194-28-8870
Phone Number (717) 249-2448
E-mail Address JoeBLaw@aol.com
The undersigned requests a refund in the amount of $ 1,700.00 for the above-referenced
decedent's estate.
REFUND REQUESTED ON:
Q Original or Supplemental ❑ Joint/Trust Assets Remainder Return Estate Tax
Probate Return
EXPLANATION OF OVERPAYMENT
Over valued home when estimating.
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12/18/2012
Signat a Date
Please allow six to eight weeks for the processing of your refund request.