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HomeMy WebLinkAbout01-18-13BUREAU DF INDIVIDUAL TAXES INHERITANCE TAX OIDSSION PO BOX 280601 HARRISBURG PA 1]128-0601 INHERITANCE TAX RECORD ADJUSTMENT ~ pennsylvania JOINTLY HELD OR TRUST ASSETS DEPARTME NT OF REVENUE REV-1604 EX AFP (12-12) RECORC~p nr~ ~r C~,DATE 01-o4-zD13 y.'. 9f,.a ESTATE OF HOFFMAN DONNA F R EG~$T~~i Ct` ~,,~,; DATE OF DEATH 01-23-2012 "' ~.-'~y FILE NUMBER 21 12-0179 tGi3 .;hPJ i$ pm COUNTY CUMBERLAND i°{ 7 SSN/D CATHERINE S GREELEY ~' `~~ pCN 12111362 402 CROSSROAD SCHOOL RD CL c-,~ {r~jK ;, CARLISLE PA 17,94 CUMBERLA~!~ ,^~± ,~ Amount Remlttad MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS H REV-1604 EX AFP (12-12) ^~ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ^^ DATE: 01-04-2013 ESTATE OF: HOFFMAN DONNA F DATE OF DEATH: 01-23-2012 COUNTY: CUMBERLAND FILE NO.: 21 12-0179 S.S/D.C. N0.:195-28-0030 ACN: 12111362 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: sUSOUEHANNA BANK ACCOUNT N0.:10009940213 TYPE OF ACCOUNT: C ) SAVINGS (X) CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 10-28-2811 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: .00 N07E: X 1.000 .00 .00 .00 X .uv~ .00 TO ENSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT 70 THE REGISTER OF WILLS AT THE ADDRESS SHOWN ABOVE. MAKE CHECK OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT INTEREST/PEN (+) PAID C-) AMOUNT PAID TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE 0 INTEREST AND PEN. 0 TOTAL DUE IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS p "CREDIT" (CRT, YOU MAY HE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ~ 7.~