HomeMy WebLinkAbout05-03-13 ` INHERITANCE TAX pennsyLvarna
RECORD ADJUSTMENT
JOINTLY HELD OR TRUST ASSETS DEPARTMENT OF REVENUE
REV-1604 EX AFP (12-12)
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION C n ,�;
PO BOX 2BO601 t
;:�1 a } i"' E�• (- ��
HARRISBURG PA 17128-0601 r.-+•-
OF J DATE 02-20-2013
p ^� ESTATE OF ANDRIUTSO DIMITRI
Li3 (�I�Y 3 C I j C19DATE OF DEATH 03-05-2010
FILE NUMBER 21 10-0345
C-1 E eIK 4 COUNTY CUMBERLAND
SSN/DC
F �S' 11114920
KEITH L DEIBERT �� NA�aJ C�.�u� i ACN
4905 E TRINDLE RD OFCOIUNIBERLAN D ^0 ' , Amount Remitted
MECHANICSBURG PA 17050-3643
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 ----------------------
REV-1604 EX AFP C12-12)
** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS *
DATE: 02-20-2013
ESTATE OF: ANDRIUTSO DIMITRI DATE OF DEATH: 03-05-2010 COUNTY: CUMBERLAND
FILE NO. : 21 10-0345 S.S/D.C. NO. :
ACN: 11114920
ADJUSTMENT BASED ON : ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: CITIZENS BANK OF PENNSYLVANIA ACCOUNT NO . : 6221033903
TYPE OF ACCOUNT: C ) SAVINGS C CHECKING ( )0 TRUST C TIME CERTIFICATE
DATE ESTABLISHED 04-17-2008
00 NOTE: TO ENSURE PROPER CREDIT TO YOUR
Account Balance 500
Percent Taxable X 0. ACCOUNT, SUBMIT THE UPPER PORTION
00 OF THIS NOTICE WITH YOUR TAX
Amount Subject to Tax .00
Debts and Deductions - PAYMENT TO THE REGISTER OF WILLS
00 AT THE ADDRESS SHOWN ABOVE.
Taxable Amount .045
Tax Rate X MAKE CHECK OR MONEY' ORDER PAYABLE
00 TO: "REGISTER OF WILLS, AGENT."
Tax Due
TAX CREDITS : -
PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-) —
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A
"CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.
INHERITANCE TAX enns lvania
=:I U039TLYE HELD OR T USTN ASSETS T.C U R'j :r' DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL T S REV-1604 EX AFP (12-12)
INHERITANCE TAX DIVISION RE "'J 'L
PO BOX 280601
HARRISBURG PA 17128-0601
DATE 02-19-2013
ESTATE OF ANDRIUTSO DIMITRI
VLid .. DATE OF DEATH 03-05-2010
ORPHANS' (,'_J ' . FILE NUMBER 21 10-0345
COUNTY CUMBERLAND
CUMBERLA!" SSN/DC
KEITH L DEIBERT ACN 11114919
4905 E TRINDLE RD OFC C Amount Remitted
MECHANICSBURG PA 17050-3643
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 4-
REV-1604 EX AFP C12-12)
** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS **
DATE: 02-19-2013
ESTATE OF: ANDRIUTSO DIMITRI DATE OF DEATH: 03-05-2010 COUNTY: CUMBERLAND
FILE NO. : 21 10-0345 S.S/D.C. NO. : ACN: 11114919
ADJUSTMENT BASED ON : ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION : CITIZENS BANK OF PENNSYLVANIA ACCOUNT NO . : 6225343796
TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING ( X) TRUST C ) TIME CERTIFICATE
DATE ESTABLISHED 06-25-2009
Account Balance • 00 NOTE: TO ENSURE PROPER CREDIT TO YOUR
Percent Taxable X 0 .500 ACCOUNT, SUBMIT THE UPPER PORTION
Amount Subject to Tax • 00 OF THIS NOTICE WITH YOUR TAX
Debts and Deductions - •00 PAYMENT TO THE REGISTER OF WILLS
Taxable Amount •00 AT THE ADDRESS SHOWN ABOVE.
Tax Rate X • 15 MAKE CHECK OR MONEY ORDER PAYABLE
Tax Due •00 TO: "REGISTER OF WILLS, AGENT."
TAX CREDITS :
PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)
TOTAL TAX PAYMENT . 00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE
* IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A
"CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. /
REV19470 EX(01-1M
pennsytvanla INHERITANCE TAX
DEPARTMENT OF REVENUE EXPLANATION
BUREAU OF INDIVTDIJAL TAXES OF CHANGES
PO Box 280601
HARRISBURG,PA 17128-0601
DECEDENT'S NAME FILE NUMBER
Dimitri Andriutsa 2110-0345
REVIEWED BY ACN
Yvonne Bricker 11114919 & 11114920
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
The In Trust For account held at citizen Bank of Pennsylvania is not taxable as the
accounts are held by the decent and his wife Pauline Andriutsa as trustees for Keith
Deibert.
ROW Paae 1