HomeMy WebLinkAbout05-05-14 INHERITANCE TAX , Pennsylvania
BUREAU OF INDIVIDUAL TAXES RECORD ADJUSTMENT
INHERITANCE TAX DIVISION BENEFICIARY FORM ASSETS - D EPARTMENT OF REVENUE
PO BOX 280603 _ - REV-1604A a AFT (12-13)
HARRISBURG PA 17128-0601 -
'RECORDED OFFICE OF DATE 04-25-2014
REGISTER OF WILLS ESTATE OF LOGAN JOHN B
(� r� DATE OF DEATH 05-22-2013
2014 �iflY 5 i p 11 t 57 FILE NUMBER 21 13-0636
EVAN DYNE COUNTY CUMBERLAND
SSN/DC
3207 ALEXANDER CIR HE CLERK OF ACN 13501852
ATLANTA GA bQ32.bA5000RT
ffiiFF''FF11 fVb Amount Remitted
CUMBERLAND CO., PA
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 F
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REV-1604A EX AFP (12-13)
INHERITANCE TAX RECORD ADJUSTMENT BENEFICIARY FORM ASSETS
DATE: 04-25-2014
ESTATE OF: LOGAN JOHN B DATE OF DEATH: 05-22-2013 COUNTY: CUMBERLAND
FILE NO. : 21 13-0636 S.S/D.C. NO. : ACN: 13501852
ADJUSTMENT BASED ON : ADMINISTRATIVE CORRECTION
BENEFICIARY FORM ASSETS
NAME OF SECURITY: EDWARD JONES ACCOUNT NO. : 616-18566
TYPE OF ACCOUNT: CX7 SECURITIES ( 7 SEC ACCT ( ) STOCK C ) BOND
DOD Valuation .00 NOTE: TO ENSURE PROPER CREDIT TO YOUR
Percent Taxable X 0.000 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 Due X . 045 MAKE CHECK OR MONEY ORDER PAYABLE
Tax Rate •00 TO: "REGISTER OF WILLS, AGENT."
TAX CREDITS :
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE
INTEREST AND PEN. .00
TOTAL DUE .00
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.