HomeMy WebLinkAbout03-03-14 INHERITANCE TAX
RECORD ADJUSTMENT Pennsylvania
BUREAU OF INDIVIDUAL TAXES JOINTLY HELD OR TRUST ASSETS DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION REV-1604 EX AFP (12-13)
PO BOX 280601
HARRISBURG PA 17128-0601
DATE 02-21-2014
ESTATE OF LONG JANE W
DATE OF DEATH 05-17-2012
FILE NUMBER 21 12-0598
COUNTY CUMBERLAND
SSN/DC
PAUL G KLIVINGTON ACN 12136695
16D W PARK ST
Amount Remittetl
CARLISLE PA 17013-2231 --_
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—
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REV-1604 EX AFP (12-13) -
�( INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETSx
DATE: 02-21-2014
ESTATE OF: LONG JANE W DATE OF DEATH: 05-17-2012 COUNTY: CUMBERLAND
FILE NO. : 21 12-0598 S.S/D.C. NO. : ACN: 12136695
ADJUSTMENT BASED ON: PROTEST BOARD DECISION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: ORRSTOWN BANK ACCOUNT NO. : 35098
TYPE OF ACCOUNT: ( X) SAVINGS t ) CHECKING C ) TRUST t 7 TIME CERTIFICATE
DATE ESTABLISHED 11-10-1997
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 WILLS� AGENT.11
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) M
DATE NUMBER INTEREST/PEN PAID I-J AMOUNT PAID _e 7�0 $�,�. _p
iR} ) f—M t^-`
y
_ 4np
T
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE DO
INTEREST AND PEN. 0
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.