HomeMy WebLinkAbout03-10-14 INHERITANCE TAX
JOINTLY
RECORD ADJUSTMENT TRUST ASSETS pennsylvania
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX QIYISZON REV-1604 EX AFP L22-133
PO BOX 280601
HARRISBURG PA 17128-0601
DATE 03-03-2014
ESTATE OF GREEY FLORENCE
DATE OF DEATH 11-19-2012
FILE NUMBER 21 13-1177
COUNTY CUMBERLAND
SSN/DC
ELMER GREEY JR ACN 12166048
8690 RICE RD Amount Remitted
SHIPPENSBURG PA 17257-8725
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
I COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ,ALONG THIS LINE -i RETAIN LOWER PORTION FOR YOUR RECORDS {-
REV-1604 EX AFP (12-13)
3Ex INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ■
DATE: 03-03-2014
ESTATE OF: GREEY FLORENCE DATE OF DEATH: 11-19-2012 COUNTY: CUMBERLAND
FILE NO. : 21 13-1177 S.S/D.C. NO. : ACN: 12166048
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: FARMERS & MERCHANTS TRUST CO ACCOUNT NO . : 3415708
TYPE OF ACCOUNT: ( ) SAVINGS C ) CHECKING ( X) TRUST t > TIME CERTIFICATE
DATE ESTABLISHED 02-13-2002
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 100 AT THE ADDRESS SHOWN ABOVE.
Tax Rate X • 045 MAKE CHECK OR MONEY ORDER PAYABLE
Tax Due .00 TO: "REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
� 2Y• :13 J
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TOTAL TAX PAYMEN W.00C/3
BALANCE OF TAX DUE
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.
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