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HomeMy WebLinkAbout03-21-14 (3) INHERITANCE TAX Pennsylvania RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES REV-1604 EX AFP C12-133 INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 DATE 03-13-2014 ESTATE OF KEHLER DOROTHY G DATE OF DEATH 02-08-2011 FILE NUMBER 70 0439078 at-12,-LOOS COUNTY CUMBERLAND SSN/DC HARRY D KEHLER ACN 11137470 421 LINCOLN ST Amount Remit#ed YORK PA 17401-2921 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE •—I- RETAIN LOWER PORTION FOR YOUR RECORDS E-- -------------—-------------------_------___----------•-------------—------—_-----------_------_--.-'-----_------—------—------_-------- REV-1604 EX AFP (12-13) ■ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS DATE: 03-13-2014 ESTATE OF: KEHLER DOROTHY G DATE OF DEATH: 02-08-2011 COUNTY: CUMBERLAND FILE NO. : 70 0439078 S.S/D.C. NO. : ACN: 11137470 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: SOVEREIGN BANK ACCOUNT NO. 1 8231025723 TYPE OF ACCOUNT: ( ) SAVINGS ( X) CHECKING C ) TRUST C ) TIME CERTIFICATE DATE ESTABLISHED 04-30-1981 Account Balance 840.68 NOTE: TO ENSURE PROPER CREDIT TO YOUR Percent Taxable X 0.500 ACCOUNT, SUBMIT THE UPPER PORTION Amount Subject to Tax 420.34 OF THIS NOTICE WITH Y!t TAX:0 Debts and Deductions - •00 PAYMENT TO TF@ REGISTEf� OFc4p;LS Taxable Amount 420.34 AT THE ADDRESS 5OWN *VEE? O Tax Rate X .045 MAKE CHECK 00@E6 OFWR 6,?LE Tax Due 18.92 TO: "REGISTEP [= FiLLV. At" C•' TAX CREDITS : v u? cO o PAYMENT RECEIPT DISCOUNT C+) C? p DATE NUMBER INTEREST/PEN PAID C-3 AMOUNT PAID p t--A tom" C> INTEREST IS CHARGED THROUGH 03-28-2014 TOTAL TAX PAYMENT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 18.92 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 1.35 TOTAL DUE 1 20.27 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.