HomeMy WebLinkAbout05-30-14 INHERITANCE TAX
RECORD ADJUSTMENT � - pennsyLvarna
BUREAU OF INDIVIDUAL TAXES --
JOINTLY HELD OR TRUST ASSETS DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION REV-1604 IX AFP (12-15)
PO BOX 280601
HARRISBURG PA 17128-0601
DATE 05-21-2014
ESTATE OF SUNDERLAND KLARE S
DATE OF DEATH 01-06-2013
FILE NUMBER 21 13-0074
COUNTY CUMBERLAND
SSN/DC
LEA R SUNDERLAND ACN 13111241
7 DEERBURN CT
Amount Remittetl
MECHANICSBURG PA 17050-7346
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
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REV-1604 EX AFP (12-13)
INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ■
DATE: 05-21-2014
ESTATE OF: SUNDERLAND KLARE S DATE OF DEATH: 01-06-2013 COUNTY: CUMBERLAND
FILE NO. : 21 13-0074 S.S/D.C. NO. : ACN: 13111241
ADJUSTMENT BASED ON : ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: SUSQUEHANNA BANK ACCOUNT NO . : 1710022045
TYPE OF ACCOUNT: ( ) SAVINGS ( X) CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 04-07-2011
Account Balance • 00 NOTE: TO ENSURE PROPER CREDIT TO YOUR
Percent Taxable X 0. 166 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 "OWN ABO%. � M
Tax Rate X • 15 MAKE CHECK OR MNEY ORDER PAYAEFE
Tax Due • 00 TO: "REGISTER d FEpILLS,9kGEk.Cry
TAX CREDITS : ✓a o
c ) rrI m
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID T3- Z r7 O
DATE NUMBER INTEREST/PEN PAID (-) Z, x �„� cn,
C7 p R) 'r]
CD O CD 'Ti r
M
!T)
A W C/)
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TOTAL TAX PAYMENT .DO
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. `^