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HomeMy WebLinkAbout06-16-14 INHERITANCE TAX W pennsylvania RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES REV-1604 EX AFP (12-13) INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 DATE 06-09-2014 ESTATE OF ROBINSON PEARL I DATE OF DEATH 02-10-2011 FILE NUMBER 21 11-0276 COUNTY CUMBERLAND SSN/DC 171-28-4887 CHARLES J ROBINSON ACN 11168579 225 W MAIN ST Amount Remitted WALNUT BOTTOM PA 17266-9708 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 -------------------.--_-M—M--------------"---------------_------'-------------------------_-- REV-1604 EX AFP (12-13) ■ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS *■ DATE: 06-09-2014 ESTATE OF: ROBINSON PEARL I DATE OF DEATH: 02-10-2011 COUNTY: CUMBERLAND FILE NO. : 21 11-0276 S.S/D.C. NO. : 171-28-4887 ACN: 11168579 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: CITIZENS BANK OF PENNSYLVANIA ACCOUNT NO . : 6100800466 TYPE OF ACCOUNT: ( ) SAVINGS ( X) CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 03-29-1980 Account Balance .00 NOTE: TO ENSURE PROPER CREDIT TO YOUR Percent Taxable X 1 . 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 .MOVE. vv Tax Rate X • 15 MAKE CHECK OR�)MONEY O"ER D-A11;•ABLE Tax Due • 00 TO: "REGISTEER qF WILC, ArGE ." TAX CREDITS : PAYMENT RECEIPT DISCOUNT (+) " ) (� F� FYI f1T DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID I— (T) z7 4 r) CD J C7 O =-3 .+ � c ~' 1— IT F I- n — Cf) b TOTAL TAX PAYMENT . 00 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. V