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HomeMy WebLinkAbout06-30-14 pennsylvania BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE PO BOX 280601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP (12-13) HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS DATE 06-30-2014 ESTATE OF MALOY MARJORIE C DATE OF DEATH 03-12-2013 FILE NUMBER —(,).' COUNTY CUMBERLAND SSN/DC KURT A LAESSIG ACN 13141686 103 BIRCH CT APPEAL BY DATE:08-29-2014 CAMP HILL PA 17011-4002 (See reverse side under Objections) Amount Remitted 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-- REV-1548 EX AFP (12-13) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 06-30-2014 ESTATE OF: MALOY MARJORIE C DATE OF DEATH:03-12-2013 COUNTY:CUMBERLAND FILE NO. : S.S/D.C. NO. : 207-14-6210 ACN: 13141686 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PSECU ACCOUNT NO. : 0207146210-S1 TYPE OF ACCOUNT: ( X)SAVINGS ( ) CHECKING ( )TRUST ( )TIME CERTIFICATE DATE ESTABLISHED 04-03-1986 Account Balance 1 ,842.47 NOTE: TO ENSURE PROPER CREDIT TO Percent Taxable X 0.500 YOUR ACC 04jNT, SUBT THEE Amount Subject to Tax 921 .24 UPPER PO RT I(�1N OF T{-7IS -� fi:I CE Debts and Deductions - .00 WITH YOU(i�TAX PAYgSNT (TOd HE Taxable Amount 921.24 RE G I STE R r OFti4I L L S�kT YH�E'� Tax Rate x .045 ABOVE ADDRESS,-; M,�E CHECK Tax Due 41.46 OR MONEY ORIIER`PAYABLE' 'T R C--)"REGISTER-7OF, �LLSD AGENT TAX CREDITS: -TI PAYMENT RECEIPT DISCOUNT DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID :--' m r r (n CD O INTEREST IS CHARGED THROUGH 07-08-2014 TOTAL TAX PAYMENT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 41 .46 REVERSE SIDE OF THIS FORM INTEREST AND PEN. .71 TOTAL DUE 42.17 x IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. I IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J pennsylvanE BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX `�l?'' INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE PO BOX 280681 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP (12-13) HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS DATE 06-30-2014 ESTATE OF MALOY MARJORIE C DATE OF DEATH 03-12-2013 FILE NUMBER 2,(-(4-6-LI COUNTY CUMBERLAND SSN/DC KURT A LAESSIG ACN 13141687 103 BIRCH CT APPEAL BY DATE:08-29-2014 CAMP HILL PA 17011-4002 (See reverse side under Objections) Amount Remitted 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 REV-1548 EX AFP C12-13) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 06-30-2014 ESTATE OF: MALOY MARJORIE C DATE OF DEATH:03-12-2013 COUNTY: CUMBERLAND FILE NO. : S.S/D.C. NO. : 207-14-6210 ACN: 13141687 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PSECU ACCOUNT NO. : 0207146210-S4 TYPE OF ACCOUNT: ( )SAVINGS ( X) CHECKING ( )TRUST ( )TIME CERTIFICATE DATE ESTABLISHED 04-03-1986 Account Balance 11 ,793.00 NOTE: TO ENSURE PROPER CREDIT TO Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 5,896.50 UPPER PORTION OF THIS NOTICE Debts and Deductions - .00 WITH YOUR TAX PAYf4§NT TO THE Taxable Amount 5,896.50 REGISTERPF WILLS--AT I�E:Z Tax Rate x .045 ABOVE ADi�ESS. MAKE QHiER Tax Due 265.34 OR MONEY;`9RER PABLEr=Tp;+ IIREGISTER��OE-- WILLSZ, AGE'Ndt" TAX CREDITS: ' r" W 1 m PAYMENT RECEIPT DISCOUNT DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID v rD n -n G'J C) T: q1 F, r m Z) r 0 O T INTEREST IS CHARGED THROUGH 07-08-2014 TOTAL TAX PAYMENT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 265.34 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 4.53 TOTAL DUE 269.87 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. ,1„I SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l,•/I`^y'/ pennsylvania BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE Iff PO BOX 280601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP (12-13) HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS DATE 06-30-2014 ESTATE OF MALOY MARJORIE C DATE OF DEATH 03-12`-12� 013 FILE NUMBER �t-1T--(aI COUNTY CUMBERLAND SSN/DC KURT A LAESSIG ACN 13141688 103 BIRCH CT APPEAL BY DATE:08-29-2014 CAMP HILL PA 17011-4002 (See reverse side under Objections) Amount Remitted 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 '-- ____-"_- REV-1548 EX AFP C12-13) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 06-30-2014 ESTATE OF: MALOY MARJORIE C DATE OF DEATH:03-12-2013 COUNTY:CUMBERLAND FILE NO. : S.S/D.C. NO. : 207-14-6210 ACN: 13141688 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PSECU ACCOUNT NO. : 0207146210-S7 TYPE OF ACCOUNT: ( X)SAVINGS ( ) CHECKING ( )TRUST C )TIME CERTIFICATE DATE ESTABLISHED 04-03-1986 Account Balance 17,531.61 NOTE: TO ENSURE PROPER CREDIT TO Percent Taxable X 0 .500 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 8,765.81 UPPER PORTION OF THIS NOTICE Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 8,765.81 REGISTER OF WILLSf-AoT THE Tax Rate x .045 ABOVE ADkRESS. MAE= CHF( Tax Due 394.46 OR MONEY TjRV5R PAYABLE 7T 0.-9 "REGISTER7,DEEn WILL AG E,�l1 " TAX CREDITS: m a, (� _i c7 . r C.,.) m rn PAYMENT RECEIPT DISCOUNT (+) r-- '-i f'TI CD CD DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID CD y � p : T T T7 � :3 � T S CO O O T INTEREST IS CHARGED THROUGH 07-08-2014 TOTAL TAX PAYMENT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 394.46 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 6.73 TOTAL DUE 401. 19 IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. i ] pennsylvan BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAXI' DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION APPRAISEME NT, ALLOWANCE OR DISALLOWANCE PO BOX 280601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP (12-13) HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS DATE 06-30-2014 ESTATE OF MALOY MARJORIE C DATE OF DEATH 03-12-2013 FILE NUMBER -U—(4-"1 COUNTY CUMBERLAND SSN/DC KURT A LAESSIG ACN 13141689 103 BIRCH CT APPEAL BY DATE:08-29-2014 CAMP HILL PA 17011-4002 (See reverse side under Objections) Amount Remitted 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-- REV-1548 EX AFP C12-13) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 06-30-2014 ESTATE OF: MALOY MARJORIE C DATE OF DEATH:03-12-2013 COUNTY:CUMBERLAND FILE NO. : S.S/D.C. NO. : 207-14-6210 ACN: 13141689 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PSECU ACCOUNT NO. : 0207146210-S51 TYPE OF ACCOUNT: ( )SAVINGS ( ) CHECKING ( )TRUST ( X)TIME CERTIFICATE DATE ESTABLISHED 04-28-2006 Account Balance 11,923.76 NOTE: TO ENSURE PROPER CREDIT TO Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 5,961 .88 UPPER PORTION OF THIS NOTICE Debts and Deductions - . DO WITH YOUR TAX PAYMENT TO THE Taxable Amount 51961 .88 REGISTER OF WILLS AT THE Tax Rate x . 045 ABOVE ADDRESS. MAK�CHECK Tax Due 268.28 OR MONEY DK-U ER PAY{CB£E Tfl:m "REGISTER 11F�ljn ILLS"GENS c", TAX CREDITS: -- c7 n :2: to PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID C") -T7 Cl DATE NUMBER INTEREST/PEN PAID (-) '- O A C7 CD M r s (n o o T INTEREST IS CHARGED THROUGH 07-08-2014 TOTAL TAX PAYMENT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 268.28 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 4.58 TOTAL DUE 272.86 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. \�O) SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. T pennsylvan BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE DR DISALLOWANCE PO BOX 280601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP (12-13) HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS DATE 06-30-2014 ESTATE OF MALOY MARJORIE C DATE OF DEATH 03-12-2013 FILE NUMBER 'jL-1Lt—(.-I COUNTY CUMBERLAND SSN/DC KURT A LAESSIG ACN 13141690 103 BIRCH CT APPEAL BY DATE:08-29-2014 CAMP HILL PA 17011-4002 (See reverse side under Objections) Amount Remitted 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 '---'---------------------------------------------------------------------- REV-1548 EX AFP C12-13) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 06-30-2014 ESTATE OF: MALOY MARJORIE C DATE OF DEATH:03-12-2013 COUNTY: CUMBERLAND FILE NO. : S.S/D.C. NO. : 207-14-6210 ACN: 13141690 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PSECU ACCOUNT NO. : 0207146210-S52 TYPE OF ACCOUNT: ( )SAVINGS ( ) CHECKING ( )TRUST ( X)TIME CERTIFICATE DATE ESTABLISHED 04-28-2003 Account Balance 5,961 .86 NOTE: TO ENSURE PROPER CREDIT TO Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 2,980.93 UPPER PORTION OF THIS NOTICE Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 2,980.93 REGISTER OF WILLS AT THE Tax Rate X .045 ABOVE ADDRESS. MAKE CHECK Tax Due 134. 14 OR MONEY MWER PAYE 1-9 "REGISTER FC:WILLS GENT R7 TAX CREDITS: c A 2 p PAYMENT RECEIPT DISCOUNT (+J Z C/J _-J `-) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID - �- (� r.T m M n CD CD m n 1 + rTi O l INTEREST IS CHARGED THROUGH 07-08-2014 TOTAL TAX PAYMENT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 134. 14 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 2.29 TOTAL DUE 136.43 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 Pennsylvania BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION APPRAISEME NT, ALLOWANCE OR DISALLOWANCE PO BOX 280601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX ARP (12-13) HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS DATE 06-30-2014 ESTATE OF MALOY MARJORIE C DATE OF DEATH 03-12- 013 3 FILE NUMBER -I ^14-k;�l1 COUNTY CUMBERLAND SSN/DC KURT A LAESSIG ACN 13141691 103 BIRCH CT APPEAL BY DATE:08-29-2014 CAMP HILL PA 17011-4002 (See reverse side under Objections) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE --10 RETAIN LOWER PORTION FOR YOUR RECORDS <-- -'-----'------"-"-----------------------__----------------- - REV-1548 EX AFP C12-13) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 06-30-2014 ESTATE OF: MALOY MARJORIE C DATE OF DEATH:03-12-2013 COUNTY:CUMBERLAND FILE NO. : S.S/D.C. NO. : 207-14-6210 ACN: 13141691 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PSECU ACCOUNT NO. : 0207146210-S53 TYPE OF ACCOUNT: ( )SAVINGS ( ) CHECKING ( )TRUST ( X)TIME CERTIFICATE DATE ESTABLISHED 05-24-2003 Account Balance 20,358.98 NOTE: TO ENSURE PROPER CREDIT TO Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 10,179.49 UPPER PORTION OF THIS NOTICE Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE Taxable Amount 10,179.49 REGISTER OF WILLS AT THE Tax Rate Y .045 ABOVE ADDRg§S. MAKE CHECK Tax Due 458.08 OR MONEY Mr PAYABLE T-P:m "REGISTER &—&ILLS L GENT. TAX CREDITS: m Z Z z PAYMENT RECEIPT DISCOUNT DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID p C7 o Q C 43 O 7 O ZE) "'7 "TI ? V7 O O �1 INTEREST IS CHARGED THROUGH 07-08-2014 TOTAL TAX PAYMENT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 458.08 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 7.81 TOTAL DUE 465.89 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. 1t^ SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ] Pennsylvania BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX M DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE PO BOX 280601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 EX AFP (12-13) HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS DATE 06-30-2014 ESTATE OF MALOY MARJORIE C DATE OF DEATH 03-12-2013 FILE NUMBER 3.�^1L4 2l COUNTY CUMBERLAND SSN/DC KURT A LAESSIG ACN 13141692 103 BIRCH CT APPEAL BY DATE:08-29-2014 CAMP HILL PA 17011-4002 (See reverse side under Objections) Amount Remitted 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' REV-1548 EX AFP C12-13) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 06-30-2014 ESTATE OF: MALOY MARJORIE C DATE OF DEATH:03-12-2013 COUNTY: CUMBERLAND FILE NO. : S.S/D.C. NO. : 207-14-6210 ACN: 13141692 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PSECU ACCOUNT NO. : 0207146210-S54 TYPE OF ACCOUNT: ( )SAVINGS C ) CHECKING ( )TRUST ( X)TIME CERTIFICATE DATE ESTABLISHED 01-12-2008 Account Balance 10,359.96 NOTE: TO ENSURE PROPER CREDIT TO Percent Taxable X 0 .500 YOUR ACCOUNT, SUBMIT THE Amount Subject to Tax 5, 179.98 UPPER PORTION OF THIS NOTICE Debts and Deductions - .DO WITH YOUR TAX PAYMENT TO THE Taxable Amount 5,179.98 REGISTER OF WILLS AT THE Tax Rate X .045 ABOVE ADDRESS. MAFg CHECK Tax Due 233. 10 OR MONEY RDER PAYABLE --P0 "REGISTERibFgWILLScAGENTd' TAX CREDITS: Co PAYMENT RECEIPT DISCOUNT f" - DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID r- y,) M O O CD > O Q F- �. C7 o - ~ r M n > C) O F INTEREST IS CHARGED THROUGH 07-08-2014 TOTAL TAX PAYMENT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 233. 10 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 3.98 TOTAL DUE 237.08 r 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.