HomeMy WebLinkAbout08-29-14 INHERITANCE TAX
RECORD ADJUSTMENT " pennsyLvama
JOINTLY HELD OR TRUST ASSETS , DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES -
INHERITANCE TAX DIVISION REV-1604 IX AFP (12-13)
PO BOX 280601
HARRISBURG PA 17128-0601
DATE 08-25-2014
ESTATE OF MATTSON WALTER E
DATE OF DEATH 03-30-2013
FILE NUMBER 21 13-0665
COUNTY 21CUMBERLAND
SSN/DC
GREGORY MATTSON ACN 13126495
APT 2
16 PEACHTREE AVE NE Amount Remitted
ATLANTA GA 30305-3021
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
____—-------____---------_----------------------—__—__—__—__—___--------------—__-- ___. ___- _______�_____�_______________________.
REV-1604 EX AFP (12-13)
�(■ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ■■
DATE: 08-25-2014
ESTATE OF: MATTSON WALTER E DATE OF DEATH: 03-30-2013 COUNTY: 21CUMBERLAND
FILE NO. : 21 13-0665 S.S/D.C. NO. : ACN: 13126495
ADJUSTMENT BASED ON : ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION : PSECU ACCOUNT NO. : 0159245129-S1
TYPE OF ACCOUNT: ( X) SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 06-01-1999
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
V
Taxable Amount •00 AT THE ADWSS SHOYMABOVP„a
Tax Rate X .045 MAKE CH ECKC:bPj MON EYsDRDF* �g4YABLE
Tax Due •00 T0: "REGI OF WLS2ACENT:"
rn M En b
TAX CREDITS : _ r- I
a Iv m M
PAYMENT RECEIPT DISCOUNT (+) CD � p
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID a (f)
O �
G7 CD .-n ?I
j C C7
r rn
Co
Cn
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.