HomeMy WebLinkAbout10-15-14 INHERITANCE TAX
RECORD ADJUSTMENT pennsytvarna
BUREAU OF INDIVIDUAL TAXES
JOINTLY HELD OR TRUST ASSETS ___ DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION REV-1604 EX AFP (12-13)
PO BOX 280601
HARRISBURG PA 17128-0601
DATE 10-01-2014
ESTATE OF TEITRICK FRANCES B
DATE OF DEATH 04-22-2013
FILE NUMBER 21 13-0546
COUNTY CUMBERLAND
CAROLYN J ESHELMAN SSN/DC 4438ACN 13169916
1944 LEONARD ST
YORK PA 17404-5233 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 +-
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REV-1604 EX AFP (12-13)
** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS
DATE: 10-01-2014
ESTATE OF: TEITRICK FRANCES B DATE OF DEATH: 04-22-2013 COUNTY: CUMBERLAND
FILE NO. : 21 13-0546 S.S/D.C. NO. : ACN: 13169916
ADJUSTMENT BASED ON : ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: SANTANDER BANK ACCOUNT NO . : 1675551632
TYPE OF ACCOUNT: C ) SAVINGS C ) CHECKING C ) TRUST ( X) TIME CERTIFICATE
DATE ESTABLISHED 08-15-2011
Account Balance 1,019.93 NOTE: TO ENSURE PROPER CREDIT TO YOUR
Percent Taxable X 0.500 ACCOUNT, SUBMIT THE UPPER PORTION
Amount Subject to Tax 509.97 OF THIS NOTICE WITH YOUR TAX
Debts and Deductions - •00 PAYMENT TO THE REGISTER OF WILLS
Taxable Amount 509.97 AT THE ADDRESS SHOWN ABOVE.
Tax Rate X •15 MAKE CHECK OR MONEY OR-RFR PAYABLE
Tax Due 76.50 TO: "REGISTEg OF WILLY Aq- "."
TAX CREDITS :
PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID M T n -� M
DATE NUMBER INTEREST/PEN PAID C-)
F— F a rTl
C-I`i CJ
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* 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.
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