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HomeMy WebLinkAbout03-02-15 " INHERITANCE TAX �^ a'` pennsylvania BUREAU OF INDIVIDUAL TAXES RECORD ADJUSTMENT DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION BENEFICIARY FORM ASSETS PO BOX 2806¢¢11 n n--) F F j;i V REV-1604A EX AFP (11-14) HARRISBURG\F��I71f 8-8601 R� 12 30 DATE 02-20-2015 ESTATE OF WILLIAMSON JOHN 1 DATE OF DEATH 04-27-2013 F FILE NUMBER 21 14-0960 "3L COUNTY CUMBERLAND DIANE AUBURN©J Pt EA ��{ SSN/DC 10 C� R���A� , t, ACN 13504827 BOILING ( LF�Wff4GS-{PA 17007-9535 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 E— REV-1604A EX AFP (11-14) ** INHERITANCE TAX RECORD ADJUSTMENT BENEFICIARY FORM ASSETS ** DATE: 02-20-2015 ESTATE OF: WILLIAMSON JOHN DATE OF DEATH: 04-27-2013 COUNTY: CUMBERLAND FILE NO. : 21 14-0960 S.S/D.C. NO. : ACN: 13504827 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION BENEFICIARY FORM ASSETS NAME OF SECURITY: MERRILL EDGE MERRILL LYNCH ACCOUNT NO . : 5BA89M05 TYPE OF ACCOUNT: (X) SECURITIES C ) SEC ACCT ( ) STOCK C ) BOND DOD Valuation •00 NOTE: TO ENSURE PROPER CREDIT TO YOUR Percent Taxable X 0.000 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 ABOVE. Tax Due X .045 MAKE CHECK OR MONEY ORDER PAYABLE Tax Rate .00 TO: "REGISTER OF WILLS, AGENT." TAX CREDITS : PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID C-) 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. \ REV-1470 EX(01-10) pennsylvanla INHERITANCE TAX DEPARTMENT OF.REVENUE EXPLANATION 4/27/2013 BUREAU OF INDIVIDUAL TAXES OF CHANGES PO Box 280601 HARRISBUR9_EL1ZJZL-0WJ DECEDENT'S NAME FILE NUMBER John Williamson 21 14-0960 REVIEWED BY ACN Steven -Agent# 193 1,3504827 ITEM SCHEDULE NO, EXPLANATION OF CHANGES The above-referenced ACN has been adjusted to $0 as the decedent was a resident of the State of Connecticut at his death. ROW Page 1