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HomeMy WebLinkAbout10-01-10~ ~'~~ r -~~ ~a ~~ O}F~~D-INHERITANCE TAX BUREAU OF INDIVIDUAL TAXES ~. APPRAiS~~~IE~~';•. AJt~OWANCE OR DISALLOWANCE INHERITANCE TAX DIVISTON - PO BOX 280601 }~- ~€ia'U~T.IO'M~, ~~ND ASSESSMENT OF TAX ON HARRISBURG PA 17T2B-oboe `~ ~`~ ~ "' JO`~~NTLY~ 'HELD OR TRUST ASSETS Lit ~ ~ ~~~ "" ~ ~ ~~; ~,~ 1 ^',; ~,' DEVON H BETZ ,.,~~ ~_ ~ ~`~,~ C; ~„ti,. 33 ROYAL PALM DRIVE MECHANICSBURG PA 17050 pennsylvania ~ DEPARTMENT OF REVENUE REV-1548 IX AFP (12-09) DATE 10-04-2010 ESTATE OF HUGHES HAYDN DATE OF DEATH 10-25-2009 FILE NUMBER 21 10-0207 COUNTY CUMBERLAND SSN/DC 169-09-9947 ACN 10047498 APPEAL BY DATE:12-03-2010 (See reverse side under Objections) Amount Remitted ~- MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE "'~ RETAIN LOWER PORTION FOR YOUR RECORDS <"~ ------------------------------------------------------------------------------------------- REV-1548 EX AFP C12-09~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE: 10-04-2010 ESTATE OF:HUGHES HAYDN FILE NO.: 21 10-0207 S.S/D.C. NO.: 169-09-9947 ACN: 10047498 TAX RETURN WAS: CX? ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: RIVERSOURCE LIFE INSURANCE ACCOUNT NO.: 9300-4260990 TYPE OF ACCOUNT: C )SAVINGS C ? CHECKING C )TRUST C TIME CERTIFICATE DATE ESTABLISHED 11-01-2008 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TeY ra~nrTC• 7,843.25 X 1.000 7,843.25 - .00 7,843.25 ~ .D45 352.95 NOTE: TO ENSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID INTEREST IS CHARGED THROUGH 10-12-2010 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM DATE OF DEATH:10-25-2009 TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE 352.95 INTEREST AND PEN. 3.07 TOTAL DUE 356.02 COUNTY:CUMBERLAND * IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ IF TDTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.