HomeMy WebLinkAbout04-08-11BUREAU OF INDIVIDUAL TAXES
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INHERITANCE TAX DIVISION
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BENEFICIARY FORK REV-154BA AFP (12-1D)
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ELIZABETH ~~-~'~ ., ~~- ~'~ }
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L15 KEMPSEN STREET
NEWPORT RI 02840
DATE 04-11-2011
ESTATE OF FIELDS GLADYS J
DATE OF DEATH 04-10-2010
FILE NUMBER 21 10-0430
COUNTY CUMBERLAND
SSN/DC 172-24-7953
ACN 10500848
APPEAL BY DATE: 06-10-2011
(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 •-
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REV-1548A AFP C12-10~ _________
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS
AND ASSESSMENT OF TAX ON SECURITY ACCOUNTS HELD IN BENEFICIARY FORM
DATE: 04-11.-2011
ESTATE OF:FIELDS G nnvS J DATE OF DEATH: 04-10-2010 COUNTY: CUMBERLAND
FILE NO.: 21 10-0430 S.S/D.C. NO.: 172-24-7953 ~4CN: 10500848
TAX RETURN WAS: (X) ACCEPTED AS FILED C CHANGED
BENEFICIARY FORM OF ASSET INFORMATION
NAME OF SECURITY: AMERIPRISE
ACCOUNT NO.:
0113292
TYPE OF ASSET: ( ) SECURITIES C ~E SECURITY ACC C ) STOCK ( ) BONDS
DOD Valuation
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
986.68
X 1.000
986.68
- .00
986.68
X .045
44 40
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 W]:LLS, AGENT."
DATE T I NUMBERT (INTEREST/PEN PAID C-~
AMOUNT PAID
INTEREST IS CHARGED THROUGH 04-19-2011* TOTAL TAX PAYMENT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE _ 44.40
REVERSE SIDE OF THIS FORM INTEREST AND PEN.
.36
TOTAL DUE ~-- 44.76
* 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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