HomeMy WebLinkAbout07-29-11BUREAU OF INDIVIDUAL TAXES ~~~~~~~~ ~ ''iii, a ~ E OF INHERITANCE TAX I
INHERITANCE TAX DIVISION ,. 9PPRAI T ALLONANCE OR DISALLONANCE penllSy`VaI1~a ~~',-
PO BOX 280601 9~, ON~ AND ASSESSNENT OF TAX ON DEPARTMENT OF REVENUE
HARRISBURG, PA 17126-0601 r``"-'"-' -p~'S~ RI~'Y ACCOUNTS HELD IN
BENEFICIARY FORM eev-,saaa aFr uz-,o,
` '' `f`'''- `~~~ ~" `-~ ` ~ DATE 08-01-2011
CLcRK Gr
ORPNA.~'~ COURT
CUB ~B<<RI_~'±x~IL1 Cif., PA.
SHEILA E EDWARDS
415 E GREEN STREET
SHIREMANSTOWN PA 17011
ESTATE OF ODONNELL WILLIAM A
DATE OF DEATH 09-22-2010
FILE NUMBER 21 11-0679
COUNTY CUMBERLAND
SSN/DC 186-28-5533
ACN 11500483
APPEAL BY DATE: 09-30-2011
(See reverse side under 06jecticrns)
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-1548A AFP (12-10)
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE Of= DEDUCTIONS
AND ASSESSMENT OF TAX ON SECURITY ACCOUNTS HELD IN BENEFICIARI( FORM
DATE: 08-O1-2011
ESTATE OF:ODONNELL WILLIAM A DATE OF DEATH: 09-22-2010 COUNTY: CUMBERLAND
FILE NO.: 21 11-0679 S.S/D.C. NO.: 186-28-5533
/-CN: 11500483
TAX RETURN WAS: CX) ACCEPTED AS FILED C )CHANGED
NAME OF SECURITY:
TYPE OF ASSET:
( ) SECURITIES ( AI SECURITY ACC ( ) STOCK ( ) BONDS
DOD Valuation
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
BENEFICIARY FORM OF ASSET INFORMATION
FIDELITY ACCOUNT NO.: 000
36,866.17
X 0.500
18,433.09
- .00
18,433.09
X .045
829.49
NOTE: TO ENSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TA}: PAYMENT TO THE
REGISTER OF 41ILLS 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
06-14-2011 CD014577 .00 829.49
TOTAL TAX PAYMENT 829.49
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 FDR INSTRUCTIONS.
~~