HomeMy WebLinkAbout11-07-11 (2)BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION ,(r'({ ~'~ i~~' p NOTICE OF INHERITANCE TAX
PO BOX 280601 '~ ~ -.'~fi~D~"T ALLONANCE OR DISALLONANCE
HARRISBURG, PA 17128-0601 r} '~ ~ ~ IQ'Nb AND ASSESSMENT OF TAX ON
,, _`.~SECURI~'Y ACCOUNTS NELD IN
BENEFICIARY FORM
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MICHAEL E COITL~S~'h~`~~'~a'\i r} (~~ ~ PA
84 FRONT STREET
WEST FAIRVIEW PA 17025
Pennsylvania ~
DEPARTMENT OF REVENUE
REV-154RA AFP (12-107
DATE 10-31-2011
ESTATE OF STEVENS CARRIE R
DATE OF DEATH 01-26-2011
FILE NUMBER 21 11-0203
COUNTY CUMBERLAND
SSN/DC 208-38-5500
ACN 115008b3
APPEAL BY DATE: 12-30-2011
(See reverse side under Objections)
Amount Reeftted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA :L 7013
CUT ALONG THIS LINE ~- RETAIN LOWER PORTION FOR YOUR RECORDS •-
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: 10-31-2011
ESTATE OF:~TEVENS eROrF R DATE OF DEATH: O1-26-2011
COUNTY: CUMBERLAND
FILE NO.: 21 11-0203 S.S/D.C. NO.: 208-38-5500
TAX RETURN WAS: ACN: 11500863
CX) ACCEPTED AS FILED C )CHANGED
BENEFICIARY FORM OF ASSET INFORMATION
NAME OF SECURITY: FIDELITY
ACCOUNT NO.: 73116
TYPE OF ASSET: C ) SECURITIES ( R SECURITY ACC ( ) STOCK C ) BONDS
DOD Valuation
Percent Taxable X 13,301.75 NOTE: TO ENSURE PROPER CREDIT TO
Amount Subject to Tax 1.000
YOUR ACCOUNT, SUBMIT THE
Debts and Deductions - 13,301.75 UPPER PORTION OF THIS NOTICE
Taxable Amount .00 WITH YOUR TAX PAYMENT TO THE
Tax Rate
X 13 301.75
REGISTER OF WILLS AT THE
Tax Due .045 ABOVE ADDRESS. MAKE CHECK
TAX CREDITS: 98 ~sl
OR MONEY ORDER PAYABLE T0:
"
PAYMENT REGISTER OF WILLS, AGENT."
RECEIPT
DATE DISCOUNT C+)
NUMBER INTEREST/PEN PAID C-) AMOUNT PAID
09-12-2011 CD014958
.00 598.58
TOTAL TAX PAYMENT 598.58
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" CCR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.