HomeMy WebLinkAbout11-07-11 (3)BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION NOTICE OF INHERITANCE TAX
Po BOX 280601 ~F~ '"~`~ ~ '' ~~c"~pT1 ALLONANCE OR DISALLONANCE
HARRISBURG, PA 17128-0601 ~ " "-!""'~`~Nb AND ASSESSNENT OF TAX ON
~ ~. ~ ,'I ! QECIIRI'~Y ACCOUNTS HELD IN
_-~~ BENEFICIARY FORN
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MICHAEL S COUL~O'1~~'-`~L,~~+~J i nt''l PA
424 RIDGE AVE
ENOLA PA 17025
Pennsylvania ~
DEPARTMENT OF REVENUE
REY-1566A AFP (12-IO)
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 11500864
APPEAL BY DATE: 12-30-2011
(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 E-
REV-1548A AFP C12-10)
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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 ARRrF 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: 11500864
CX) ACCEPTED AS FILED C )CHANGED
BENEFICIARY FORM OF ASSET INFORMATION
NAME OF SECURITY: FIDELITY
ACCOUNT NO.: 73116
TYPE OF ASSET: ( ) SECURITIES ( ~ SECURITY ACC C ) STOCK ( ) BONDS
DOD Valuation
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
6,650.87
X 1.000
6,650.87
.00
6 650.87
X .045
99 9
TAX CREDITS:
PAYMENT RECEIPT
DATE NUMBER
08-29-2011 CD014909
DISCOUNT (+)
INTEREST/PEN PAID C-)
.00
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."
AMOUNT PAID
299.29
TOTAL TAX PAYMENT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
299.29
~ 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 FDRM FOR INSTRUCTIONS.