HomeMy WebLinkAbout06-06-11 (2)BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX
INHERITANCE TAX DIVISION APPRAISENENT ALLONANCE OR DISALLONANCE
Po Box 280601 ~j~'(~~'{ ~~ ION AND ASSESS![ENT OF TAX ON
HARRISBURG, PA 17128-0601 aVV~ `L), ~f ~+~"~~~ECURI~'Y ACCOUNTS HELD IN
(fir ~+ Mr, ;- _ ~~s( BENEFICIARY FORM
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~'C~9I JUN -~ P ~ 12~
f CLERK ~OF
E R I C T S T~y~~~~~,S COURT'
426 RIDGE AVE "`~ R~~~+~ ~Q. PA
ENOLA PA 17025
Pennsylvania ~ u:"
DEPARTMENT OF REVENUE
REV -1548A AFP (12-30)
DATE 05-30-2011
ESTATE OF STEVENS CARRIE R
DATE OF DEATH 01-26-2011
FILE NUMBER 21 11-0203
COUNTY CUMBERLAND
SSN/DC 208-38-5500
ACN 11500862
APPEAL BY DATE: 07-29-2011
(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 <"'
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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: 05-30-2011
ESTATE OF:STEVENS CARRIE R DATE OF DEATH: O1-26-2011 COUNTY: CUMBERLAND
FILE NO.: 21 11-0203 S.S/D.C. NO.: 208-38-5500
ACN: 11500862
lAX RETURN WAS: CX) ACCEPTED AS FILED C )CHANGED
BENEFICIARY FORM OF ASSET INFORMATION
NAME OF SECURITY: FIDELITY
ACCOUNT NO.: 73116
TYPE OF ASSET: ( ) SECURITIES ( ~ SECURITY ACC ( ) STOCK C ) BONDS
DOD Valuation
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
106,413.96
X 1.000
106,413.96
- .00
106,413.96
X .00
.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."
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT C+)
INTEREST/PEN PAID C-)
AMOUNT PAID
TOTAL TAX PAYMENT .00
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 FOR INSTRUCTIONS.
O