HomeMy WebLinkAbout11-26-12 (2)BUREAU OF INDIVIDUAL TAXES ~~~.,',.,,,, F... f. ~_..,. ICE OF INHERITANCE TAX
INHERITANCE TAX DIVISION ~ ,~.,_ _: APPiR~,I`S P~~NT ALLOiiANCE OR DISALLOiiANCE
Po eox 280601 r -,, - --. OF DEDy ION, AND ASSESSMENT OF TAX ON
HARRISBURG, PA 17128-0601 -w r'. - ;SxFCURITY ACCOUNTS HELD IN
BENEFICIARY FORM
SHELLY A SCHUB~'i~'~1' ~ ~'' ~~-~~-'
24694 NETTLE MILL SQ
STONE RIDGE VA 20105-2995
ACCOUNT NO.: 7935829
CUT ALONG THIS LINE ------- RETAIN LOWER PORTION FOR YOUR RECORDS ~-
REV-1548A AFP C12-11~ ---------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS
AND ASSESSMENT OF TAX ON SECURITY ACCOUNTS HELD IN BENEFICIARY FORM
DATE: 11-26-2012
ESTATE OF:JONES HARRY D DATE OF DEATH: 02-24-2012 COUNTY: CUMBERLAND
FILE NO.: 21 12-0321 S.S/D.C. NO.: 175-18-2025
pennsylvania ~
DEPARTMENT OF REVENUE
REY-1548A AFP C12-11) .. ... ....
ACN: 12503183
TAX RETURN WAS: (X1 ACCEPTED AS FILED t )CHANGED
BENEFICIARY FORM OF ASSET INFORMATION
NAME OF SECURITY: BANKERS LIFE
TYPE OF ASSET
C ) SECURITIES (}~ SECURITY ACC ( ) STOCK ( ) BONDS
DOD Valuation
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
12,563.13
X 1.000
12,563.13
- .00
12,563.13
X .045
565.34
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 (+)
INTEREST/PEN PAID (-~
AMOUNT PAID
08-09-2012 CD016373 .00 565.34
TOTAL TAX PAYMENT 565.34
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
''~,,
* IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. * ~ \~f
IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. )
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.
DATE 11-26-2012
ESTATE OF JONES HARRY D
DATE OF DEATH 02-24-2012
FILE NUMBER 21 12-0321
COUNTY CUMBERLAND
SSN/DC 175-18-2025
ACN 12503183
APPEAL BY DATE: O1-25-2013
(See reverse side under Objections)
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013