HomeMy WebLinkAbout11-26-12 (3)BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX ~-~ ---
INHERITANCE TAX DIVISION ~~~~ ~ ~`?'~'~PPRAISEI'I~NT,~ ALLOfiANCE OR DISALLORANCE pennsylvanla ~
Po sox z8o6ol '~ -~ - flR DEDUCZ'I
AND ASSESSPIENT OF TAX ON DEPARTMENT OF REVENUE
HARRISBURG, PA I7I2E-0601 '_ "~ SBC~URITY ACCOUNTS HELD IN
4 - ~-=.BENEFICIARY FORM REV-1548A APP (12-ll)
~_ ' _
L' ..:
1,,~ _
SANDRA L MEMBRI1J~u'~~ ~~ ~ } ~ 1 ' ' ~ ~"~
457 S OLD MIDDLETOWN RD
MEDIA PA 19063-4859
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 12503182
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
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
ACN: 12503182
TAX RETURN WAS: (X) ACCEPTED AS FILED C )CHANGED
BENEFICIARY FORM OF ASSET INFORMATION
NAME OF SECURITY: BANKERS LIFE ACCOUNT NO.: 7936776
TYPE OF ASSET: t ~ 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:
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 C+)
INTEREST/PEN PAID C-)
AMOUNT PAID
1NItKt51 15 CHARGED THROUGH 12-04-2012*
AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORM
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE 565.34
INTEREST AND PEN. .46
TOTAL DUE 565.80
~'~
* IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRS, YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.