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BUREAU OF INDIVIDUAL TAN` _ NOTICE OF INHERITANCE TAX _
INHERITANCE TAX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE pennsylvania
PO BOX 280601 OF DEDUCTIONS AND ASSESSMENT OF TAX ON
HARRISBURG, PA 17128-0601 J ~1~ 8gCURIfY ACCOUNTS HELD IN DEPARTMENT OF REVENUE
CuiC L,LL ! k BENEFICIARY FORM REV-1848A AFP (12-12)
, g'-' DATE 12-24-2012
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ORPHANS' ,4 ESTATE OF AMMERMAN HELEN 0
DATE OF DEATH 06-09-2011
CUMBERLAND i, FILE NUMBER 21 11-0$01
COUNTY CUMBERLAND
SSN/DC 153-16-4575
LOUISE A MORGAN ACN 12503927
757 WESTERLY PKWY APPEAL BY DATE: 02-22-2013
STATE COLLEGE PA 16801-4227 (See reverse side under Objections)
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS
REV--1-5448A 8A A -FP-(-1-2--1-2-)---------------------------------------------------------
REV
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS
AND ASSESSMENT OF TAX ON SECURITY ACCOUNTS HELD IN BENEFICIARY FORM
DATE: 12-24-2012
ESTATE OF:AMMERMAN HELEN 0 DATE OF DEATH: 06-09-2011 COUNTY: CUMBERLAND
FILE NO.: 21 11-0801 S.S/D.C. NO.: 153-16-4575 ACN: 12503927
TAX RETURN WAS: (X) ACCEPTED AS FILED C )CHANGED
BENEFICIARY FORM OF ASSET INFORMATION
NAME OF SECURITY: WELLS FARGO ACCOUNT NO.: 3501761939
TYPE OF ASSET: C ) SECURITIES C ) SECURITY ACC (X) STOCK C ) BONDS
DOD Valuation 6,336.00 NOTE: TO ENSURE PROPER CREDIT TO
Percent Taxable X 0.333 YOUR ACCOUNT, SUBMIT THE
Amount Subject to Tax 2,111.98 UPPER PORTION OF THIS NOTICE
Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE
Taxable Amount 2,111.98 REGISTER OF WILLS AT THE
Tax Rate X .045 ABOVE ADDRESS. MAKE CHECK
Tax Due 95.04 OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT
DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID
INTEREST IS CHARGED THROUGH 01-01-2013* TOTAL TAX PAYMENT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 95.04
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 2.32
TOTAL DUE 97.36
* 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. 41