HomeMy WebLinkAbout09-30-13 BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX
INHERITANCE AX DIVISION APPRAISSMENT
ON ALLOWANCE AESSM£NT DISALLOWANCE
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PO HARRISBURG. PA 17120-9661 SECURRY ACCOUNTS HELD IN DEPARTMENT OF REVENUE
BENEFICIARY FORM en.ts,en ur<t xsxs
RECORD'"". O�Flr- OF DATE 09-23-2013
RECISi _J OF t.iLLS ESTATE OF BERKEBILE PHYLLIS V
DATE OF DEATH 10-08-2012
�11 �^;� FILE NUMBER 21 12-1178
:.�i.'J SEP 30 Pn 12 37 COUNTY CUMBERLAND
SSN/DC
JAMES A BERKEB�IL-E, Or ACN 12504181
19199 S SAGAMORE � Lts _ APPEAL BY DATE: 11-22-2013
FAIRVIEW PARKORP AAA'lQA4P6T7 (See reverse side under Objections)
CUMBERLA14D CO., PA Amount Remitted F-
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
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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: 09-23-2013
ESTATE OF:BERKEBILE PHYLLIS V..._DATE OF DEATH: 10-08-2012 COUNTY: CUMBERLAND
FILE NO. : 21 12-1178 S.S/D.C. NO. : ACN: 12504181
TAX RETURN WAS: (X) ACCEPTED AS FILED < )CHANGED
BENEFICIARY FORM OF ASSET INFORMATION
NAME OF SECURITY: AMERIPRISE FINANCIAL ACCOUNT NO. : 178467619
TYPE OF ASSET: C I SECURITIES [ X SECURITY ACC C ) STOCK C ) BONDS
DOD Valuation 57, 171 . 11 NOTE: TO ENSURE PROPER CREDIT TO
Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE
Amount Subject to Tax 28,585.56 UPPER PORTION OF THIS NOTICE
Debts and Deductions .00 WITH YOUR TAX PAYMENT TO THE
Taxable Amount 28,585.56 REGISTER OF WILLS AT THE
Tax Rate X .045 ABOVE ADDRESS. MAKE CHECK
Tax Due 1 .286.35 OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)
INTEREST IS CHARGED THROUGH 10-01-2013* TOTAL TAX PAYMENT .00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 1,286.35
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 8.97
TOTAL DUE 1,295.32
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.