HomeMy WebLinkAbout09-30-13 (2) BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX
INHERITANCE TAX DIVISION APPRAISEMENT ALL014ANCE OR DISALLORANCE r pennsylvani 3
Po Box 250601 OF DEDUCTION AND ASSESSMENT OF TAX ON
HARRISBURG, PA 17128-0601 SECURI'T'Y ACCOUNTS HELD IN DEPARTMENT OF REVENUE
BENEFICIARY FORM -- - ccvsxa arr ur.:n
RECOR' " C"F` OF DATE 09-23-2013
RESI5' w s {tF 1 -L$ ESTATE OF BERKEBILE PHYLLIS V
DATE OF DEATH 10-08-2012
p�1 7 nF FILE NUMBER 21 12-1178
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6113 30 3 t1 �i COUNTY CUMBERLAND
SSN/DC
DAVID A 8ERMLBLI,LE C ACN 12504182
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2700 LINCOLN ST APPEAL BY DATE: 11-22-2013
CAMP HILL O R P H S1 1- X836 (See reverse side under Objections)
CUMBERLAND " t'A 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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REV-1548A AFP C12-12)
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: 12504182
TAX RETURN WAS: (X) ACCEPTED AS FILED C )CHANGED
BENEFICIARY FORM OF ASSET INFORMATION
NAME OF SECURITY: AMERIPRISE FINANCIAL ACCOUNT NO. : 178467619
TYPE OF ASSET: ( ) SECURITIES ( X SECURITY ACC C ) STOCK ( ) 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.