HomeMy WebLinkAbout10-07-13 (3) BUREAU OF INDIVIDUAL TAXES NO?ICE OF INHERITANCE TAX •
POHBOXT 80601� DIVISION OF DEDUC�TI�� SAND A�'S$�BSS�MENTS�L��Q�I�j � p�nnsylvan�a
HARRISBURG, PA 1712B-0601 SECURI� ACCOUN'L'S�MB�B�LD IN DEPARTNIENT OF REVENUE
B�ICI�Y rVR�1 REV-1548A AFP(12-12)
DATE 10-07-2013
ESTATE OF HOLLER LOIS M
DATE OF DEATH 07-10-2013
FILE NUMBER 21 13-1006
COUNTY CUMBERLAND
SSN/DC
AMY S FRITZINGER ACN 13503293
1775 KECKS RD APPEAL BY DATE: 12-06-2013
B R E I N I G S V I L L E P A 18 0 31-2 219 (See reverse side under Objections)
A�ount Re�itted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALON6 THIS LINE �► RETAIN LOWER PQRTION FOR YOUR RECORDS �
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REV-1548A AFP C12-12�
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS
AND ASSESSMENT OF TAX ON SECURITY ACCOUNTS HELD IN BENEFICIARY FORM
DATE: ZO-07-2013
ESTATE OF:HOLLER LOIS M DATE OF DEATH: 07-10-2013 COUNTY: CUMBERLAND
FILE N�. : 21 13-1006 S.S/D.C. NO. s 182-22-9395 ACN: - 13503293
TAX RETURN WAS: CX) ACCEPTED AS FILED t )CHANGED
BENEFICIARY FORM OF ASSET INFORMATION
NAME �F SECURITY: AMERIPRISE ACCOUNT NO. : 02148127002002
TYPE OF ASSET: C ) SECURITIES C J( SECURITY ACC C ) STOCK C ) BONDS � � �
�
"�' � � � p
DOD Valuation 7,702.61 NOTE: TO E�U�E�ROPf�R (��T TO
Percent Taxable X 0.500 YOUR�bG�ptl'NT, .SUB �HE
Amount Subject to Tax 3,851.31 UPPEI�,P�'��N OF T SC�NOTICE
Debts and Deductions - 3,852.00 WITH �DUR �AX �!►YME'�IT�TO THE
�
Taxable A�ount .00 REGIS��O`� WIk�S � �}I��
Tax Rate X .045 ABOVE�►I�$,3RESS.F-MAKB�,Ci#LCK
Tax Due .00 OR MOItlEY--0RDER�1YA�ii.�TO:
"REGIS�ER OF W#�L.S, AGENT."
TAX CREAITS:
PAYMENT RECEIPT DISCOUNT C+)
DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE • �
INTEREST AND PEN. .00
TOTlkt DUE ` .00
* IF PAID AFTER TH`IS DAff, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. * �\,�
IF TDTAL DUE IS REFLECTED AS A "CREDIT" tCR), YOU MAY BE DUE A REFUND. O�1
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. �'