HomeMy WebLinkAbout10-07-13 (4) BUREAU OF INDIVIDUAL TAXES NOTICE OF INBERITANCE TAX •
POHBOXT280601� DIVISION O PD Iv�� AL���D=S�Lr�N , pennsylvan�a
HARRISBURG, PA 17128-0601 SECURI'I�Y AC'CO�UpI�iTS�HpEftLD IN DEPARTMENT OF REVENUE
BENEFICIA�CY rVRA � REY-1546A 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
ROXANNE C MORGAN ACN 13503294
203 E WALNUT ST APPEAL BY DATE: 12-06-2013
SH I REMANSTOWN PA 17011-6768 (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 PORTION FfJR 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 �N SECURITY ACCOUNTS HELD IN BENEFICIARY FORM
DATE: 10-07-2013
ESTATE OF:HOLLER LOIS M DATE OF DEATH: 07-10-2013 COUNTY: CUMBERIAND
FILE NO. : 21 13-1006 S.S/D.C. NO. : 182-22-9395 ACN: 13503294
TAX RETURN WAS: CX) ACCEPTED AS FILED t )CHANGED ,
BENEFICIARY FORM OF ASSET INFORMATIbN
NAME OF SECURITY: AMERIPRISE ACCOUNT NO. : 02148127002002
TYPE OF ASSET: C ) SECURITIES C X SECURITY ACC C ) STOCK C ) BONDS
DOD Valuation 7,702.61 NOTE: TO ENSURE PROPER CREDIT TO
Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE
Amount Subject to Tax 3,851.31 UPPER PORTIOP�F THI� NOTICE
Debts and Ded�ctians - 3,852.00 WITM�"�YOUR TA�AY�NT� TO T.,HE
Taxable Amount .00 REGI�f OF M�LS��THE,
�
Tax Rate X .045 ABOV� D ESSt--tMAICS �IECK
Tax Due , ._ OR M�1� �RDER PA�BtrE T0:
. "REG�,ST�R�F �LL�; A�ENT."
TAX CREDITS:
.��" U? � C, t�
"t.T "�'t �
PAYMENT RECEIPT DISCOUNT C+) AMOUNT Pq�iD� � � "'`" ��
DATE NUMBER INTEREST/PEN PAID (-) � � ; �`-�-" �
t—� �° i�t
. � ---� � i'„�1�, c�
� N �
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL Dt1E .00
* IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATIDN OF ADDITIONAL INTEREST. * �`
IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A R�FUND. �
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.