HomeMy WebLinkAbout05-30-14 (2) BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX
PON BOXT 280601AX APPRAISEMENT ALLOWANCE
ESSMENT DISALLOWANCE
ON pen nsylvania
HARRISBURG, PA 17128-0601 SECURI{'Y ACCOUNTS HELD IN DEPARTMENT OF REVENUE
BENEFICIARY FORM - eevasae ,rr nzas,
DATE 06-03-2014
ESTATE OF DEMARTYN KENNETH J
DATE OF DEATH 11-23-2010
FILE NUMBER 21 10-1206
COUNTY CUMBERLAND
SSN/DC
DAWN A FLEMING ACN 13502322
1268 S MOUNTAIN RD APPEAL BY DATE: 08-02-2014
DILLSBURG PA 17019-9705 (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-1548A AFP C12-13)
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS
AND ASSESSMENT OF TAX ON SECURITY ACCOUNTS HELD IN BENEFICIARY FORM
DATE: 06-03-2014
ESTATE OF: DEMARTYN KENNETH J DATE OF DEATH: 11-23-2010 COUNTY: CUMBERLAND
FILE NO. : 21 10-1206 S.S/D.C. NO. : ACN: 13502322
TAX RETURN WAS: (X) ACCEPTED AS FILED ( )CHANGED
BENEFICIARY FORM OF ASSET INFORMATION
NAME OF SECURITY: FIDELITY ACCOUNT NO. : X47-244805
TYPE OF ASSET: ( ) SECURITIES ( X SECURITY ACC ( ) STOCK ( ) BONDS
DOD Valuation 92,463.93 NOTE: TO ENSURE PROPER CREDIT TO
Percent Taxable X 0.500 YOUR ACCOUNT, SUB QT THE
Amount Subject to Tax 46,231 .97 UPPER PORTION OF TjHIS :NOA CE
Debts and Deductions . 00 WITH YOUR TP PAYME�JT �Th SHE
Taxable Amount 46,231 .97 REGISTER�GF7WILLS=-Lef TLHE j
Tax Rate X . 15 ABOVE ADDRESS. -MAU CHf CIv_
Tax Due 6.934.80 OR MONEY;QR:DER:]PAYABLF-- T03
"REGISTER=O`9 WILLS, AGENT-"
TAX CREDITS: U � o --I
PAYMENT RECEIPT DISCOUNT (+)
AMOUNT PAID F rrn
DATE NUMBER INTEREST/PEN PAID (-) - fV
r o
INTEREST IS CHARGED THROUGH 06-11-2014* TOTAL TAX PAYMENT . 00
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 6,934.80
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 581 .73
TOTAL DUE 7,516.53
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. t
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ]XT