HomeMy WebLinkAbout07-28-14 BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX
INHERITANCE TAX DIVISION APPRAISEMENT ALLORANCE OR DISALLONANCE pennsylvarna
PO BOX 280661 OF DEDVCTIONi AND ASSESSMENT OF TAX ON
HARRISBURG, PA 17128-0601 SECURITY ACCOUNTS HELD IN DEPARTMENT OF REVENUE
BENEFICIARY FORM -- RcvasAAA All ux-w
DATE 07-28-2014
ESTATE OF ROGERS KIM L
DATE OF DEATH 02-21-2014
FILE NUMBER 21 14-0184
COUNTY CUMBERLAND
SSN/DC
SALLY I SEGAL ACN 14503453
APT 301 APPEAL BY DATE: 09-26-2014
3865 LONE PINE RD (See reverse side underObjecdons)
W BLOOMFIELD MI 48323-2930 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 _ _ _ _ _ _
REV-1548A AFP C12-13)
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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: 07-28-2014
ESTATE OF:ROGERS KIM L DATE OF DEATH: 02-21-2014 COUNTY: CUMBERLAND
FILE NO. : 21 14-0184 S.S/D.C. NO. : ACN: 14503453
TAX RETURN WAS: (X) ACCEPTED AS FILED C )CHANGED
BENEFICIARY FORM OF ASSET INFORMATION
NAME OF SECURITY: FIDELITY INVSTMNTS ACCOUNT NO. : 261212384
TYPE OF ASSET: { } SECURITIES C X SECURITY ACC ( ) STOCK C ) BONDS
DOD Valuation 26,510.16 NOTE: TO ENSURE PROPER CREDIT TO
Percent Taxable X 1 .000 YOUR ACCOUNT, SUBMIT THE
Amount Subject to Tax 26,510 . 16 UPPER PORTION OF THIS NOTICE
Debts and Deductions . 00 WITH YOUR TAX PAYMENT TO THE
Taxable Amount 26,510.16 REGISTER OF WILLS AT THE
Tax Rate X .12 ABOVE ADDRESS. MAKE CHECK
Tax Due 3. 181 .22 OR MONEY ORDER PAYABLE TO:
TAX CREDITS: "REGISTER OF WILLS, AGENT."
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PAYMENT RECEIPT DISCDUNT (+) . ' >--
DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID C O �J T
2
PAYMENT MUST BE MADE BY 11-22-2014X. TOTAL TAX PAYMENT v .00
BALANCE OF TAX DUE 3,181 .22
INTEREST AND PEN. . 00
TOTAL DUE 3,181.22
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.