HomeMy WebLinkAbout08-29-14 (3) BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX ENT PO
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HARRISBURG, PA 17128-8601 SECURITY ACCOUNTS HELD IN DEPARTMENT OF REVENUE
BENEFICIARY FORM 2¢r J".w 112.131
DATE 09-01-2014
ESTATE OF MENGLE PHYLISS C
DATE OF DEATH 05-30-2014
FILE NUMBER 21 14-0566
COUNTY 21CUMBERLAND
SSN/DC
MARK R MENGLE ACN 14504392
76 SKYLINE DR APPEAL BY DATE: 10-31-2014
MECHANICSBURG PA 17050-1750 (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 'y RETAIN LOWER PORTION FOR YOUR RECORDS 4—
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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: 09-01-2014
ESTATE OF:MENGLF PHYLTSS r DATE OF DEATH: 05-30-2014 COUNTY: 21CUMBERLAND
FILE NO. : 21 14-0566 S.S/D.C. NO. : ACN: 14504392
TAX RETURN WAS: (X) ACCEPTED AS FILED ( )CHANGED
BENEFICIARY FORM OF ASSET INFORMATION
NAME OF SECURITY: AMERIPRISE ACCOUNT NO. : 078192123
TYPE OF ASSET: ( ) SECURITIES I X SECURITY ACC f ) STOCK ( ) BONDS
DOD Valuation 33,613.84 NOTE: TO ENSURE PROPER CREDIT TO
Percent Taxable X 1.000 YOUR ACCOUNT, SUBMIT THE
Amount Subject to Tax 33,613.84 UPPER PORTION OF THIS NOTICE
Debts and Deductions - . 00 WITH YOUR TAX PAYMENT TO THE
Taxable Amount _ 33,613.84 REGISTER OF WILLS AT THE
Tax Rate X .045 ABOVE ADDRESS. MAKE CHECK i
Tax Due 1 .512.62 OR MONEY ORDER PA'MPLE TO:
"REGISTER= .:OF WILLS AGEN ��
TAX CREDITS: 7: q
O rn
PAYMENT RECEIPT DISCOUNT r*1 G�
DATE NUMBER INTEREST/PEN PAID AMOUNT PAID C 2
D (-) cn 117
08-02-2014 CD019504 75.63 1,436.99221 � CO 2 O
Cs C>
G7 C C
.T) !•-� r" ITT F
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TOTAL TAX PAYMENT 1,512.62
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .p0
f 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.