HomeMy WebLinkAbout11-17-14 BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX
INHERITANCE TAX DIVISION APPRAISEMENT ALLONANCE OR DISALLONANCE pennsylvania
PO BOX 280601n rpF DEDUCTIONAND ASSESSMENT OF TAX ON
HARRISBURG, PA 1712RE®r I l J E D OFFICE 0 f SECURITY ACCOUNTS HELD IN DEPARTMENT OF REVENUE
REGISTER �`' BENEFICIARY FORM REV-1548A AFP (u-13)
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DATE OF DEATH 06-27-2013
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FILE NUMBER S J--J �—,�
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4028 Ck1UY&iRC-T c �� ACN APPEAL BY DATE 13505508
0 0816 -2015
E N O L A PA 17025-1489 (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 THISLINE —61 RETAIN LOWER PORTION FOR YOUR RECORDS 4--'
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R -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: 11-17-2014
ESTATE OF:SIMMONS ELMER L DATE OF DEATH: 06-27-2013 COUNTY: CUMBERLAND
FILE NO. : S.S/D.C. NO. : ACN: 13505508
TAX RETURN WAS: (X) ACCEPTED AS FILED C )CHANGED
BENEFICIARY FORM OF ASSET INFORMATION
NAME OF SECURITY: AMERIPRISE AFG ACCOUNT NO. : 99250099680
TYPE OF ASSET: C ) SECURITIES C X SECURITY ACC C ) STOCK C ) BONDS
DOD Valuation 139,665.55 NOTE: TO ENSURE PROPER CREDIT TO
Percent Taxable X 1 . 000 YOUR ACCOUNT, SUBMIT THE
Amount Subject to Tax 139,665.55 UPPER PORTION OF THIS NOTICE
Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE
Taxable Amount 139,665.55 REGISTER OF WILLS AT THE
Tax Rate X .00 ABOVE ADDRESS. MAKE CHECK
Tax Due .00 OR MONEY ORDER PAYABLE TO:
TAX CREDITS: "REGISTER OF WILLS, AGENT."
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE . 00
INTEREST AND PEN. .00
TOTAL DUE .00
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. \ 1�
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ��VJJ