HomeMy WebLinkAbout04-26-07
COM~!ONWEALTI:' OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
CIUK THOMAS W
565 PLEASANT VIEW ROAD
LEWISBERRY, PA 17339
_.____n fold
ESTATE INFORMATION: SSN: 030-05-5745
FILE NUMBER: 2107-0409
DECEDENT NAME: CIUK THOMAS W
DATE OF PAYMENT: 04/27/2007
POSTMARK DATE: 04/26/2007
COUNTY: CUMBERLAND
DATE OF DEATH: 02/10/2007
NO. CD 008086
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $3,572.58
I
I
I
I
I
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TOTAL AMOUNT PAID:
$3,572.58
REMARKS: SENT RECEIPT TO
JAN L BROWN ESQ
CHECK# 629
INITIALS: AJW
RECEIVED BY:
SEAL
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
FOR REGISTER'S OFFICE USE ONLY
Rev-346 EX (8-92)
PA DEPARTMENT OF REVENUE
ESTATE INFORMATION SHEET
County Code
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6,ar
ttiD'iber
: nter ata as It WI appear on a ocuments su IDltte to the denartment.
Name (Last) (First) (Middle)
Ciuk Thomas W
Decedent's Social Security Number Date of Death Date of Birth
030-05-5745 2/10/2007 8/5/1916
DECEDENT INFORMATION E
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d
TYPE FILING: Enter check ( ,r) mark to indicate the nature of the return to be filed with the deoartment.
o Probate Return
IXI Joint Assets Only
o Estate Tax Only
o Litigation Purposes (No Other Assets)
LETTERS GRANTED: Enter check (,r) mark to indicate the nature of the proceedings at the Register of Wills Office.
(Attach additional sheets if explanation is necessary.)
o Testamentary
o Administration
IXI No Letters
o Other (Please Explain)
ATTORNEY/CORRESPONDENT: Enter all data concerning the attorney or other individual to receive all tax information and
correspondence.
Name (Last) (First) (Middle) Supreme Court J.D. No.
Brown Jan L 67993
Street Address
845 Sir Thomas Court Suite 12
City State Zip Code Telephone Number
Harrisbura PA 17109 717-541-5550
PERSONAL REPRESENTATIVE Enter all data concerning the personal representative(s) of the estate authorized by the
INFORMATION: Register of Wills
Executor! Administrator
Name (Last) (First) (Middle) Social Security Number
Street Address
City State Zip Code Telephone Number
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Name (Last) (First) (Middle) Social Security Number _ r'O'",.
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Street Address "--. -....,
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State Zip Code Telephone Number _."- '.
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Co Executor! Administrator
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Name (Last) (First) (Middle) Social Security Number
Street Address
City State Zip Code Telephone Number
Prepared By
Jan L Brown Es uire
rev. J O. /3. 06
Date
4/25/2007