HomeMy WebLinkAbout11-13-07 (2)
.
1~/29/2007 11:08
REV-Sola EX 16-97)
71 77720412
PAGE 02/02
INl-lERIT ANCE TAX
INHERITANCE TAX JOINT BANK ACCOUNT
ADVANCE PAYMENT WORKSHEET
COUNTY FILE NUMBER
2107-0613
INHIiRfTANCE: TAX RECEIPT NUMBER
CD008710
DECEDENT
INFORMATION
DECEDENTS NAME (I.AST)
DUDEK JR
DECEDENT'S SOCIAL SECURITY NUMIil5R
(FIRST)
STANLEY
DATE OF DEA~
(MIDDLE INITIAL)
A
ADDRIiSS OF DEceDeNt
32 PALMER DR
STATE
PA
ZIP
17011
HILL
FINANCIAL
INSTITUTION
INFORMATION
ACCOUNT
INFORMATION
NAME OF FINANCIAL INSTITUTION
FIRST NATIONAL BANK (FORMERLY LEGACY BANK)
ADDFlESS CITY
4140 ESTATE ST HERMITAGE
TTSLEl'HONE NUMBEFl
( 800 )555-5455
TYPE OF ACCOUNT
o SAVINGS m CHECKING
- )
SiATlib-C-' zrP.
PAn_ 1 6 H 8
c
neitHER
o TRUST
o CERTIFICATE OF DEPOSIT
---
..
ACCOUNT BALANCE (INCWee INTEREST TO DATE OF DEATH)
ACCOUNT NUMBER
701147803
ORIGINAL DATE ESTAlill.ISHF.%D
4/9/07
c~,
50.00
ACCOUNT TITLE AS APPEARS ON SIGNAlURE CARD OR CD
STANLEY DUDEK JR , LINDA J LUNDBERG
NAME (Last)
LUNDBERG
SURVIVING ADOFlI:SS
JOINT OWNER 5634 AKRON DR
CITY
INFORMATION HARRISBURG
RELATIONSHIP TO OF.CF.OE';NT
DAUGHTER
NAME (Lasl)
SURVIVING ADORESS
JOINT OWNER CITY
INFORMATION
RELATIONSHIP TO OI:CI:OeNT
NAME (La~l)
SURVIVING ADDRESS
JOINT OWNER CITY
INFORMATION
FlELATJONSHIi=' TO DECeOENT
(FIrst)
LINDA
Dept;lrtml'nt of Revenue
U~e Only
(Middle Initial}
J
. J:'~C!iNT.TAX"''''''!! .. :. . "
. OR', .
STATE
7.IP CODE
PA 17109
TELEPHONE NUMBER
717) 730-2265(WORK)
(First) (Midd141nitj;;ll)
. TAX RATE
. '.:
PERCENt'fj\jl(ABtE
STATE ZIP CODe
TELEPHONe NUMBER lAX RATE
(Firat) (Middl~ Initial)
P:lFlCaNT TAXABLE:
STATE ZIl' COOl:
TELEPHONE NUMBER TAiX,AATe. .
Date Paid
LIST D~BTS & DEDUCTIONS BELOW
\.J'
Note: Please attach tD receipt
Total $
l-Q/29/2007 11: 08
RIOV.548 EX (8.97)
7177720412
INHERITANCE TAX
t->Abl:. l::l:Lll::lL
INHERITANCE TAX JOINT BANK ACCOUNT
ADVANCE PAYMENT WORKSHEET
COUNTY FilE. NUMBER
2107-0613
INHF.RITANce TAX IiECEIPT NUMBER
CD008710
DECEDENT
INFORMATION
FINANCIAL
INSTITUTION
INFORMATION
ACCOUNT
INFORMATION
(MIDDLE INITIAL)
DECEDENT'S NAME (I.A$T)
DUDEK JR
.
DECEDENT'S SOCIAL SECURITY NUMS5R
(FIRST)
STANLEY
DATE OF DEA~
A
7
ADDRESS OF DECEOENT
32 PALMER DR
STATE
PA
ZIP
17011
CITY
CAMP HILL
NAMe OF FINANCIAL INSTITUTION
FIRST NATIONAL BANK (FORMERLY LEGACY BANK)
ADDRESS CITY
4140 ESTATE ST HERMITAGE
TeLEPHONE NUMseFi
( 800 )555-5455
TYPE OF ACCOUNT
D SAVINGS 0 CHECKING
STAT!:
PA
ZIP
16148
o TRUST
~ CERTIFICATE OF DEPOSIT
D OTHER
ACCOUNT BALANce (INCLUDE INTE~EST TO DATE OF DEATH)
70,000.00
ACCOUNT NUMBER
100186717
ORIGINAL DATE ESTAEII.ISH5D
4/7/04
ACCOUNT TITLE AS APPEARS ON SIGNATURE CARD OR CD
STANLEY DUDEK JR , LINDA J LUNDBERG
NAME (Last)
LUNDBERG
SURVIVING ADDFlESS
5634 AKRON DR
JOINT OWNER CITY
INFORMATION HARRISBURG
RELATIONSHIP TO OSCF.OENT
DAUGHTER
N.AME (Lasl)
SURVIVING ADDRess
JOINT OWNER CITY
INFORMATION
RELATIONSHIP TO OF.CF.05NT
NAME (La~l)
SURVIVING ADDRESS
JOINT OWNER CITY
INFORMATION
RELATIONSHIP TO DeCEDeNT
Oer.wrtmp.nt of Revenue
U.e Only
(FIrS!)
LINDA
(Middle Initial)
J
:. ~E~S!"NT. TAXASl.fl ..:. . ..
. ..... .
STATE
7.11" CODE
PA 17109
TELEPHONE NUMBER . TAX. RATE
717) 730-2265(WORK)
(Firat) (Middl~ l~iti;;ll)
PERt:ENt"fIliXA9'lE
STATE ZIP CODE
TELEPHONE: NUMBER TAX RATE
(Firs!) (Middl.. Inilial)
FeAt; e:JIIT TAXABLE
STATE ZIP COOF.
TELEPHONE NUMBER TA'lC.RA"ti:S
LIST DEBTS & DEDUCTIONS BELOW
Total S
Note: Please attach to receipt
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COMMONWEALTH 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
LUNDBERG LINDA J
5634 AKRON DRIVE
HARRISBURG, PA 17109
-------~ fold
ESTATE INFORMATION: SSN: 178-22-2184
FILE NUMBER: 2107-0613
DECEDENT NAME: DUDEK STANLEY A
DATE OF PAYMENT: 09/19/2007
POSTMARK DATE: 09/19/2007
COUNTY: CUMBERLAND
DATE OF DEATH: 06/22/2007
NO. CD 008710
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1,498.39
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 8496
SEAL
INITIALS: AJW
RECEIVED BY:
TAXPAYER
$1,498.39
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS