HomeMy WebLinkAbout01-30-08COMMONWEALTH OF PENNSYLVANIA
` UEP -TMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
N0. CD 009224
STINE SAMUEL L JR
15 CHERRY STREET
NEWVILLE, PA 17241
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
fold
ESTATE INFORMATION: SSN: 203-1o-2s45
FILE NUMBER: 2108-0108
DECEDENT NAME: STINE SAMUEL L
DATE OF PAYMENT: 01 /30/2008
POSTMARK DATE: 01 /29/2008
COUNTY: CUMBERLAND
DATE OF DEATH: 09/26/2007
REMARKS: SAMUEL L STINE JR
CHECK# 266
SEAL
101 ~ $1,316.66
TOTAL AMOUNT PAID:
INITIALS: WZ
REV-1162 EX111-961
51,316.66
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE INFORMATION NOTICE FILE No. 21
BUREAU OF INDIVIDUAL TAXES AN D
DEPT. 280601 ACN 08103036
HARRISBURG, PA 171za-BCnI TAXPAY E R R E S P O N S E
DATE 01-22-2008
REV-1543 E% AFP (09-00)
TYPE OF ACCOUNT
EST. OF SAMUEL L STINE ~ SAVINGS
$.$. N0. 203-10-2645 ® CHECKING
DATE OF DEATH 09-26-2007 ~ TRUST
COITNTY CUMBERLAND ~ CERTIF.
REMIT PAYMENT AND FORMS T0:
SANUEL L STINE JR REGISTER OF WILLS
15 CHERRY ST CUMBERLAND CO COURT HOUSE
NEWVILLE PA 17241 CARLISLE, PA 17013
ADAMS COUNT NATIONAL BANK has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a ]oint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction fro^ the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Ynheritance Tax Laws of the Commonwealth
of Pennsylvania. Questions may be answered by calling C717) 787-8327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
MBER
DATE
TOTAL CEnter on Line 5 of Tax Computation) S
Under penalties of perjury, I declare that the facts I have reported above are true, correct and '~
complete to the best of my knowledge and belief. ~ ~ ~
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