HomeMy WebLinkAbout03-20-08
REV.!l48 EX (12-03)
INHERITANCE TAX JOINT BANK ACCOUNT
ADVANCE PAYMENT WORKSHEET
COUNTY FILE NUMBER
1-\ - O~ - b,)\6
INHERITANCE TAX RECEIPT NUMBER
ADDRESS OF DECEDENT
185 Old State Road,
(FIRST) (MIDDLE INITIAL)
Juanita B
DATE OF DEATH
0612012007
CITY STATE ZIP
Gardners PA 17324
DECEDENT
INFORMATION
DECEDENTS NAME (LAST)
Frost
DECEDENTS SOCIAL SECURITY NUMBER
171-28-0853
FINANCIAL
INSnTUnON
INFORMATION
NAME OF FINANCIAL INSTITUTION
Allianz Insurance Company of North America
ADDRESS
5701 Golden Hills Drive
TELEPHONE NUMBER
CITY
Minneapolis
STATE
MN
ZIP
55416
ACCOUNT
INFORMATION
TYPE OF ACCOUNT
D SAVINGS D CHECKING
DrRUST
D CERTIFICATE OF DEPOSIT
II OTHER Annuity
ACCOUNT BALANCE (INCLUDE INTEREST TO DATE OF DEATH)
51,055.68
ACCOUNT TITLE AS APPEARS ON SIGNATURE CARD OR CD
Juanita Frost
ACCOUNT NUMBER
06/20/2007
ORIGINAL DATE ESTABLISHED
09/28/1998
NAME (Last)
Conley
SURVIVING ADDRESS
185 Old State Road
JOINT OWNER CITY
INFORMATION Gardners
RELATIONSHIP TO DECEDENT
Granddaughter
NAME (Last)
Frost
SURVIVING ADDRESS
185 Old State Road
JOINT OWNER CITY
INFORMATION Gardners
RELATIONSHIP TO DECEDENT
Granddaughter
NAME (Last)
SURVIVING ADDRESS
JOINT OWNER CITY
INFORMATION
RELATIONSHIP TO DECEDENT
E
[)f~PO! tmt'nt of Rt'\d'IHJI'
U,e Only
PERCENTTAXABU
(First)
Heather
(Middle Innlal)
STATE
PA
ZIP CODE
17324
TELEPHONE NUMBER
(717) 4864923
TAX RATE
(First)
Johanna
(Middle Innial)
C
PERCENT TAXABLE
STATE
PA
ZIP CODE
17324
TELEPHONE NUMBER
(717) 486-5611
TAX RATE
(First)
(Middle Innlal)
PERCENT TAXABLE
STATE ZIP CODE
TELEPHONE NUMBEfI TAX RATE
LIST DEBTS & DEDUCTIONS BELOW
Date Paid
Deecrl Ion Amount Paid
Note: P/eIJse attach to receipt
Total $ 0.00
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-961
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
FROST DEBRA R
185 OLD STATE ROAD
GARDNERS, PA 17324
__nun fold
ESTATE INFORMATION: SSN: 171-28-0853
FILE NUMBER: 2108-0316
DECEDENT NAME: FROST JUANITA B
DATE OF PAYMENT: 03/20/2008
POSTMARK DATE: 03/20/2008
COUNTY: CUMBERLAND
DATE OF DEATH: 06/20/2007
NO. CD 009441
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $2/297.42
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$2,297.42
REMARKS:
CHECK# 4394
INITIALS: MAW
RECEIVED BY:
SEAL
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS