HomeMy WebLinkAbout09-25-08 (2)COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
INFORMATAIND NOTICE
TA~~;AYER- RESPONSE
REY-1543 E% AFP (09-00) - '
FILE N0. 21 Ci~ J?~I
ACN 08137389
DATE 08-22-2008
1, TYPE OF ACCOUNT
~~~4~ ~~P ~;~$T.~'~g`~H~~N CARR ~ SAVINGS
S.S. N0. ® CHECKING
C Q~,~~;~OF DEATH O8-o5-2008 ~ TRUST
Oh~~ ~Ot(Nq'S~l;~i CUMBERLAND ~ CERTIF.
v` `., r _ 1' f ~`, REMIT PAYMENT AND FORMS T0:
TERRY SWARTZ V REGISTER OF WILLS
RD 1 BOX 1107 CUMBERLAND CO COURT HOUSE
BLAIN PA 17006 CARLISLE, PA 17013
MEMBERS 1ST FCU 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 joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. Questions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
TOTAL (Enter on L1ne 5 of iax t;ompucacion~ a
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. HOME ~ )
WORK C )
TAXPAYER SIGNATURE TELEPHONE NUMBER DATE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 010315
SWARTZ TERRY
100 SWARTZ LANE
BLAIR, PA 17006
-------- fold
ESTATE INFORMATION: ssN:
FILE NUMBER: 2108-0874
DECEDENT NAME: CARR HELEN
DATE OF PAYMENT: 09/25/2008
POSTMARK DATE: 09/25/2008
couNTY: CUMBERLAND
DATE OF DEATH: 08/05/2008
REMARKS:
SEAL
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
08137389 ~ 597.92
TOTAL AMOUNT PAID:
INITIALS: JN
REV-1162 EX(11-96)
597.92
GLENDA EARNER STRASBAUGH
RECEIVED BY:
REGISTER OF WILLS
REGISTER OF WILLS