HomeMy WebLinkAbout11-02-09 (4)BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
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PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND
~4~ J ~~i'~"1(ER RESPONSE
F I L E N0. 21-° C~~" I X33
ACN 09161725
DATE 09-28-2009
~QQ~ l~OV "`~ AM Ilz VEST. OF GREGORY GEORGE
SSN 183-46-8104
~~.~. `DATE OF DEATH 0 9 -17 - 2 0 0 9
~~~~~ ~'~ , COUNTY CUMBERLAND
/~ b~~f ~~ .~ ,; REMIT PAYMENT AND FORMS T0:
MICHAEL GEORGE L. REGISTER OF WILLS
3001 ST REGENTS DRIVE ~ CUMBERLAND CO COURT HOUSE
APT 274 .~~ , j,~ `, ` ~'~ CARLISLE, PA 17013
FAIRFAX VA 22031
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
MEMBERS 1ST F CU provided the Department with the information below, which has been used in calculating the
potential tax due. Records indicate that at the death of the above-named decedent, You were a point owner/beneficiary of this account.
If you feel the 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. Please cell 0717) 787-8327 with questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
complete t/o the best of my knowledge and belief. HOME C9~7 ) ..51 y ~.S.Sy~
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-XPAYER SIGNATURE TELEPHONE NUMBER DATE
TOTAL CEnter on Line 5 of Tax Computation) $