HomeMy WebLinkAbout07-26-10COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 013099
SHANNON STANLEY J
15 SOUTHSIDE DRIVE
NEWVILLE, PA 17241
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ESTATE INFORMATION: Ss-v: 207-22-2194
FILE NUMBER: 2110-0753
DECEDENT NAME: SHANNON ARLENE R
DATE OF PAYMENT: 07/ 26/ 2010
POSTMARK DATE: 07/24/2010
COUNTY: CUMBERLAND
DATE OF DEATH: 05/ 1 3/201 0
ACN
ASSESSMENT ,4MOUNT
CONTROL
NUMBER
10135448 $138.56
TOTAL AMOUNT PAID:
REV-1162 EX111-96)
$138.56
REMARKS: STANLEY J SHANNON
SEAL
INITIALS: WZ
RECEIVED BY: GLENDA EARNER STRASRAl1C;H
REGISTER OF WILLS
REGISTER OF WILLS
. PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF` INDIVIDUAL TAXES - ~ -~- ` ~'"; AND
Po Box 2BO6o1 +I'A~`~AYER RESPONSE
HARRISBURG PA 17128-0601 _,-
REV-1543 EX AFP (OB-OB)
STANLEY J SHANNON
15 SOUTHSIDE DR
NEWVILLE PA 17241
FILE N0. 21 _ ~C/ ° ~~5~
ACN 10135448
DATE 06-23-2010
EST. OF ARLENE R SHANNON
SSN 207-22-2194
DATE OF DEATH 05-13-2010
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
SUSQUEHANNA BANK 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 joint owner/benefic:iary of this account.
It 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 lax laws of the Commonwealth of
Pennsylvania. Pleas call :717? .'87.5327 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 truQQe~, "corre(:t andt"f~jp~ °~ ~'
complete to the best of y knowledge and belief. HOME C 'jr~ ) ~(,T~'fS~'~' 17U"~ 4~`~~'
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T PAYER S NATURE TELEPHONE NUMBER DATE
TOTAL CEnter on Line 5 of Tax Computation) S
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