HomeMy WebLinkAbout06-03-10COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
KUPCHIK CAROL
1003 ALDEN WAY
LEBANON, PA 17042
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1 162 EX(1 1-96)
NO. CD 012844
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
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ESTATE INFORMATION: SSN: 065-16-0992
FILE NUMBER: 2110-0557
DECEDENT NAME: ERIKSON MARY T
DATE OF PAYMENT: 06/03/2010
POSTMARK DATE: 06/02/2010
COUNTY: CUMBERLAND
DATE OF DEATH: 03/ 28/ 201 0
10126683 ~ $10.69
TOTAL AMOUNT PAID:
REMARKS: CAROL KUPCHIK
SEAL
CHECK# 848
$10.69
INITIALS: WZ
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
PO BOX 280601
HARRISBURG PA 17128-0601
REV-1543 EX 14FP C.DB-,qSJ;-
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
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FILE N0. 21 -- ~~' •" ` ~ I
ACN 10126682
DATE 05-13-2010
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CAROL A KUPCHIK
1003 ALDEN WAY
LEBANON PA 17042
EST. OF MARY T ERIKSON
SSN 065-16-0992
DATE OF DEATH 03-28-2010
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
SOVEREIGN 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 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
Panrsylvar.ia. ^leasa call (7173 7o7-&3c7 wiih questions.
COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Under enalties of p ~ ury, I declare that the facts I have reported above are true, correct an
com et to the est my kno ledge and belief. H O M E C )
_ WORK C ) ~ ~ ~j
.XP R SIG ATU E TELEPHONE NUMBER D TE
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